From the Guidelines
Optiflow, a high-flow nasal cannula oxygen therapy system, is recommended for patients with severe hypoxemia as it provides the added benefit of continued oxygen flow into the nasopharynx during laryngoscopy, although NIPPV appears to have the strongest evidence for decreasing the incidence of critical desaturation during RSI. When using Optiflow, typical initial settings include a flow rate of 30-40 L/min with FiO2 adjusted to maintain oxygen saturation above 92% (or target range specified by the provider) 1. The temperature is usually set at 37°C for optimal comfort and humidity. Optiflow works by providing positive airway pressure, washing out anatomical dead space, and delivering precise oxygen concentrations, which reduces work of breathing, improves oxygenation, and helps prevent intubation in many cases 1.
Some key considerations when implementing Optiflow include:
- Ensuring the patient is positioned upright if possible to reduce respiratory effort
- Explaining the procedure to reduce anxiety and improve tolerance
- Monitoring vital signs, work of breathing, and oxygen saturation regularly to adjust settings as needed
- Being aware of the potential risks of gastric insufflation and aspiration, particularly at high flow rates 1
It's also important to note that while Optiflow can be an effective oxygen therapy system, it may not be suitable for all patients, particularly those with severe respiratory failure or those who require immediate intubation 1. In such cases, other oxygen therapy systems or mechanical ventilation may be more appropriate. Overall, Optiflow can be a valuable tool in the management of patients with severe hypoxemia, but its use should be carefully considered and monitored to ensure optimal outcomes.
From the Research
Optiflow Overview
- Optiflow, also known as high-flow nasal cannula (HFNC), is a respiratory support technique that delivers high flow, heated, and humidified oxygen via the nasal route 2.
- HFNC has been increasingly used for various clinical indications, including hypoxemic respiratory failure, post-extubation, and postoperative care 2, 3.
Clinical Applications
- HFNC is recommended for use in hypoxemic respiratory failure, with a strong recommendation compared to conventional oxygen therapy (COT) 2.
- Conditional recommendations have been made for HFNC use following extubation and in postoperative care for high-risk and/or obese patients following cardiac or thoracic surgery 2.
- HFNC has also been studied as an initial oxygen administration method in acute hypercapnic respiratory failure, with ongoing trials investigating its effectiveness 3.
Efficacy and Safety
- Studies have shown that HFNC can decrease respiratory rate and improve oxygenation in patients with acute respiratory failure 4, 5.
- However, the need for mechanical ventilation was found to be similar between HFNC and COT in some studies 4.
- HFNC has been found to be generally well-tolerated, with few adverse events reported 6, 5.
- The safety of HFNC for healthcare workers has also been evaluated, with low rates of COVID-19 transmission reported in one study 5.
Specific Patient Populations
- HFNC has been used in patients with do-not-intubate (DNI) and/or do-not-resuscitate (DNR) orders, with variable hospital mortality rates reported 6.
- In patients with COVID-19-related acute respiratory distress syndrome (ARDS), HFNC has been found to be a safe and effective treatment option, with some patients avoiding the need for endotracheal intubation 5.