From the Guidelines
Neither High Flow Nasal Cannula (HFNC, often called "high flow" or "HiFlo") nor BiPAP (Bilevel Positive Airway Pressure) is universally "better" than the other; they serve different purposes and are appropriate for different clinical situations. HFNC delivers heated, humidified oxygen at high flow rates (up to 60 L/min) through nasal prongs, while BiPAP provides two levels of positive pressure - higher pressure during inhalation and lower pressure during exhalation. The choice between these therapies depends on the specific clinical scenario, the patient's underlying condition, and their tolerance of the device, as suggested by the American College of Physicians guideline 1. Some key points to consider include:
- HFNC is generally more comfortable and better tolerated by patients, allows eating and speaking, and works well for hypoxemic respiratory failure.
- BiPAP provides more respiratory support for patients with hypercapnic respiratory failure (like COPD exacerbations), neuromuscular weakness, or obstructive sleep apnea.
- The decision should be made by healthcare providers based on the individual patient's needs and response to therapy, taking into account the benefits and harms of each option, as well as patient values and preferences 1. In some cases, patients may start on HFNC and progress to BiPAP if they require additional respiratory support, or vice versa as they improve. It's also important to note that high-flow nasal oxygen can be used as respiratory support in critically ill patients for several indications, including initial or postextubation management of respiratory failure 1. However, the effect of HFNO on clinical outcomes is not well established, and few clinical guidelines exist to provide clinicians with evidence-based recommendations on its appropriate use. Overall, the choice between HFNC and BiPAP should be individualized and based on the best available evidence, as well as clinical judgment and patient-centered care.
From the Research
Comparison of HiFlow and BiPAP
- HiFlow and BiPAP are both non-invasive respiratory support modes used to treat patients with acute respiratory failure.
- A study published in JAMA pediatrics 2 found that CPAP and HFNC were more effective than COT in reducing extubation failure and treatment failure in critically ill children.
- Another study published in Respirology 3 found that CPAP was more effective than HFNC in reducing the risk of meeting the prespecified criteria for intubation in patients with acute hypoxemic respiratory failure.
- A randomized clinical trial published in JAMA 4 found that high-flow nasal oxygen therapy was not inferior to BiPAP for preventing or resolving acute respiratory failure after cardiothoracic surgery.
- A systematic review and meta-analysis published in Annals of thoracic medicine 5 found that BiPAP appears similar to CPAP in reducing the rates of endotracheal intubation and mortality in patients with acute hypercapnic respiratory failure due to acute cardiogenic pulmonary edema.
- A review published in Diagnostics 6 suggests that BiPAP, CPAP, and HFNC may be beneficial alternatives to invasive mechanical ventilation for COVID-19-associated acute respiratory failure.
Effectiveness of HiFlow and BiPAP
- The effectiveness of HiFlow and BiPAP may depend on the specific patient population and condition being treated.
- HiFlow may be more effective than BiPAP in certain situations, such as after cardiothoracic surgery 4.
- BiPAP may be more effective than HiFlow in other situations, such as in patients with acute hypoxemic respiratory failure 3.
- CPAP may be more effective than both HiFlow and BiPAP in reducing extubation failure and treatment failure in critically ill children 2.