• Bram Rochwerg, Sharon Einav, Dipayan Chaudhuri, Jordi Mancebo, Tommaso Mauri, Yigal Helviz, Ewan C Goligher, Samir Jaber, Jean-Damien Ricard, Nuttapol Rittayamai, Oriol Roca, Massimo Antonelli, Salvatore Maurizio Maggiore, Alexandre Demoule, Carol L Hodgson, Alain Mercat, M Elizabeth Wilcox, David Granton, Dominic Wang, Elie Azoulay, Lamia Ouanes-Besbes, Gilda Cinnella, Michela Rauseo, Carlos Carvalho, Armand Dessap-Mekontso, John Fraser, Jean-Pierre Frat, Charles Gomersall, Giacomo Grasselli, Gonzalo Hernandez, Sameer Jog, Antonio Pesenti, Elisabeth D Riviello, Arthur S Slutsky, Renee D Stapleton, Daniel Talmor, Arnaud W Thille, Laurent Brochard, and Burns Karen E A KEA Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada. Karen.Burns@unityhealth.to. .
• Department of Medicine, McMaster University, Hamilton, ON, Canada.
• Intensive Care Med. 2020 Dec 1; 46 (12): 2226-2237.

PurposeHigh flow nasal cannula (HFNC) is a relatively recent respiratory support technique which delivers high flow, heated and humidified controlled concentration of oxygen via the nasal route. Recently, its use has increased for a variety of clinical indications. To guide clinical practice, we developed evidence-based recommendations regarding use of HFNC in various clinical settings.MethodsWe formed a guideline panel composed of clinicians, methodologists and experts in respiratory medicine. Using GRADE, the panel developed recommendations for four actionable questions.ResultsThe guideline panel made a strong recommendation for HFNC in hypoxemic respiratory failure compared to conventional oxygen therapy (COT) (moderate certainty), a conditional recommendation for HFNC following extubation (moderate certainty), no recommendation regarding HFNC in the peri-intubation period (moderate certainty), and a conditional recommendation for postoperative HFNC in high risk and/or obese patients following cardiac or thoracic surgery (moderate certainty).ConclusionsThis clinical practice guideline synthesizes current best-evidence into four recommendations for HFNC use in patients with hypoxemic respiratory failure, following extubation, in the peri-intubation period, and postoperatively for bedside clinicians.

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