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Table 1 Summary of findings in studies of the HFNT with regard to dyspnea, comfort, and respiratory rate

From: Effect of high-flow nasal therapy on dyspnea, comfort, and respiratory rate

Study

Type

Design

Intervention (N)

Control (N)

Treatment methods

Measurement method

Dyspnea

Comfort

Respiratory rate

Bell N. [6]

Emerg Med Australas 2015

AHRF

RCT

HFNT (48)

COT (52)

HFNT: flow 50 L/m, FiO2 30% titrated to SpO2 95%

COT: discretion of the treating physician

Dyspnea: Borg Scale

Comfort: Likert Scale

HFNT§

HFNT§ (1 h)

HFNT§ (2 h)

Frat J.P. [7]

N Engl J Med 2015

AHRF

RCT

HFNT (106)

COT (94)

NIV (110)

HFNT: flow 50 L/m, FiO2 100% then titrated to SpO2 92%

COT: O2 titrated to SpO2 92%

NIV: PSV PEEP from 2 up to 10 fiO2 adjusted to SpO2 92%

Dyspnea: Likert Scale

Comfort: VAS

HFNT§

HFNT§

HFNT§ (1 h)

Lemiale V. [8]

Crit Care 2015

AHRF

(Immunocompromised)

RCT

HFNT (52)

COT (52)

HFNT: flow from 40 up to 50 L/m, FiO2 titrated to SpO2 95%

COT: O2 titrated to SpO2 95%

Dyspnea: VAS

Comfort: VAS

NS

NS

NS

Jones P.G. [9]

Respir Care 2016

AHRF

RCT

HFNT (172)

COT (150)

HFNT: flow 40 L/m, 37 °C, FiO2 28%

COT: FiO2 titrated to clinical needs

Dyspnea: Survey questions

Comfort: Survey questions

NS

Overall comfort: NS

“Dry my nose”: HFNT§

“In future I prefer”: COT§

“This method is worst”: HFNT§

NS

Doshi P. [10]

Ann Emergency Med 2017

AHRF

RCT

HFNT (104)

NIV (112)

HFNT: flow from 35 L/m up to 40 L/m, T° between 35 and 37 °C

NIV: IPAP from 10 up to 20 cmH20, EPAP from 5 up to 10 cmH20, FiO2 100%

Dyspnea: Borg Scale

Comfort: NA

NA

NA

NA

Makdee O. [11]

Ann Emergency Med 2017

AHRF

(CPE)

RCT

HFNT (63)

COT (65)

HFNT: flow from 35 up to 60 L/m, FiO2 titrated to SpO2 95%

COT: O2 titrated to SpO2 95%

Dyspnea: VAS

Comfort: NA

NS

NA

HFNT§

(15, 30, 60 min)

Azoulay E. [12]

JAMA 2018

AHRF

(Immunocompromised)

RCT

HFNT (388)

COT (388)

HFNT: flow 50 L/min, FiO2 titrated to SpO2 95%

COT: O2 titrated to SpO2 95%

Dyspnea: Dyspnea Score

Comfort: VAS

NS

NS

HFNC§ (6 h)

Spoletini G. [13]

J Crit Care 2018

AHRF

(On NIV)

RCT

HFNT (23)

COT (24)

HFNT: flow 35 L/m, FiO2 titrated to SpO2 92% (hypoxic) or to 88–92%(hypercapnic)

COT: flow adjusted to maintain the same SpO2

Dyspnea: Borg Scale

Comfort: VAS

NS

HFNT§

NS

Cuquemelle E. [14]

Respir Care 2012

AHRF

Crossover

HFNT (37)

COT (37)

HFNT: flow 40 L/m, FiO2 titrated to SpO2 95%

COT: O2 titrated to SpO2 95%

Dyspnea: NA

Comfort: Dryness

NA

HFNT§

NA

Schwabbauer N. [15]

BMC Anesthesiol 2014

AHRF

Crossover

HFNT (14)

COT (14)

NIV (14)

HFNT: flow 55 L/m, FiO2 60%

COT: Venturi mask FiO2 60%

NIV: PSV FiO2 60% PEEP 5 cmH20 PS 6-8 ml/kg PBW

Dyspnea: Borg Scale

Comfort: NRS

HFNT vs. COT

HFNT§ vs. NIV

HFNT vs. COT

HFNT§ vs. NIV

HFNT vs. COT

HFNT vs. NIV

COT vs. NIV§

Vargas F. [16]

Respir Care 2015

AHRF

Crossover

HFNT

(n = 12)

COT (12)

CPAP (12)

HFNT: flow 60 L/m, T 37 °C, FiO2 same as COT

COT: O2 titrated to SpO2 90%

CPAP: 5 cmH20 FiO2 same as COT

Dyspnea: Dyspnea Score

Comfort: NRS

NS

NS

HFNT§ vs. COT

HFNT vs. CPAP

Mauri T. [17]

Am J Respir Crit Care Med 2017

AHRF

Crossover

HFNT (15)

COT (15)

HFNT: flow 40 L/m, FiO2 titrated to SpO2 90–95%

COT: Airvo2 face mask 12 L/min same FiO2

Dyspnea: DeltaPes

Comfort: NA

HFNT§

NA

HFNT§

Sklar M.C. [18]

Ann Intensive Care 2018

ARF

(Exacerbation of cystic fibrosis)

Crossover

HFNT (15)

NIV (15)

HFNT: flow 55 L/m, T° 34 or 37 °C FiO2 titrated to SpO2 92%

NIV: FiO2 titrated to SpO2 92%, setting as previously adjusted

Dyspnea: VAS

Comfort: VAS

NS

NS

NS

Parke R. [19]

Br J Anaesth 2013

Post-extubation

(Cardiac surgery)

RCT

HFNT (169)

COT (171)

HFNT: flow 45 L/m, FiO2 titrated to SpO2 93%

COT: O2 titrated to SpO2 93%

Dyspnea: NA

Comfort: NRS

NA

HFNT§

NA

Maggiore S.M. [20]

Am J Respir Crit Care Med 2014

Post-extubation

RCT

HFNT (53)

COT (52)

HFNT: flow 50 L/m, FiO2 titrated to SpO2 92–98% (hypoxic) or to 88–95%(hypercapnic)

COT: O2 titrated to SpO2 92–98% (hypoxic) or 88–95%(hypercapnic)

Dyspnea: NA

Comfort: NRS

NA

Interface:

HFNT§ (from 12 h)

Dryness:

HFNT§ (from 24 h)

HFNT§ (from 1 h)

Corley A. [21]

Intensive Care Med 2015

Post-extubation

(Cardiac)

RCT

HFNT (81)

COT (74)

HFNT: flow 35 up to 50 L/min, T 37 °C, FiO2 titrated to SpO2 95%

COT: O2 titrated to SpO2 95%

Dyspnea: Borg Scale

Comfort: NA

COT§ (8 h)

NA

NS

Stephan F. [22]

JAMA 2015

Post-extubation

(Cardiac)

RCT

HFNT (414)

NIV (416)

HFNT: flow 50 L/m, FiO2 titrated to SpO2 92–98%

NIV: PEEP and PS adjusted to RR < 25/min and TV 8 ml/kg, FiO2

SpO2 92–98%

Dyspnea: Dyspnea Score

Comfort: NRS

NS

NS

HFNT§(1 h, 1 day, 2 days, 3 days)

Futier E. [23]

Intensive Care Med 2016

Post-extubation

(Abdominal or thoracic)

RCT

HFNT (108)

COT (112)

HFNT: flow 50–60 L/m, FiO2 titrated to SpO2 95%

COT: O2 titrated to SpO2 95%

Dyspnea: NA

Comfort: NRS

NA

NS

NA

Hernandez G. (a) [24]

JAMA 2016

Post-extubation

(Low-risk extubation failure)

RCT

HFNT (264)

COT (263)

HFNT: flow 10 L/m titrated in 5 L step until discomfort, FiO2 to SpO2 92%, T 37 °C

COT: O2 titrated to SpO2 92%

Dyspnea: NA

Comfort: NA

NA

NA

NA

Hernandez G. (b) [25]

JAMA 2016

Post-extubation

(High-risk extubation failure)

RCT

HFNT (290)

NIV (314)

HFNT: flow 10 L/m titrated in 5 L step until discomfort, FiO2 to SpO2 92%, T 37 °C

NIV: PEEP and PS adjusted to RR 25/min, SpO2 92%, pH 7.35

Dyspnea: NA

Comfort: NA

NA

NA

NA

Fernandez R. [26]

Ann Intensive Care 2017

Post-extubation

(High-risk extubation failure)

RCT

HFNT (78)

COT (77)

HFNT: flow 40 L/min (adjusted on tolerance), T 37 or 34 °C, FiO2 titrated to SpO2 92–95%

COT: O2 titrated to SpO2 92–95%

Dyspnea: NA

Comfort: NA

NA

NA

NA

Yu Y. [27]

Can Respir J 2017

Post-extubation

(Thoracic)

RCT

HFNT (56)

COT (54)

HFNT: flow from 35 to 60 L/m, FiO2 titrated to SpO2 95%

COT: O2 titrated to SpO2 95%

Dyspnea: NA

Comfort: Rates of throat/nasal pain

NA

HFNT§

HFNT§

(1 h, 2 h, 6 h, 24 h, 48 h, 72 h)

Song H.Z. [28]

Clinics (Sao Paulo) 2017

post-extubation

RCT

HFNT (30)

COT (30)

HFNT: flow 60 L/m, FiO2 titrated to SpO2 94–98% (hypoxic) or to 88–92% (hypercapnic)

COT: O2 titrated to SpO2 94–98% (hypoxic) or 88–92%(hypercapnic)

Dyspnea: NA

Comfort: VAS

NA

HFNT§ (interface)

HFNT§ (dryness)

HFNT§

Rittayamai N. [29]

Respir Care 2014

post-extubation

Crossover

HFNT (17)

COT (17)

HFNT: flow 35 L/m, FiO2 titrated to SpO2 94%

COT: O2 titrated to SpO2 94%

Dyspnea: VAS

Comfort: VAS

HFNT§

(10, 15, 30 min)

NS

HFNT§

(5, 10, 15, 30 min)

  1. AHFR acute hypoxemic respiratory failure, ARF acute respiratory failure, CPAP continuous positive airway pressure, COT conventional oxygen therapy, HFNT high-flow nasal treatment, h hours, IPAP inspiratory positive airway pressure, N number of patients, NA not available, NIV noninvasive ventilation, NS not statistically significant, PES esophageal pressure, PSV pressure support ventilation, RCT randomized controlled trial, VAS visual analog scale
  2. §Comparison between intervention and control with a statistically significant p value in favor of (the specified intervention)