Comparison of clinical characteristics and hospital mortality in critically ill patients without COVID-19 before and during the COVID-19 pandemic: a multicenter, retrospective, propensity score-matched study Sua Kim, Hangseok Choi, Jae Kyeom Sim, Won Jai Jung, Young Seok Lee, Je Hyeong Kim Annals of Intensive Care.2022;[Epub] CrossRef
The high-flow nasal cannula (HFNC) has been recently used in several clinical settings for oxygenation in adults. In particular, the advantages of HFNC compared with low-flow oxygen systems or non-invasive ventilation include enhanced comfort, increased humidification of secretions to facilitate expectoration, washout of nasopharyngeal dead space to improve the efficiency of ventilation, provision of a small positive end-inspiratory pressure effect, and fixed and rapid delivery of an accurate fraction of inspired oxygen (FiO2) by minimizing the entrainment of room air. HFNC has been successfully used in critically ill patients with several conditions, such as hypoxemic respiratory failure, hypercapneic respiratory failure (exacerbation of chronic obstructive lung disease), post-extubation respiratory failure, pre-intubation oxygenation, and others. However, the indications are not absolute, and much of the proven benefit remains subjective and physiologic. This review discusses the practical application and clinical uses of HFNC in adults, including its unique respiratory physiologic effects, device settings, and clinical indications.
Citations
Citations to this article as recorded by
Prediction of high-flow nasal cannula failure in critically ill patients: a narrative review Yaxiaerjiang Muhetaer, Shi-min Zhang, Amanguli Moming, Kai Liu, Ming Zhong Journal of Intensive Care.2026;[Epub] CrossRef
Heated and Humidified Oxygen in Critical Care Transport: Evaluating the Use of Aerogen Pro-X Nebulizer as an Alternative to Traditional High-Flow Humidifiers Maria Karas, Trace Choulat, Jamie Persten, Conner Rucks, Ravi Panchigar, Emma Beqaj, Emily Puckett, Andrew Joseph, Derek Hunt Air Medical Journal.2026;[Epub] CrossRef
The effect of high-flow nasal cannula oxygen therapy on preventing hypoxemia during deep sedation extubation after laparoscopic surgery: a prospective randomized controlled trial Yi-Kai Wang, Xiang Li, Shi-You Wei, Hui Yang, Zhou-Peng Tan, Sheng-Ming Yan, Wei Liu, Xin Lv BMC Anesthesiology.2026;[Epub] CrossRef
Adherence and influencing factors of high-flow nasal cannula humidified oxygen therapy in elderly patients with stable chronic obstructive pulmonary disease: A meta-analysis Yang Yang, Ting-Ting Liu, Dong-Mei Li, Xue-Ling Ren, Zheng Luo, Xue-Li Chen, Ying-Zhen Du, Yan-Shuang Cheng Annals of Thoracic Medicine.2025; 20(1): 49. CrossRef
Comparison of high flow nasal cannula and conventional oxygen therapy post-extubation in intensive care unit: A prospective crossover observational study Govindraj M Bhat, Anil R Shetty, Gouri Pratyusha Kintamani Indian Journal of Clinical Anaesthesia.2025; 12(1): 125. CrossRef
Impact of the Early Use of High-flow Nasal Cannula in Patients with Post-traumatic Lung Contusion: A Randomized Clinical Trial Rania G Elsayed, Amr F Hafez, Mohammed M Maarouf, Farouk KE AbdElAziz Indian Journal of Critical Care Medicine.2025; 29(2): 117. CrossRef
Comparison of high-flow nasal oxygen therapy and noninvasive ventilation in suspected sepsis patients with acute respiratory distress in the emergency department: a retrospective cohort study Chuenruthai Angkoontassaneeyarat, Prapimporn Charoenphon, Pitsucha Sanguanwit, Chaiyaporn Yuksen, Suteenun Seesuklom International Journal of Emergency Medicine.2025;[Epub] CrossRef
Comparison of Procedural Oxygen Mask and Nasal Cannula in Endoscopic Procedures: A Prospective Observational Study Aydogan Celik, Mehmet Yilmaz, Ahmet Yuksek, Sema Candan, Ayse Zeynep Turan Civraz, Merve Yazici Kara, Bedirhan Gunel Bratislava Medical Journal.2025; 126(6): 1085. CrossRef
A comparison of conventional high-flow nasal cannula vs the duet high-flow nasal cannula in extubated patients: a randomized crossover trial Ravindranath Tiruvoipati, Mallikarjuna Ponnapa Reddy, Eldho Paul, Sachin Gupta, Ashwin Subramaniam, David Zhang, Kavi Haji European Journal of Medical Research.2025;[Epub] CrossRef
Home High-Flow Nasal Cannula in Patients with Chronic Respiratory Failure: A Literature Review and Suggestions for Clinical Practice Youjin Chang, Moon Seong Baek, Sei Won Kim, Su Hwan Lee, Jung Soo Kim, So Young Park, Jin Woo Kim, Jae Hwa Cho, Sunghoon Park Tuberculosis and Respiratory Diseases.2025; 88(2): 264. CrossRef
Unraveling relevant cross-waves pattern drifts in patient-hospital risk factors among hospitalized COVID-19 patients using explainable machine learning methods Fernanda Cristina Barbosa Lana, Carolina Coimbra Marinho, Bruno Barbosa Miranda de Paiva, Lucas Rocha Valle, Guilherme Fonseca do Nascimento, Leonardo Chaves Dutra da Rocha, Marcelo Carneiro, Joanna d‘Arc Lyra Batista, Fernando Anschau, Pedro Gibson Parai BMC Infectious Diseases.2025;[Epub] CrossRef
THRIVE Prevent Postoperative Hypoxemia in Elderly Patients Undergoing Laparoscopic Surgery in PACU: A Randomized Controlled Clinical Trial Xingxing Chen, Kang Gu, Yunqing Yang, Bingbing Zhou, Yunchang Mo, Yingying Tu Journal of Multidisciplinary Healthcare.2025; Volume 18: 2651. CrossRef
Implementation of High-Flow Oxygen Therapy in a Surgical High-Dependency Unit: A Cohort Study Joanne Chong Hui Ling , Bridget Ng Si Min, Shi Min Tan, Wei Qin Teo, Irene Too Ai Ling, Jolin Wong, Vui K Ho, Shin Yi Ng, Aarthi Suhitharan, Suhitharan Thangavelautham Cureus.2025;[Epub] CrossRef
Trends and management of acute respiratory failure in hospitalized patients: a multicenter retrospective study in South Korea Won Jin Yang, Yong Jun Choi, Kyung Soo Chung, Ji Soo Choi, Bo Mi Jung, Jae Hwa Cho Acute and Critical Care.2025; 40(2): 171. CrossRef
Breathing Easy Stephanie Gregory, Sandra Waugaman, Sarah Zeller Critical Care Nursing Clinics of North America.2025; 37(3): 461. CrossRef
Factors affecting critical care outcomes in the emergency department Taylor M. Fontenot, Ioana Antonescu, Heatherlee Bailey Current Opinion in Critical Care.2025; 31(5): 566. CrossRef
Comparison of three different flow rates of oxygen with high-flow nasal cannula versus conventional nasal oxygen therapy in adult patients undergoing endoscopic retrograde cholangiopancreatography Arundhati Chadha, Anil Yogendra Yadav, Udit Dhingra, Gaurav Sindwani, Vinod Arora, Deepak K. Tempe Trends in Anaesthesia and Critical Care.2025; 65: 101600. CrossRef
Practice of High-Flow Nasal Cannula in Patients with Mild to Moderate COPD Among Healthcare Providers in Saudi Arabia: A Cross-Sectional Study Abdulelah Aldhahir, Mohammed Alyami, Osama Alanazi, Ahmed Alasimi, Abdullah Alqarni, Jaber Alqahtani, Abdallah Naser, Hassan Alwafi, Mohammad Dairi, Saeed Alghamdi, Rayan Siraj, Nowaf Alobaidi, Mohammed Almeshari, Abdulrhman Alghamdi Journal of Multidisciplinary Healthcare.2025; Volume 18: 7567. CrossRef
Continuous non-invasive measurement of tidal volume and minute ventilation using a smart nasal cannula Alan B. Dogan, Neel Patel, Carter Gottschalk, Rae L. Blankenship, Valerie K. Young, Alfred Wicks, Umar F. Sofi Critical Care.2025;[Epub] CrossRef
Effect of high-flow nasal cannula therapy on adults with obstructive sleep apnea: A meta-analysis Shuang Bian, Jiaqi Di, Kai Shi, Dongwei Yu, Yuejuan Feng Medicine.2025; 104(48): e45782. CrossRef
Physical and Physiological Mechanisms of Emergent Hydrodynamic Pressure in High-Flow Nasal Cannula Therapy Jose Luis Estela-Zape Advances in Respiratory Medicine.2025; 94(1): 1. CrossRef
Asymmetrical high-flow nasal cannula performs similarly to standard interface in patients with acute hypoxemic post-extubation respiratory failure: a pilot study Annalisa Boscolo, Tommaso Pettenuzzo, Francesco Zarantonello, Nicolò Sella, Elisa Pistollato, Alessandro De Cassai, Sabrina Congedi, Irene Paiusco, Giacomo Bertoldo, Silvia Crociani, Francesca Toma, Giulia Mormando, Giulia Lorenzoni, Dario Gregori, Paolo BMC Pulmonary Medicine.2024;[Epub] CrossRef
Recommendations from The Medical Education Editor Mark Lavercombe Respirology.2024; 29(4): 266. CrossRef
Liberation from mechanical ventilation in critically ill patients: Korean Society of Critical Care Medicine Clinical Practice Guidelines Tae Sun Ha, Dong Kyu Oh, Hak-Jae Lee, Youjin Chang, In Seok Jeong, Yun Su Sim, Suk-Kyung Hong, Sunghoon Park, Gee Young Suh, So Young Park Acute and Critical Care.2024; 39(1): 1. CrossRef
Clinical Practice of High-Flow Nasal Cannula Therapy in ARDS Patients: A Cross-Sectional Survey of Respiratory Therapists Mohammed Alyami, Abdulelah Aldhahir, Abdullah Alqarni, Khalid Salwi, Abdullah Sarhan, Mohammed Almeshari, Nowaf Alobaidi, Jaber Alqahtani, Rayan Siraj, Abdullah Alsulayyim, Saeed Alghamdi, Ahmed Alasimi, Omar Alqarni, Mansour Majrshi, Hassan Alwafi Journal of Multidisciplinary Healthcare.2024; Volume 17: 1401. CrossRef
Evaluating high-flow oxygen therapy after mechanical thrombectomy under general anesthesia in acute ischemic stroke: A retrospective single-center study Pingyou He, Xiang Bao, FengFeng Jiang, Xiaobo Liu, Wei Xu, Danfeng Yu, Lin Chen, Feng Chen Clinical Neurology and Neurosurgery.2024; 243: 108359. CrossRef
A Comprehensive Review on High-Flow Nasal Cannula Oxygen Therapy in Critical Care: Evidence-Based Insights and Future Directions Shubham Petkar, Dnyanshree Wanjari, Vishnu Priya Cureus.2024;[Epub] CrossRef
Does apneic oxygenation with nasopharyngeal cannula during intubation improve the oxygenation in patients with acute hypoxemic respiratory failure compared to the standard bag valve mask preoxygenation? An open-labeled randomized control trial Irfan Zubair Shahul Hameed, Darpanarayan Hazra, Priya Ganesan, Abhilash Kundavaram Paul Prabhakar Turkish Journal of Emergency Medicine.2024; 24(1): 33. CrossRef
Liberation from Mechanical Ventilation in Critically Ill Patients: Korean Society of Critical Care Medicine Clinical Practice Guidelines Tae Sun Ha, Dong Kyu Oh, Hak-Jae Lee, Youjin Chang, In Seok Jeong, Yun Su Sim, Suk-Kyung Hong, Sunghoon Park, Gee Young Suh, So Young Park Tuberculosis and Respiratory Diseases.2024; 87(4): 415. CrossRef
High-Flow and Low-Flow Oxygen Delivery by Nasal Cannula Evaluated in Infant and Adult Airway Replicas Mozhgan Sabz, Michelle L Noga, Warren H Finlay, Hossein Rouhani, Andrew R Martin Respiratory Care.2024; 69(4): 438. CrossRef
Recomendaciones de terapia de alto flujo nasal en el servicio de Urgencias PARTE 1 Saúl Trejo-Rosas, Ignacio Alberto Mendez-Jesus, Elizabeth Mendoza-Portillo, David Sanabría-Cordero, Miguel Russi-Hernández Archivos de Medicina de Urgencia de México.2024; 16(3): 210. CrossRef
The Impact of High-Flow Nasal Cannula Therapy on Acute Respiratory Distress Syndrome Patients: A Systematic Review Ahmed M Abdelbaky, Wael G Elmasry , Ahmed H. Awad, Sarrosh Khan, Maryam Jarrahi Cureus.2023;[Epub] CrossRef
High-Flow Oxygen Therapy in the Perioperative Setting and Procedural Sedation: A Review of Current Evidence Lou’i Al-Husinat, Basil Jouryyeh, Ahlam Rawashdeh, Abdelrahman Alenaizat, Mohammad Abushehab, Mohammad Wasfi Amir, Zaid Al Modanat, Denise Battaglini, Gilda Cinnella Journal of Clinical Medicine.2023; 12(20): 6685. CrossRef
Current status of treatment of acute respiratory failure in Korea Yong Jun Choi, Jae Hwa Cho Journal of the Korean Medical Association.2022; 65(3): 124. CrossRef
Transnasal High-Flow Oxygen Therapy versus Noninvasive Positive Pressure Ventilation in the Treatment of COPD with Type II Respiratory Failure: A Meta-Analysis Wei Liu, Mingli Zhu, Liuqin Xia, Xiangying Yang, Pei Huang, Yanming Sun, Ye Shen, Jianping Ma, Gang Chen Computational and Mathematical Methods in Medicine.2022; 2022: 1. CrossRef
Association between timing of intubation and mortality in patients with idiopathic pulmonary fibrosis Eunhye Bae, Jimyung Park, Sun Mi Choi, Jinwoo Lee, Sang-Min Lee, Hong Yeul Lee Acute and Critical Care.2022; 37(4): 561. CrossRef
Effect of high-flow oxygen versus T-piece ventilation strategies during spontaneous breathing trials on weaning failure among patients receiving mechanical ventilation: a randomized controlled trial Hong Yeul Lee, Jinwoo Lee, Sang-Min Lee Critical Care.2022;[Epub] CrossRef
Background The molecular adsorbent recirculating system (MARS) is a hepatic replacement system that supports excretory liver function in patients with liver failure. However, since MARS has been employed in our hospital, bleeding complications have occurred in many patients during or after MARS. The objective of this study was to determine how MARS affects coagulopathy and identify specific factors associated with bleeding complications.
Methods We retrospectively analyzed data from 17 patients undergoing a total of 41 MARS sessions. Complete blood count, coagulation profiles, and blood chemistry values were compared before and after MARS. To identify pre-MARS factors associated with increased bleeding after MARS, we divided patients into bleeder and non-bleeder groups and compared their pre-MARS laboratory values.
Results MARS significantly reduced bilirubin and creatinine levels. MARS also increased prothrombin time and reduced platelet and fibrinogen, thus negatively impacting coagulation. Pre-MARS hemoglobin was significantly lower in the bleeder group than in the non-bleeder group (P=0.015). When comparing the upper and lower 33% of MARS sessions based on the hemoglobin reduction rate, hemoglobin reduction was significantly greater in MARS sessions involving patients with low pre-MARS international normalized ratio of prothrombin time (PT-INR) and factor V (P=0.038 and P=0.023, respectively).
Conclusions MARS could appears to alter coagulation-related factors such as factor V and increase the risk of bleeding complications particularly in patient with low hemoglobin. However, individual differences among patients were large, and various factors, such as low hemoglobin, PT-INR, and factor V levels, appear to be involved.
Citations
Citations to this article as recorded by
Fractionated plasma separation and adsorption integrated with continuous veno‐venous hemofiltration in patients with acute liver failure: A single center experience from China Jianhua Dong, Li Huang, Chuan Li, Bian Wu, Xi Yang, Yongchun Ge Journal of Clinical Apheresis.2024;[Epub] CrossRef
Crosslinked Bifunctional Particles for the Removal of Bilirubin in Hyperbilirubinemia Cases María del Prado Garrido, Ana Maria Borreguero, Maria Jesús Ramos, Manuel Carmona, Francisco Javier Redondo Calvo, Juan Francisco Rodriguez Materials.2023; 16(8): 2999. CrossRef
The Effect of Molecular Adsorbent Recirculating System in Patients With Liver Failure: A Case Series of 44 Patients Shahin Isha, Anna S. Jenkins, Abby J. Hanson, Parthkumar H. Satashia, Sai Abhishek Narra, Gunjan D. Mundhra, Mohammed Mustafa Hasan, Ashrita Donepudi, Abishek Giri, Patrick W. Johnson, Dolores Villar, Christan Santos, Juan Canabal, Philip Lowman, Pablo Mo Transplantation Proceedings.2023; 55(9): 2126. CrossRef
Extracorporeal organ support and the kidney Maria-Jimena Muciño-Bermejo Frontiers in Nephrology.2022;[Epub] CrossRef