High flow nasal cannula, aka nasal high flow, high flow oxygen, etc. is a technology that I have reviewed extensively before. It has numerous uses including pneumonia, asthma, heart failure, and even COPD. The ROX Index will also help us predict who will likely need to be intubated after failing high flow. That being said, high flow does not fit nicely in the Berlin Definition of ARDS even though we routinely use it in ARDS. Below, I have cited two full free articles where the authors discuss the rationale of why we should expand the definition of ARDS to include patients who are on high flow nasal cannula.
In my opinion, it doesn’t really matter because we’re taking care of patients. From the research and administrative perspective, I understand the nuance and why we should include high flow in the ARDS definition.
Citations looking at High Flow and ARDS/Berlin Criteria
Ware LB. Go with the Flow: Expanding the Definition of Acute Respiratory Distress Syndrome to Include High-Flow Nasal Oxygen. Am J Respir Crit Care Med. 2022 Feb 15;205(4):380-382. doi: 10.1164/rccm.202112-2727ED. PMID: 35007489; PMCID: PMC8886950.
Link to Article
Link to FULL FREE PDF
Matthay MA, Thompson BT, Ware LB. The Berlin definition of acute respiratory distress syndrome: should patients receiving high-flow nasal oxygen be included? Lancet Respir Med. 2021 Aug;9(8):933-936. doi: 10.1016/S2213-2600(21)00105-3. Epub 2021 Apr 27. PMID: 33915103; PMCID: PMC8075801.
Link to Article
Link to FULL FREE PDF
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