High Flow Nasal Oxygen & The Berlin Definition of ARDS

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

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

How to support my work

My efforts are at no cost to you and I would like to keep it that way. You have to look at ads on this website, listen to them on my podcast and YouTube content. Thanks for bearing with me. You could also support my work by clicking on my Amazon Affiliate links prior to ordering things off of Amazon.

For example, if you want to learn more about Mechanical Ventilation, I recommend starting off with The Ventilator Book by Will Owens. If you click on that link, a window for Amazon will open up and I will earn between a 1-3% commission at no expense to you. The fun thing is that if you order anything else on Amazon, I will earn that amount off of your shopping cart even if you do not purchase the book. Pretty cool, right? In 2020, Amazon Affiliates helped me pay for the hosting of my website, LLC fees, and Netflix.


Although great care has been taken to ensure that the information in this post is accurate, eddyjoe, LLC shall not be held responsible or in any way liable for the continued accuracy of the information, or for any errors, omissions or inaccuracies, or for any consequences arising therefrom.