An intensivist on a learning frenzy. Caring for the critically ill using evidence-based medicine.
This is a one-minute journal club.This is not medical advice. Read the full free article for yourself (link below).Hat tip to the authors.Link in my stories for the next 24 hours.How do you predict whether a patient on high-flow will need to be intubated?Eyeballing your patient is not quite good enough.The ROX index is a …
Continue reading VOX Index: Predicting HFNC Failure (One-Minute Journal Club)
We have all had this patient. Someone who is in acute hypoxemic respiratory failure, let's just call it pneumonia of some sort or ARDS, and the regular nasal cannula or a venti-mask can't cut it. They're not at the severity where you can eyeball the patient and just know that they need to be intubated. …
Continue reading ROX Index: Predicting Who Is or Isn’t Going to Fly on HFNC
A sentinel event is one where, amongst other different outcomes, leads to death. In critical care, anesthesia, and emergency medicine, we often deal with emergent airways on patients who are on the brink of death unless we intervene expediently. Despite having performed many intubations in my young career, I have the utmost respect for every …
Continue reading Pre-oxygenation: High flow nasal cannula vs. BVM
I've reviewed numerous mechanisms of action and functions of High Flow Nasal Cannula (HFNC) but I haven't touch on whether or not it works to help ventilate patients. I have discussed in the mechanisms of action that it does wash out the CO2 from the dead space in the nasopharynx, oropharynx, etc, but does that …
Continue reading High Flow Nasal Cannula (HFNC): Does it Ventilate COPD Patients?
Fortunately in the critical ill population, we do not necessarily have to abide by the saying that "if all you have is a hammer, everything looks like a nail". What I'm referring to is regarding utilizing high-flow nasal cannula in acute heart failure exacerbations. I already dissected how HFNC generated a "PEEP" equivalent airway pressure …
Continue reading High Flow Nasal Cannula in Acute Decompensated Heart Failure
High-flow nasal cannula oxygen therapy in adults Some of you have asked what I mean every time I post something regarding high flow nasal cannula. Let's start by defining the flow in the different oxygen devices. Regular nasal cannula provides between 1-6 liters of flow. A simple face mask can get you flows between 6-10L/min. …
This study was the first randomized control trial looking at whether high-flow nasal cannula (HFNC) decreases the need for mechanical ventilation in the emergency department. In addition they looked at emergency department and hospital lengths of stays, 90 day mortality, adverse effects in the hospital, and patient experience. I sympathize for the authors of this …
Continue reading High Flow Nasal Cannula in the Emergency Department: Avoid Intubations
I have extensively covered high flow nasal cannula, HFNC on this page due to a talk I'm creating on the matter. We've witnessed it first hand keep patients off of the ventilator. This article published in the American Journal of Respiratory and Critical Care Medicine, which as an aside is the highest impact factor publication …
Continue reading High Flow Nasal Cannula: Physiologic Effects
Please note that I have sorted out this issue and the following rant is a rant on my thought process leading up to my eventual resolution looking at PEEP and high flow nasal cannula. I was trained, or maybe even made it up in my head, that for every 10L of flow increase on the high …
Continue reading HFNC/High Flow Nasal Cannula: Does it generate “PEEP”?
This topic is very dear to me because I am a huuuuuuuge proponent for appropriate end of life care. I'm an Intensivist after all and people unfortunately die on my service. We all are going to have our day. My goal with the patients I take care of is to make their passing to the …
Continue reading Do Not Resuscitate (DNR) does NOT mean you can’t use high flow.