Summary: High-flow nasal cannula: impact on oxygenation and ventilation in an acute lung injury model.

Topic: Flush

Meg Frizzola. 2011 Jan;46(1):67-74. doi: 10.1002/ppul.21326. Epub 2010 Nov 23.

Frizzola and colleagues demonstrate that by way of purging anatomical dead space in a piglet model, High Flow Therapy (HFT) results in a ventilation effect that is not matched by CPAP therapy. The study shows that the impact HFT has on blood gas parameters is a function of flow, and not inadvertent pressure development. Moreover, these data demonstrate that cannulae which do not obstruct the nares, as compared to more obstructive cannulae, produce the optimal effect on blood O2 and CO2 at significantly lower flow rates and subsequently lower resulting end-distending pressure development. In simpler terms, the more of the nares that are exposed the greater the degree of flush. Therefore, this validation research for the mechanisms behind the efficacy of HFT provides evidence that HFT should be applied with minimally occlusive nasal prongs, and flow parameters set to optimize anatomical flush, and not administered in a way to promote pressure development.

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