a) List the indications, contraindications, uses and adverse effects of high-flow nasal cannulae (HFNC). (40% marks)
b) Critically evaluate the use of HFNC use in adult ICU patients. (60% marks)
The wording of this SAQ might have confused some people, as some trainees would have found it difficult to find the subtle difference between the indications for high flow nasal oxygen and the uses of high flow nasal oxygen.
Fortunately, this question is a mutant hybrid offspring of Question 2 from the first paper of 2013 and Question 3 from the first paper of 2017, which means the candidates should have been well prepared for it. Thus:
"Critically evaluate" in 6 minutes or less, omitting elements already covered in the preceding question and stripping a more comprehensive answer down to some kind of bare metal:
PREOXYFLOW (2015): no difference when HFNP was used to preoxygenate for intubation
THRIVE (2014): greatly improved apnoea time in difficult intubation patients
S68 Hi-Flo study (2014): no difference with HFNP (babies with bronchiolitis)
BiPOP (2015): non-inferior to NIV in post-op CABG patients
Groves, Nicole, and Antony Tobin. "High flow nasal oxygen generates positive airway pressure in adult volunteers." Australian Critical Care 20.4 (2007): 126-131.
Ricard, J. D. "High flow nasal oxygen in acute respiratory failure." Minerva Anestesiol 78.7 (2012): 836-841.
Locke, Robert G., et al. "Inadvertent administration of positive end-distending pressure during nasal cannula flow." Pediatrics 91.1 (1993): 135-138.
O’Brien, Bj, J. V. Rosenfeld, and J. E. Elder. "Tension pneumo‐orbitus and pneumocephalus induced by a nasal oxygen cannula: Report on two paediatric cases." Journal of paediatrics and child health 36.5 (2000): 511-514.
Corley, Amanda, et al. "Oxygen delivery through high-flow nasal cannulae increase end-expiratory lung volume and reduce respiratory rate in post-cardiac surgical patients." British journal of anaesthesia (2011): aer265.
Boyer, Alexandre, et al. "Prognostic impact of high-flow nasal cannula oxygen supply in an ICU patient with pulmonary fibrosis complicated by acute respiratory failure." Intensive care medicine 37.3 (2011): 558-559.
Stéphan, François, et al. "High-flow nasal oxygen vs noninvasive positive airway pressure in hypoxemic patients after cardiothoracic surgery: a randomized clinical trial." JAMA (2015).
Miguel-Montanes, Romain, et al. "Use of high-flow nasal cannula oxygen therapy to prevent desaturation during tracheal intubation of intensive care patients with mild-to-moderate hypoxemia*." Critical care medicine 43.3 (2015): 574-583.
Kang, Byung Ju, et al. "Failure of high-flow nasal cannula therapy may delay intubation and increase mortality." Intensive care medicine 41.4 (2015): 623-632.
Frat, Jean-Pierre, et al. "High-Flow Oxygen through Nasal Cannula in Acute Hypoxemic Respiratory Failure." New England Journal of Medicine (2015).
Vourc’h, Mickaël, et al. "High-flow nasal cannula oxygen during endotracheal intubation in hypoxemic patients: a randomized controlled clinical trial." Intensive care medicine (2015): 1-11.
Patel, A., and S. A. R. Nouraei. "Transnasal Humidified Rapid‐Insufflation Ventilatory Exchange (THRIVE): a physiological method of increasing apnoea time in patients with difficult airways." Anaesthesia 70.3 (2015): 323-329.
Hathorn, C., et al. "S68 The Hi-flo Study: A Prospective Open Randomised Controlled Trial Of High Flow Nasal Cannula Oxygen Therapy Against Standard Care In Bronchiolitis." Thorax 69.Suppl 2 (2014): A38-A38.
Parke, Rachael L., Shay P. McGuinness, and Michelle L. Eccleston. "A preliminary randomized controlled trial to assess effectiveness of nasal high-flow oxygen in intensive care patients." Respiratory Care 56.3 (2011): 265-270.
Vourc’h, Mickaël, et al. "High-flow nasal cannula oxygen during endotracheal intubation in hypoxemic patients: a randomized controlled clinical trial." Intensive care medicine 41.9 (2015): 1538-1548.