HFNC in "post-COVID era"

High-flow nasal cannula (HFNC) is a respiratory support device, which is used early in management of acute respiratory failure alongside with conventional oxygen therapy and non-invasive ventilation (NIV). The benefits of HFNC are on both aspects of physiological  and clinical. It can provide high oxygen concentration to the patient with additional benefit of alveolar recruitment, humidification and heating, increased secretion clearance and reduction of dead space. Many patients like it because of comfort and ease of use.

HFNC is used widely among COVID-19 patient with the above benefits. It can delay intubation and very useful during resource constraint situation such as during COVID-19 pandemic. Among the concern in using non-invasive respiratory support to the COVID-19 is exhale excursion which create the potential risk to healthcare workers. Some studies have shown that the risk of excursion is lower in HFNC compared to NIV however it need to be verified in more major trials

Post pandemic HFNC is still widely used in many clinical areas such Emergency Department, ward, Intensive Unit and other critical areas. HFNC is incorporated in many invasive mechanical ventilator. It can be used early in management of ARF and able to delay or avoid intubation in many cases. It is also very useful as a weaning tool post extubation especially among patients who have high risk of extubation failure. Currently HFNC is  being widely used in acute hypoxaemic respiratory failure and also been assessed  in acute hypercapnic respiratory failure. More works are required to expand the usage in other clinical condition of patients.