Does high flow therapy play a role in lung transplantation?
High flow nasal cannula therapy (HFNC) may be useful in patients who undergo lung transplantation. There is some isolated experience of its successful use in patients with interstitial lung disease who are awaiting transplantation and have exacerbations with acute respiratory failure. Avoiding intubation and mechanical ventilation is very desirable in these patients. But where more literature exists is in patients already transplanted, in this case seeking to optimize the results of extubation. Thus, some studies support the usefulness of high-flow therapy in patients with a high risk of post-extubation failure. In these patients, non-invasive mechanical ventilation has been compared with HFNC, demonstrating a lower incidence of reintubation among patients who received high-flow. Masclans et al. were able to show for the first time in a non-randomized retrospective study in transplant patients re-admitted to an ICU with symptoms of acute respiratory failure, that the HFNC reduced the need for invasive mechanical ventilation in up to one third of patients, which improved survival In lung transplant recipients. HFNC may be useful to accelerate extubation in some patients and to provide support for those who are readmitted with hypoxemia, thus avoiding intubation and invasive ventilation and the associated impact on prognosis. These results are encouraging and put on the table the need for more studies in patients receiving lung transplantation. We must not forget that delaying intubation and invasive ventilation in cases in which the technique fails, is associated with a worse prognosis of the patient. The HFNC can play, therefore, a very important role both in patients who are awaiting transplantation, and in those who have already been transplanted.