High-flow nasal cannula oxygen therapy (HFNC) has revolutionized the treatment of patients with respiratory failure in different settings. Several mechanisms of action explain us why HFNC has become a first line therapy for these patients. Some authors have referred to the adverse effects that can occur when we use HFNC and its limitations. However, there are numerous aspects that we should consider when prescribing this treatment and that are not documented in the literature to date. In a Task Force carried on by International High-Flow Network members in Madrid, the things that should be taken into account when put a patient on HFNC were addressed. We have discussed in this article aspects related to the device, oxygenation, humidification, tubing, nasal cannula, alarms and finally, those related to the patient who receive the treatment.
The study conclusion establish that HFNC therapy is not as simple as it seems, and many things have to be taken into account when we put a patient on this therapy. We should pay attention to many aspects related to the therapy. We can be in front of a device with the latest technology, however it can fail. As we know, HFNC is not just a device to turn on and off. The training of health professionals is essential to ensure the proper use of the technique and patient safety. Adaptation and training are also necessary for the patient and the caregiver in cases of long term HFNC prescription. This review aims to highlight some of the innumerable aspects that we should not forget when treating patients with HFNC and have interest in clinical practice. Training is necessary because the devil is in the detail.
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