have shown that the flow that achieves the greatest effect on the mechanisms of action of the HFNC is 60 L/min. ğlow: It has been recommended in the literature to start with low flows (30-35 L/min) and to go up as tolerated by the patient. The adequate selection of the flow and FiO 2 that the patient needs is key to achieve the proposed objective. This, which seems obvious, is a very important aspect. View Table 1 Aspects Related to the Device Setting Table 1: Aspects to be consider when put a patient on HFNC. We will discuss the aspects related to the device, oxygenation, humidification, tubing, nasal cannula, alarms and finally, those related to the patient who receive the treatment. We will review the main aspects to consider and potential problems that we can find when we use the HFNC (Table 1). The high-flow devices that generates the flow through oxygen and air intakes to the wall, such as the Opti flow (Fisher & Paykel, Auckland, New Zealand), can pose significantly different problems by not integrating turbine, although many of the comments here are applicable. The integrated flow generator delivers a wide flow range (10-60 L/min for adults' patients) and no wall air supply is required in the AIRVO 2. We are going to refer mainly to the Airvo 2 device (Fisher & Paykel, Auckland, New Zealand) because it is the most used device in our daily practice in the hospitalization and emergency facilities, also being used in critical areas. Many of the comments herein are the result of the experience of Task Force members. 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. The fact that in the end the patient receives the therapy through a nasal cannula does not mean that the patient is not critical or does not require monitoring. However, there are numerous aspects that we should consider when prescribing this treatment and that are not documented in the literature to date. Some authors have referred to the adverse effects that can occur when we use HFNC and its limitations. The evidence for HFNC use in adults has increased exponentially year after year since the publication of the first study in 2008. These HFNC effects have placed this therapy in the first line of treatment of patients with hypoxemic respiratory failure and as a main alternative in patients with hypercapnic respiratory failure when they do not tolerate noninvasive ventilation (NIV), reject it or is contraindicated and when NIV fails in patients not subsidiary of intubation and invasive ventilation. It has been proven that when the patient breathes with a closed mouth, the pressure achieved is optimized, maximizing the dead-space CO 2 washing effect if the patient breathes with an open mouth. By providing the gas breathed at 37 ℃ and 100% humidity, the HFNC is better tolerated and more comfortable for the patient. The mechanisms of action of the HFNC are multiple, highlighting its ability to increase alveolar recruitment, improve the ventilatory pattern, generate a positive expiratory pressure (PEEP) and produce dead-space CO 2 washout. Although HFNC is not a mechanical ventilation system, it is considered more and more as a respiratory support system. It consists in the administration of a gas flow that exceeds the patient's peak inspiratory flow, above 30 L/min in adults, heated to 37 ✬ and with a humidity of 100%. Its effectiveness in patients with different severity levels has facilitated its use in multiple areas of the hospital (emergencies, critical areas, ward.) and there are already experiences of its use at home. Moreover, recent studies suggested that HFNC is effective in hypercapnic patients with a stable status. High-flow nasal cannula oxygen therapy (HFNC) is an innovative respiratory support for critically ill patients with acute hypoxemic respiratory failure. We will discuss 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. Several mechanisms of action explain us why HFNC has become a first line therapy for these patients. High-flow nasal cannula oxygen therapy (HFNC) has revolutionized the treatment of patients with respiratory failure in different settings.
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