Evidence map›Paper›PMID 33201321›Full record

GuidelineIntensive care medicine2020

The role for high flow nasal cannula as a respiratory support strategy in adults: a clinical practice guideline.

Bram Rochwerg, Sharon Einav, Dipayan Chaudhuri, Jordi Mancebo, Tommaso Mauri, Yigal Helviz, Ewan C Goligher, Samir Jaber, Jean-Damien Ricard, Nuttapol Rittayamai and 29 more

7 registry-linked trialsOpen access · bronzeAbstract readPractice Guideline
PubMed Full text at PMC Publisher
In one paragraph

Guideline in Intensive care medicine, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 7 registered trials, which are not on this map. Cited by 191 papers, 19 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
191citing papers in PubMed, 19 pooled it
30.5field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT04655638 nacompletednot on this mapstarted 2021, after this paper: background citation

High-Flow Nasal Therapy Versus Conventional Oxygen Therapy in Patients With COVID-19: A Randomized Controlled Trial (The COVID-HIGH Trial)

TypeinterventionalSponsorAzienda Ospedaliera Universitaria Policlinico Paolo Giaccone PalermoRan2021 to 2021Enrolled364ConditionsCovid19, Acute Respiratory FailureArmsHigh Flow Nasal Therapy, Conventional Oxygen Therapy
NCT04799132 completednot on this map

Association Between Body Mass Index and High-flow Cannula Therapy Success in Patients With Severe Covid 19 Related Pneumonia. Retrospective Study.

TypeobservationalSponsorClínica del countryRan2020 to 2021Enrolled303ConditionsCovid19, Obesity, Overweight, Pneumonia, Viral
NCT04934163 nacompletednot on this mapstarted 2021, after this paper: background citation

Effect of Flow Rates of Postextubation High-flow Nasal Cannula on Extubation Outcome: An Open-label, Randomized Controlled Trial

TypeinterventionalSponsorNational Taiwan University HospitalRan2021 to 2023Enrolled180ConditionsHypoxemic Respiratory FailureArmsFlow rate setting of high-flow nasal cannula (initially 60L/min), Flow rate setting of high-flow nasal cannula (initially 40L/min)
NCT05323266 nacompletednot on this mapstarted 2022, after this paper: background citation

Effect of Different Ventilation Modalities on the Early Prognosis of Patients With Sleep Apnea After Acute Ischemic Stroke

TypeinterventionalSponsorUnion Hospital, Tongji Medical College, Huazhong University of Science and TechnologyRan2022 to 2023Enrolled195ConditionsAcute Ischemic Stroke, Sleep Apnea, ObstructiveArmsNasal Continuous Positive Airway Pressure (nCPAP), High-Flow Nasal Cannula (HFNC)
NCT05688189 nacompletednot on this mapstarted 2023, after this paper: background citation

Initial Temperature Setting of High Flow Nasal Cannula in Critically Ill Patients: a Pragmatic Randomized Trial

TypeinterventionalSponsorFondazione IRCCS Ca' Granda, Ospedale Maggiore PoliclinicoRan2023 to 2023Enrolled21ConditionsOxygen TherapyArmsdifferent starting temperature setting of HFNC
NCT06204276 nacompletednot on this mapstarted 2024, after this paper: background citation

The Physiologic Effects of Asymmetrical Versus Conventional High-flow Nasal Cannula in Acute Respiratory Failure. A Randomized Crossover Study.

TypeinterventionalSponsorSiriraj HospitalRan2024 to 2024Enrolled40ConditionsAcute Hypoxemic Respiratory Failure, Acute Hypercapnic Respiratory FailureArmsExperimental: Asymmetrical high-flow nasal cannula, Active comparator: Conventional high-flow nasal cannula
NCT06582459 active not recruitingnot on this mapstarted 2023, after this paper: background citation

Efficacy and Safety of High-Flow Nasal Cannula Versus Noninvasive Ventilation for Pulmonary Arterial Hypertension-Associated Acute Respiratory Failure: A Retrospective Cohort Study Stratified by Right Ventricular Dysfunction Severity

TypeobservationalSponsorThe First People's Hospital of NeijiangRan2023 to 2025Enrolled90ConditionsPulmonary Arterial Hypertension, Acute Respiratory Failure, High-flow Nasal Cannula, Noninvasive VentilationArmsHFNC treatment, NIV treatment
3 · Its place in the literature

Who cites it

191 citing papers in PubMed, 19 syntheses or guidelines pooled it, 394 citations in OpenAlex.

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  2. Manual compared to automated closed-loop oxygen control strategies in hospitalised adults: a systematic review and meta-analysis.European respiratory review : an official journal of the European Respiratory Society · 2026
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  13. Effect of noninvasive respiratory support on interstitial lung disease with acute respiratory failure: A systematic review and meta-analysis.Canadian journal of respiratory therapy : CJRT = Revue canadienne de la therapie respiratoire : RCTR · 2023
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  19. High-flow nasal cannulaTherapeutic advances in respiratory disease
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  20. Trial

131 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

39 authors at 20 institutions in 13 countries.

Bram RochwergDepartment of Medicine, McMaster University, Hamilton, ON, Canada.
Sharon EinavGeneral Intensive Care Unit, Shaare Zedek Medical Center, Jerusalem, Israel.
Dipayan ChaudhuriDepartment of Medicine, McMaster University, Hamilton, ON, Canada.ORCID 0000-0002-8305-1481
Jordi ManceboServei de Medicina Intensiva, Hospital Universitari Sant Pau, Barcelona, Spain.
Tommaso MauriDipartimento Di Fisopatologia Medico-Chirurgica E Dei Trapianti, Università Degli Studi Di Milano, Milan, Italy.
Yigal HelvizGeneral Intensive Care Unit, Shaare Zedek Medical Center, Jerusalem, Israel.
Ewan C GoligherDepartment of Medicine, Division of Respirology, University Health Network, Toronto, Canada.
Samir JaberUniversity Hospital of Montpellier and Saint Eloi Hospital, Montpellier University, Montpellier, France.
Jean-Damien RicardAssistance Publique-Hôpitaux de Paris, DMU ESPRIT, Médecine Intensive Réanimation, Hôpital Louis Mourier, 92700, Colombes, France.
Nuttapol RittayamaiDivision of Respiratory Diseases and Tuberculosis, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Oriol RocaServei de Medicina Intensiva, Hospital Universitari Vall D'Hebron, Institut de Recerca Vall D'Hebron, Barcelona, Spain.
Massimo AntonelliDepartment of Anesthesiology Intensive Care and Emergency Medicine, Fondazione Policlinico Universitario A.Gemelli IRCCS, Rome, Italy.
Salvatore Maurizio MaggioreUniversity Department of Medical, Oral and Biotechnological Sciences, G. D'Annunzio University of Chieti-Pescara and Clinical, Department of Anesthesia, Critical Care and Pain Medicine, SS. Annunziata Hospital, Chieti, Italy.
Alexandre DemouleSorbonne Université, INSERM, UMRS1158, Neurophysiologie Respiratoire Expérimentale Et Clinique, Paris, France.
Carol L HodgsonAustralian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Australia.
Alain MercatDépartement de Médecine Intensive-Réanimation, CHU D'Angers, Université D'Angers, Angers, France.
M Elizabeth WilcoxDepartment of Medicine, Division of Respirology, University Health Network, Toronto, Canada.
David GrantonDepartment of Medicine, McMaster University, Hamilton, ON, Canada.
Dominic WangDepartment of Medicine, McMaster University, Hamilton, ON, Canada.
Elie AzoulayService de Médecine Intensive Et Réanimation. APHP, Hôpital Saint-Louis, Université de Paris, Paris, France.
Lamia Ouanes-BesbesIntensive Care Unit, CHU F. Bourguiba Monastir, Université de Monastir, 5000, Monastir, Tunisia.
Gilda CinnellaDepartment of Anesthesia and Intensive Care, University of Foggia, Foggia, Italy.
Michela RauseoDepartment of Anesthesia and Intensive Care, University of Foggia, Foggia, Italy.
Carlos CarvalhoPulmonary Division, Hospital das Clinicas - Heart Institute (InCor), School of Medicine, University of São Paulo, São Paulo, SP, Brazil.
Armand Dessap-MekontsoAP-HP; Hôpitaux universitaires Henri Mondor, Service de Médecine Intensive Réanimation, 94010, Créteil, France.
John FraserCritical Care Research Group, University of Queensland, Brisbane, Australia.
Jean-Pierre FratCHU de Poitiers, Réanimation Médicale, INSERM, CIC-1402, équipe 5 ALIVE, Faculté de Médecine Et de Pharmacie de Poitiers, Université de Poitiers, Poitiers, France.
Charles GomersallDepartment of Anaesthesia and Intensive Care, Chinese University of Hong Kong, Shatin, New Territories, Hong Kong.
Giacomo GrasselliDipartimento Di Fisopatologia Medico-Chirurgica E Dei Trapianti, Università Degli Studi Di Milano, Milan, Italy.
Gonzalo HernandezUniversity Hospital Virgen de La Salud, Toledo, Spain.
Sameer JogDepartment of Intensive Care Medicine, Deenanath Mangeshkar Hospital and Research Centre, Pune, India.
Antonio PesentiDepartment of Pathophysiology and Transplantation, 9304, Universita Degli Studi Di Milano, Milano, Italy.
Elisabeth D RivielloDivision of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, USA.
Arthur S SlutskyInterdepartment Division of Critical Care Medicine, University of Toronto, Toronto, Canada.
Renee D StapletonDivision of Pulmonary and Critical Care Medicine, University of Vermont Larner College of Medicine, Burlington, VT, USA.
Daniel TalmorDepartment of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA.
Arnaud W ThilleCentre Hospitalier Universitaire de Poitiers, Médecine Intensive Réanimation, INSERM CIC 1402 ALIVE Research Group, University of Poitiers, Poitiers, France.
Laurent BrochardInterdepartment Division of Critical Care Medicine, University of Toronto, Toronto, Canada.
Karen E A BurnsDepartment of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada. Karen.Burns@unityhealth.to.
Inserm · FRMcMaster University · CASt. Michael's Hospital · CAUniversity of Milan · ITBeth Israel Deaconess Medical Center · USUniversity Health Network · CAUniversity of Foggia · ITAustralian and New Zealand Intensive Care Society · AUCentre Hospitalier Universitaire d'Angers · FRChinese University of Hong Kong · HKDeenanath Mangeshkar Hospital and Research Center · INHebrew University of Jerusalem · ILHospital de Sant Pau · ESHospital Virgen de la Salud · ESImpact · CAInstituto de Salud Carlos III · ESShaare Zedek Medical Center · ILSiriraj Hospital · THThe University of Queensland · AUUniversidade de São Paulo · BR

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeHigh flow nasal cannula (HFNC) is a relatively recent respiratory support technique which delivers high flow, heated and humidified controlled concentration of oxygen via the nasal route. Recently, its use has increased for a variety of clinical indications. To guide clinical practice, we developed evidence-based recommendations regarding use of HFNC in various clinical settings.

methodsWe formed a guideline panel composed of clinicians, methodologists and experts in respiratory medicine. Using GRADE, the panel developed recommendations for four actionable questions.

resultsThe guideline panel made a strong recommendation for HFNC in hypoxemic respiratory failure compared to conventional oxygen therapy (COT) (moderate certainty), a conditional recommendation for HFNC following extubation (moderate certainty), no recommendation regarding HFNC in the peri-intubation period (moderate certainty), and a conditional recommendation for postoperative HFNC in high risk and/or obese patients following cardiac or thoracic surgery (moderate certainty).

conclusionsThis clinical practice guideline synthesizes current best-evidence into four recommendations for HFNC use in patients with hypoxemic respiratory failure, following extubation, in the peri-intubation period, and postoperatively for bedside clinicians.

Indexed as

Noninvasive VentilationRespiratory InsufficiencyAdultAirway ExtubationCannulaHumansOxygenOxygen Inhalation TherapyOxygenExtubationHigh flow nasal cannulaMortalityPeri-intubationPostoperativeRespiratory failure

Identifiers

PMID33201321
PMCPMC7670292
OpenAlexW3098648006

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

and 1 more above

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.