High-flow oxygen therapy, noninvasive ventilation, invasive mechanical ventilation:

Optimal respiratory care requires optimal technique

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It’s a challenge to keep up with the latest innovations in hospital respiratory care: high-flow oxygen therapy (HFT), noninvasive ventilation (NIV), invasive mechanical ventilation (IMV). While often complementary, these techniques aren’t always interchangeable. Understanding which technique is appropriate and when, can help improve patient care and assist clinical teams for success.

High flow therapy (HFT) delivers:

Appropriate flow demand
Wide range of FiO₂
Small PEEP effect
CO₂ washout
Heated humidification

Noninvasive ventilation (NIV) support delivers:

Appropriate noninvasive ventilatory support
Adjustable IPAP (Pressure Support) levels
Adjustable EPAP (PEEP) levels
Back-up rate
Wide range of FiO₂
Patient monitored parameters and alarms
The same physiological effect as invasive mechanical ventilation

Determine the optimal respiratory technique for optimal care

Managing patients in respiratory failure - from the very mild to the very severe – presents a range of options to consider. Clinicians can utilize them based upon the need for oxygenation support alone, or the need for both oxygenation support and ventilation support. HFT provides a high level of oxygenation support, but only limited and somewhat variable ventilation support. NIV provides both oxygenation support and ventilation support. Other factors such as the patient interface and device performance can be considerations in determining when to use a particular modality, once oxygenation and ventilatory needs are addressed.

Click the respiratory technique below to align with patient severity.

Low flow oxygen therapy
Low flow oxygen therapy

Nasal cannula or non-rebreathing mask, 21-100% O₂, FiO₂ a function of inspiratory flow rate¹
High flow oxygen therapy
High flow oxygen therapy

Nasal cannula, 21-100% O₂ with high flow rates of 40 to 100 L/min, highly humidified, clears dead space, limited and variable PEEP¹
Noninvasive ventilation
Noninvasive ventilation

Face mask, 21 to 100% O₂, PEEP and PS controllable, various modes, monitoring and alarms¹
Invasive mechanical ventilation
Invasive mechanical ventilation

ET tube/trach, 21-100% O₂, PEEP and higher levels of PS available, various modes, monitoring and alarms²
Invasive mechanical ventilation and ECMO
Invasive mechanical ventilation and ECMO

ET tube/trach, 21-100% O₂, higher levels of PEEP and lower levels of tidal volume, monitoring and alarms²

Timely transition of therapies is important - whether escalation or de-escalation of therapy - or providing HFT between NIV sessions. Although the ability to escalate therapy is important, preventing the delay of intubation in patients who need invasive mechanical ventilation requires understanding and recognition of predictors of failure.

In a recent non-inferiority study,

87%

                of patients who were placed on
                NIV after failing on HFT avoided
                intubation.³

In a recent non-inferiority study,

87%

of patients who were placed on NIV after failing on HFT avoided intubation.³

NIV reduced hospital length of stay by more than 3 days. ⁴
NIV reduces hospital mortality by 16%. ⁵
NIV reduces the need for endotracheal intubation by 38%. ⁵

Clinical insights

Are HFOT and NIV complementary for acute respiratory failure?

FJ Belda, MD, PhD

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Providing evidence- based care to patients in need of respiratory support

T Piraino, RRT, FCSRT

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Evidence-based practice for noninvasive ventilation and high flow nasal cannula

T Piraino, RRT, FCSRT

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Webinar: High flow nasal cannula and non-invasive ventilation

T Piraino, RRT, FCSRT

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Succeed in respiratory care: NIV and
high-flow oxygen therapy

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Philips Respironics V60 noninvasive ventilator

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References:

Drake. High-Flow Nasal Cannula Oxygen in Adult: An Evidence-based Assessment. Ann Am Thoracic Society. 2018;15(2): 145-155.
Schmidt, Pellegrino, Combes, Scheinkestel, Cooper, Hodgson. Mechanical ventilation during extracorporeal membrane oxygenation. Critical Care. 2014;18:203.
Piraino. Noninvasive Respiratory Support in Acute Hypoxemic Respiratory Failure. Respir Care 2019;64(6):638 –646.
Non-invasive positive pressure ventilation to treat respiratory failure resulting from exacerbations of chronic obstructive pulmonary disease: Cochrane systematic review and meta-analysis. BMJ 2003; 326 doi: https://doi.org/10.1136/bmj.326.7382.185;
Experiences of noninvasive ventilation in adults with hypercapnic respiratory failure: a review of evidence. Hamadziripi Ngandu, Nichola Gale, Jane B. Hopkinson; European Respiratory Review Dec 2016, 25 (142) 451-471; DOI: 10.1183/16000617.0002-2016

High-flow oxygen therapy, noninvasive ventilation, invasive mechanical ventilation:

Optimal respiratory care requires optimal technique

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High flow therapy (HFT) delivers:

Noninvasive ventilation (NIV) support delivers:

Determine the optimal respiratory technique for optimal care

Click the respiratory technique below to align with patient severity.

In a recent non-inferiority study,

87%

of patients who were placed on NIV after failing on HFT avoided intubation.3

In a recent non-inferiority study,

87%

of patients who were placed on NIV after failing on HFT avoided intubation.3

NIV reduced hospital length of stay by more than 3 days. 4

NIV reduces hospital mortality by 16%. 5

NIV reduces the need for endotracheal intubation by 38%. 5

Clinical insights

FJ Belda, MD, PhD

T Piraino, RRT, FCSRT

T Piraino, RRT, FCSRT

Webinar: High flow nasal cannula and non-invasive ventilation

Contact information

Contact details

Company details

Contact information

Contact details

Company details

Succeed in respiratory care: NIV and high-flow oxygen therapy

Philips Respironics V60 noninvasive ventilator

of patients who were placed on
NIV after failing on HFT avoided
intubation.³

of patients who were placed on NIV after failing on HFT avoided intubation.³

NIV reduced hospital length of stay by more than 3 days. ⁴

NIV reduces hospital mortality by 16%. ⁵

NIV reduces the need for endotracheal intubation by 38%. ⁵

Succeed in respiratory care: NIV and
high-flow oxygen therapy