The use of high-flow nasal oxygen therapy in the management of hypercarbic respiratory failure

Ther Adv Respir Dis. 2014 Apr;8(2):63-4. doi: 10.1177/1753465814521890.


Hypercarbic respiratory failure, occurring secondary to chronic lung disease, is a frequently encountered problem. These patients present a significant challenge to respiratory and critical care services, as many are unsuitable for mechanical ventilation and most have multiple comorbidities. Recently, noninvasive ventilation (NIV) has become established as the primary modality for respiratory support in this group of patients. Several factors limit patient compliance with NIV, not least comfort and tolerability. A recent innovation in adult critical care is the use of high-flow nasal oxygen (HFNO) devices. These systems are capable of delivering high gas flows via nasal cannulae, with the ability to blend air and oxygen to give a controlled FiO2. Few clinical studies have been conducted in adults, although several are planned. To date the majority of available evidence addresses the use of HFNO in hypoxemic respiratory failure. Here we present a case in which a HFNO system was used to successfully manage hypercarbic respiratory failure in a patient unable to tolerate conventional NIV.

Keywords: chronic obstructive pulmonary disease; high-flow nasal oxygen; hypercarbic respiratory failure; noninvasive ventilation; type II respiratory failure.

Publication types

  • Case Reports
  • Letter

MeSH terms

  • Equipment Design
  • Female
  • Humans
  • Hypercapnia / diagnosis
  • Hypercapnia / etiology
  • Hypercapnia / physiopathology
  • Hypercapnia / therapy*
  • Middle Aged
  • Oxygen Inhalation Therapy / instrumentation
  • Oxygen Inhalation Therapy / methods*
  • Pulmonary Disease, Chronic Obstructive / complications
  • Pulmonary Disease, Chronic Obstructive / diagnosis
  • Pulmonary Disease, Chronic Obstructive / physiopathology
  • Pulmonary Disease, Chronic Obstructive / therapy*
  • Respiratory Insufficiency / diagnosis
  • Respiratory Insufficiency / etiology
  • Respiratory Insufficiency / physiopathology
  • Respiratory Insufficiency / therapy*
  • Treatment Outcome