High flow of oxygen delivered by nasal cannula can avoid the need for intubation and mechanical ventilation in some patients. Certain findings can help to identify a patient for whom high-flow nasal oxygen therapy may be inadequate and who need to be intubated.
Failure of high-flow nasal cannula oxygen therapy indicates the need for invasive mechanical ventilation.
Criteria for failure of high-flow nasal cannula oxygen therapy - one or more of the following:
(1) Glasgow coma scale < 12
(2) cardiac arrest or arrhythmia with severe hemodynamic instability and need for vasopressors (> 0.1 micrograms per kg per min)
(3) persisting or worsening respiratory disease with >= 2 of the following
(3a) PaO2 < 60 mm Hg or SpO2 < 90% AND oxygen flow >= 30 liters per minute and FIO2=1.
(3b) respiratory acidosis (PaCO2 > 50 mm Hg or PvCO2 > 55 mm Hg AND pH < 7.25)
(3c) respiratory rate > 30 breaths per minute
(3d) inability to clear secretions
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