All Flow, No O’s: High Flow Nasal Room Air!

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Steve Haywood
Steve Haywood
Former Respiratory Therapist working to de-mystify the ventilator through hands-on workshops and online education. Additional interests include HFNC in CHF and COPD, Medical Education, and Tupperware.
Caleb Harrell
Caleb Harrell

Emergency Medicine by day, Critical Care by night. Trained at The University of Tennessee and The University of Florida. Hobbies include hiking, biking, liking, and pyrex portables.

The Pre-brief

When patients present in respiratory distress, we want to help them. However, we must use caution to assure we are not deploying an intervention that may cause harm. We know that hyperoxic states can be harmful. High Flow Nasal Cannula offers benefit in that we can deliver high flows through a nasal cannula but we can also titrate the FiO2 as low as needed; even as low as 21%.

The De-brief

  • The study cited below found that High Flow Nasal Room Air did provide relief to normoxemic patients in respiratory distress. 
  • Patients felt better with High Flow Nasal Room Air than they did with low flow oxygen. 
  • Normoxemic patients do not need supplemental oxygen, but may feel better with High Flow Nasal Room Air

**Editors Commentary**

“I am a big fan of this concept. High Flow Room Air is something that I use on patients with a severe metabolic acidosis and increased work of breathing.” – Dr. Matt Siuba

“A simple fan blowing in the face has been show to provide some relief to patients in respiratory distress. This intervention is an enhanced version .” – Dr. Aman Thind. 

Read more on the potential harms of hyperoxia next week as presented by Dr. Komal Parikh


  1. Hui D, Hernandez F, Urbauer D, Thomas S, Lu Z, Elsayem A, Bruera E. High Flow Oxygen and High Flow Air for Dyspnea in Hospitalized Patients with Cancer: A Pilot Crossover Randomized Clinical Trial. Oncologist. 2020 Dec 1. doi: 10.1002/onco.13622. Epub ahead of print. PMID: 33289276.


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