Oxygen Therapy and Nasal High-Flow Therapy

  • Ipek S. Edipoglu
  • Yalim Dikmen


Oxygen therapy is one of the most common forms of treatment in patients with respiratory distress. The main purpose of oxygen therapy is to increase alveolar oxygen tension and increase oxygen diffusion. This may be achieved by traditional oxygen delivery systems, or by using nasal high flow. In recent years, nasal high flow is gaining popularity in the setting of acute hypoxemic respiratory failure, due to the physiologic benefits of application of heated and humidified gasses with flows approaching 60 L/min. In this chapter, the use of oxygen in elderly patients and at the end of life is discussed.



Acute hypoxemic respiratory failure


Chronic obstructive pulmonary disease


Do not intubate


Fraction of oxygen in the inspired gas


Nasal high-flow therapy


Non-invasive ventilation


Alveolar oxygen partial pressure


Arterial oxygen partial pressure


Saturation of peripheral oxygen


  1. 1.
    Uronis HE, Abernethy AP. Oxygen for relief of dyspnea: what is the evidence? Curr Opin Support Palliat Care. 2008;2(2):89–94.CrossRefGoogle Scholar
  2. 2.
    Baldwin J, Cox J. Treating dyspnea is oxygen therapy the best option for all patients. Med Clin N Am. 2016;100:1123–30.CrossRefGoogle Scholar
  3. 3.
    Cranston JM, Crockett A, Currow D. Oxygen therapy for dyspnoea in adults (Review). Cochrane Database Syst Rev. 2008;(3):CD004769.Google Scholar
  4. 4.
    O’Driscoll BR, et al. BTS guideline for oxygen use in adults in healthcare and emergency settings. Thorax. 2017;72:i1–90.CrossRefGoogle Scholar
  5. 5.
    Philip J, Gold M, Milner A, et al. A randomized, double-blind, crossover trial of the effect of oxygen on dyspnea in patients with advanced cancer. J Pain Symptom Manag. 2006;32:541–50.CrossRefGoogle Scholar
  6. 6.
    Clemens KE, Klaschik E. Symptomatic treatment of dyspnoea in patients receiving palliative care: nasal delivery of oxygen compared with opioid administration. Dtsch Med Wochenschr. 2007;132:1939–43.CrossRefGoogle Scholar
  7. 7.
    Bajwah S, Ross JR, Peacock JL, et al. Interventions to improve symptoms and quality of life of patients with fibrotic interstitial lung disease: a systematic review of the literature. Thorax. 2013;68:867–79.CrossRefGoogle Scholar
  8. 8.
    Currow DC, Agar M, Smith J, et al. Does palliative home oxygen improve dyspnoea? A consecutive cohort study. Palliat Med. 2009;23:309–16.CrossRefGoogle Scholar
  9. 9.
    Galbraith S, Fagan P, Perkins P, et al. Does the use of a handheld fan improve chronic dyspnea? A randomized, controlled, crossover trial. J Pain Symptom Manag. 2010;39(5):831–8.CrossRefGoogle Scholar
  10. 10.
    Booth S, Wade R, Johnson M, et al. The use of oxygen in the palliation of breathlessness. A report of the expert working group of the Scientific Committee of the Association of Palliative Medicine. Respir Med. 2004;98:66–77.CrossRefGoogle Scholar
  11. 11.
    Pisani I, Comellini V, Nava S. Noninvasive ventilation versus oxygen therapy for the treatment of acute respiratory failure. Expert Rev Respir Med. 2016;10(7):813–21.CrossRefGoogle Scholar
  12. 12.
    Nishimura M. High-flow nasal cannula oxygen therapy in adults. J Intensive Care. 2015;3:15.CrossRefGoogle Scholar
  13. 13.
    Corley A, Caruana LR, Barnett AG, et al. Oxygen delivery through high-flow nasal cannulae increase end-expiratory lung volume and reduce respiratory rate in post-cardiac surgical patients. Br J Anaesth. 2011;107(6):998–1004.CrossRefGoogle Scholar
  14. 14.
    Coudroy R, Jamet A, Petua P, et al. High-flow nasal cannula oxygen therapy versus noninvasive ventilation in immunocompromised patients with acute respiratory failure: an observational cohort study. Ann Intensive Care. 2016;6:45. Scholar
  15. 15.
    Frat JP, Brugiere B, Ragot S, et al. Sequential application of oxygen therapy via high-flow nasal cannula and noninvasive ventilation in acute respiratory failure: an observational pilot study. Respir Care. 2015;60(2):170–8.CrossRefGoogle Scholar
  16. 16.
    Roca O, Riera J, Torres F, Masclans JR. High-flow oxygen therapy in acute respiratory failure. Respir Care. 2010;55(4):408–13.Google Scholar
  17. 17.
    Nava S, Ferrer M, Esquinas A, et al. Palliative use of non-invasive ventilation in end-of-life patients with solid tumours: a randomised feasibility trial. Lancet Oncol. 2013;14:219–27.CrossRefGoogle Scholar
  18. 18.
    Peters SG, Holets SR, Gay PC. High-flow nasal cannula therapy in do-not-intubate patients with hypoxemic respiratory distress. Respir Care. 2013;58(4):597–600.PubMedGoogle Scholar
  19. 19.
    Curtis JR, Cook DJ, Sinuff T, et al. Noninvasive positive pressure ventilation in critical and palliative care settings: understanding the goals of therapy. Crit Care Med. 2007;35(3):932–9.CrossRefGoogle Scholar
  20. 20.
    Frat JP, Ragot S, Girault C, et al. Effect of non-invasive oxygenation strategies in immunocompromised patients with severe acute respiratory failure: a post-hoc analysis of a randomised trial. Lancet Respir Med. 2016;4(8):646–52.CrossRefGoogle Scholar
  21. 21.
    Calvano TP, Sill JM, Kemp KR, Chung KK. Use of a high-flow oxygen delivery system in a critically ill patient with dementia. Respir Care. 2008;53(12):1739–43.PubMedPubMedCentralGoogle Scholar
  22. 22.
    Esquinas AM, Dikmen Y. Hyperoxemia in critically mechanical ventilation patients: a factor yet to be fit for intensivists. J Crit Care. 2014;29(1):172. Scholar
  23. 23.
    de Jonge E, Peelen L, Keijzers PJ, Joore H, de Lange D, van der Voort PH, et al. Association between administered oxygen, arterial partial oxygen pressure and mortality in mechanically ventilated intensive care unit patients. Crit Care. 2008;12(6):R156. Scholar
  24. 24.
    Dikmen Y, Onur A. Perioperative hyperoxia: perhaps a malady in disguise. Rom J Anaesth Intensive Care. 2017;24(1):53–6.PubMedPubMedCentralGoogle Scholar
  25. 25.
    Llitjos JF, Mira JP, Duranteau J, Cariou A. Hyperoxia toxicity after cardiac arrest: what is the evidence? Ann Intensive Care. 2016;6(1):23. Epub 2016 Mar 22.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Orbegozo Cortés D, Puflea F, Donadello K, Taccone FS, Gottin L, Creteur J, et al. Normobaric hyperoxia alters the microcirculation in healthy volunteers. Microvasc Res. 2015;98:23–8. Scholar
  27. 27.
    Damiani E, Adrario E, Girardis M, Romano R, Pelaia P, Singer M, Donati A. Arterial hyperoxia and mortality in critically ill patients: a systematic review and meta-analysis. Crit Care. 2014;18(6):711. Scholar
  28. 28.
    Chu DK, Kim LH, Young PJ, Zamiri N, Almenawer SA, Jaeschke R, Szczeklik W, Schünemann HJ, Neary JD, Alhazzani W. Mortality and morbidity in acutely ill adults treated with liberal versus conservative oxygen therapy (IOTA): a systematic review and meta-analysis. Lancet. 2018;391(10131):1693–705. Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Ipek S. Edipoglu
    • 1
  • Yalim Dikmen
    • 2
  1. 1.Department of Anesthesiology and ReanimationUniversity of Health Sciences, Istanbul Training and Research HospitalIstanbulTurkey
  2. 2.Anesthesiology and Reanimation DepartmentCerrahpasa Medical School, Istanbul University-CerrahpasaIstanbulTurkey

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