UMEM Educational Pearls

High-Flow Nasal Cannula for Apneic Oxygenation

  • In recent years, much has been written about the use of apneic oxygenation for patients who require endotracheal intubation (ETI).
  • Critically ill patients often have little cardiopulmonary reserve and can rapidly desaturate during ETI.
  • High-flow nasal cannula (HFNC) devices can deliver heated, humidified O2 up to 60 L/min and can provide a modest amount of positive pressure.
  • A recent study evaluated the use of a HFNC device for apneic oxygenation in ICU patients requiring ETI:
    • Prospective, quasi-experimental, before-after study
    • 101 patients in a single ICU in France
    • Compared NRB + nasal cannula to HFNC for preoxygenation/apneic oxygenation
    • Prevelance of severe hypoxemia (SpO2 < 80%) was significantly lower in the HFNC group
  • Clinical Application: Consider using HFNC for apneic oxygenation in critically ill patients with mild-to-moderate hypoxemia who require ETI.


Miguel-Montanes R, et al. Use of high-flow nasal cannula oxygen therapy to prevent desaturation during tracheal intubation of intensive care patients with mild-to-moderate hypoxemia. Crit Care Med 2015;43:574-83.