High-flow nasal cannula should be considered a first-line therapy in all patients with hypoxemic respiratory failure not from cardiogenic pulmonary edema and without concomitant hypercapnia. The high flow rate of HFNC offers many advantages over low flow nasal cannula and NRB that include washout of dead space leading to reduction in the work of breathing, better titration of oxygen, heated and humidified gas to promote secretion clearance, and a low level of positive pressure. This therapy may ultimately decrease mortality in patients with pneumonia as compared to NIPPV and low flow oxygen devices. When initiating therapy, start the patient at 30-35 L/min of flow and titrate the flow rate and FiO2to work of breathing and oxygen saturation. Reach for HFNC on your next shift.

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