Emergency physicians should be familiar with the benefits and pitfalls of high-flow nasal cannula (HFNC).

HFNC is well tolerated by patients, and its use contributes to superior outcomes for patients with pure hypoxemic respiratory failure.

It may be useful in cardiogenic pulmonary edema and hypercapnic respiratory failure, but noninvasive positive pressure ventilation (NIPPV) should be the first line therapy in those disease processes.

If you are concerned patients will need mechanical ventilation to support them through their illness, do not delay intubation with NIPPV or HFNC.

If the patient’s trajectory is toward intubation, HFNC can facilitate preoxygenation and apneic oxygenation as well or better than standard measures.

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