Tutorial presented by Joe Annandale, Respiratory Nurse Specialist.

High-flow nasal oxygen (HFNO) is a device that is capable of delivering high flows and high concentrations of humidified oxygen, via a nasal cannula to the patient. According to the pathway ‘Management of oxygenation failure on COVID-19 wards’ (attached below), high-flow nasal oxygen should be administered following a trial of CPAP. Importantly, HFNO should only be given to patients who do not tolerate CPAP, not to those who are deteriorating despite optimal CPAP therapy.

The initiation of HFNO should follow the principle of ‘Start high, titrate down’; start the patient on maximal inspired oxygen concentration (usually 95%) and machine flow rates (60L/min) and titrate down the inspired oxygen concentration to achieve target oxygen saturations of 90-94%. Remember this is an AGP so follow appropriate infection control measures.