Epistaxis as a complication of high-flow nasal cannula therapy in adults - Critical Care Science (CCS)

INTRODUCTION

High-flow nasal cannula (HFNC) therapy has emerged as a valuable therapy for adult patients with acute respiratory failure^(,) or to prevent postextubation respiratory failure.^(,) Currently, HFNC therapy is recommended in guidelines on the management of patients with coronavirus 2019 disease (COVID-19).⁽⁾ HFNC therapy delivers humidified and heated gas at a high flow that can exceed the patient’s inspiratory demand of flow, contributing to alleviating breathlessness.⁽⁾ It promotes washout of the nasopharyngeal space, creating a pharyngeal reserve of fresh gas for subsequent inspiration.⁽⁾ These mechanisms result in improved oxygenation and reduced work of breathing.⁽⁾ Clinical complications of HFNC therapy have rarely been reported.⁽⁾ Some studies have described mild complaints, such as feeling too warm, unpleasant smell or thoracic discomfort.⁽⁾ Epistaxis is a rare adverse event associated with HFNC therapy in children.⁽⁾ However, HFNC-related epistaxis in adults has been reported only in one patient under higher than recommended flow (65L/min).⁽⁾ Here, we report 7 cases of epistaxis we observed in a series of 70 adults treated with HFNC therapy.

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