Management of Hypercapnic Acute Respiratory Failure with High-Flow Nasal Cannula Therapy: A Narrative Review
Abstract
Hypercapnic acute respiratory failure (ARF) is a life-threatning condition and a leading cause of hospital admission, mainly in acute exacerbation of chronic obstructive pulmonary disease (COPD). Although non-invasive ventilation (NIV) currently represents the first-line ventilatory strategy in patients exhibiting hypercapnic ARF, NIV may fail primarily due to worsening of ARF, patient-ventilator asynchrony, interface intolerance, even cardiovascular instability. Consequently, the operating principles and physiological effects of HFNC could be interesting and useful for applying this technique to the management of hypercapnic ARF. Therefore, from a clinical point of view, HFNC could be used alone continuously as an alternative to standard oxygen therapy or NIV, either at the initial phase of hypercapnic ARF or after extubation. In addition, according to the severity and etiology of the underlying hypercapnic ARF, HFNC could also be used in combination with NIV during breaks of spontaneous breathing. In this narrative review, we aimed therefore to provide an updated overview of the physiological rationale and clinical evidence for using HFNC in patients with hypercapnic ARF, with a particular focus on acute exacerbations of COPD.
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BibTeX
@article{girault2026management,
title = {{Management of Hypercapnic Acute Respiratory Failure with High-Flow Nasal Cannula Therapy: A Narrative Review}},
author = {Christophe Girault and Elise Artaud-Macari and Pierre-Louis Declercq and Jean-Pierre Frat and Jean-Damien Ricard and Arnaud W. Thille and Gaëtan Béduneau},
journal = {Annals of Intensive Care},
year = {2026},
month = oct,
doi = {10.1016/j.aicoj.2026.100053},
url = {https://normandie-univ.hal.science/hal-05835205v1},
note = {CC BY},
}
RIS
TY - JOUR
TI - Management of Hypercapnic Acute Respiratory Failure with High-Flow Nasal Cannula Therapy: A Narrative Review
AU - Christophe Girault
AU - Elise Artaud-Macari
AU - Pierre-Louis Declercq
AU - Jean-Pierre Frat
AU - Jean-Damien Ricard
AU - Arnaud W. Thille
AU - Gaëtan Béduneau
PY - 2026
DA - 2026/10/22
JO - Annals of Intensive Care
DO - 10.1016/j.aicoj.2026.100053
UR - https://normandie-univ.hal.science/hal-05835205v1
AB - Hypercapnic acute respiratory failure (ARF) is a life-threatning condition and a leading cause of hospital admission, mainly in acute exacerbation of chronic obstructive pulmonary disease (COPD). Although non-invasive ventilation (NIV) currently represents the first-line ventilatory strategy in patients exhibiting hypercapnic ARF, NIV may fail primarily due to worsening of ARF, patient-ventilator asynchrony, interface intolerance, even cardiovascular instability. Consequently, the operating principles and physiological effects of HFNC could be interesting and useful for applying this technique to the management of hypercapnic ARF. Therefore, from a clinical point of view, HFNC could be used alone continuously as an alternative to standard oxygen therapy or NIV, either at the initial phase of hypercapnic ARF or after extubation. In addition, according to the severity and etiology of the underlying hypercapnic ARF, HFNC could also be used in combination with NIV during breaks of spontaneous breathing. In this narrative review, we aimed therefore to provide an updated overview of the physiological rationale and clinical evidence for using HFNC in patients with hypercapnic ARF, with a particular focus on acute exacerbations of COPD.
SN - 2110-5820
ER -