Jean Damien RicardOriol RocaVirginie LemialeAmanda CorleyJens BraunlichPeter JonesByung Ju KangFrançois LelloucheStefano NavaNuttapol RittayamaiGiulia SpoletiniSamir JaberGonzalo HernandezIAME Infection Antimicrobials Modelling EvolutionCentro de Investigación Biomédica en Red de Enfermedades RespiratoriasInstitut universitaire de cardiologie et de pneumologie de Québec - Université LavalCHU MontpellierThe University of QueenslandAlma Mater Studiorum Università di BolognaComplejo Hospitalario de ToledoSt James's University HospitalHospital Universitari Vall d'HebronUniversity of LeedsAuckland City HospitalFaculty of Medicine, Siriraj Hospital, Mahidol UniversityUniversität LeipzigUniversity of Ulsan, College of MedicineUniversity of AucklandHopital Louis-MourierThe Prince Charles HospitalHôpital Saint-LouisKlinikum Emden2020-12-282020-12-282020-12-01Intensive Care Medicine. Vol.46, No.12 (2020), 2238-224714321238034246422-s2.0-85090430406https://repository.li.mahidol.ac.th/handle/20.500.14594/60548© 2020, Springer-Verlag GmbH Germany, part of Springer Nature. Nasal high flow (NHF) has gained popularity among intensivists to manage patients with acute respiratory failure. An important literature has accompanied this evolution. In this review, an international panel of experts assessed potential benefits of NHF in different areas of acute respiratory failure management. Analyses of the physiological effects of NHF indicate flow-dependent improvement in various respiratory function parameters. These beneficial effects allow some patients with severe acute hypoxemic respiratory failure to avoid intubation and improve their outcome. They require close monitoring to not delay intubation. Such a delay may worsen outcome. The ROX index may help clinicians decide when to intubate. In immunocompromised patients, NHF reduces the need for intubation but does not impact mortality. Beneficial physiological effects of NHF have also been reported in patients with chronic respiratory failure, suggesting a possible indication in acute hypercapnic respiratory failure. When intubation is required, NHF can be used to pre-oxygenate patients either alone or in combination with non-invasive ventilation (NIV). Similarly, NHF reduces reintubation alone in low-risk patients and in combination with NIV in high-risk patients. NHF may be used in the emergency department in patients who would not be offered intubation and can be better tolerated than NIV.Mahidol UniversityMedicineArticleSCOPUS10.1007/s00134-020-06228-7