The use of high-flow nasal cannula in acute decompensated heart failure: ready for prime time yet?

The incidence of heart failure has been rising rapidly. The cornerstone of therapy in acute decompensated heart failure (ADHF) with hypoxemia in the emergency department (ED) includes administration of nitrates, loop diuretics and provision of supplemental oxygen, which can be delivered in various forms depending on severity. High-flow nasal cannula (HFNC) oxygenation has been increasingly used for conditions with type 1 respiratory failure, such as severe pneumonia, and post-extubation in the intensive care unit (ICU). We evaluate the physiology and current evidence behind the use of HFNC oxygenation, and whether it is a viable alternative in the delivery of oxygen in ADHF in the ED, general inpatient ward and ICU.