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High Flow Nasal Cannula Use in Patients Outside of the Intensive Care Unit

Pathway Background and Objectives

High flow systems are designed to heat and humidify gas mixtures for safe delivery at flow rates that meet or exceed a patient’s inspiratory flow demands, thereby decreasing work of breathing in the setting of respiratory illness. In addition to the benefits of avoiding more invasive modes of ventilatory support, HFNC therapy has the potential to decrease metabolic demands and facilitate safe enteral nutrition earlier in the disease course.

The objectives of this pathway are to:

  • Define the criteria for initiating HFNC on patients who may be appropriately managed outside of the ICU
  • Outline the management for titration and weaning of respiratory support
  • Review the feeding and monitoring guidelines for this group of patients
  • Identify the circumstances under which a Medical Emergency Team (MET) should be activated


Download HFNC Outside of ICU Pathway Algorithm Updated March 16, 2023

Quality Metrics

  • Duration of HFNC support
  • Percentage of patients with MET activations
  • Percentage of patients requiring transfer to the ICU
  • Hospital length of stay

Educational Module

Download HFNC Outside of ICU Educational Module Updated March 16, 2023

Key References

Pathway Contacts

  • Kathy Kalkbrenner, MD
  • Kara Denz Fluck, PAC
  • Lisa LeBon, RRT
  • Justin Rearick, RRT


The clinical pathways in the above links have been developed specifically for use at Connecticut Children’s and are made available publicly for informational and/or educational purposes only. The clinical pathways are not intended to be, nor are they, a substitute for individualized professional medical judgment, advice, diagnosis, or treatment. Although Connecticut Children’s makes all efforts to ensure the accuracy of the posted content, Connecticut Children’s makes no warranty of any kind as to the accuracy or completeness of the information or its fitness for use at any particular facility or in any individual case.

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