Article Text

Download PDFPDF

Evaluation by various methods of the physiological mechanism of a high-flow nasal cannula (HFNC) in healthy volunteers
  1. Miyuki Okuda1,
  2. Nobuya Tanaka1,
  3. Kazuyuki Naito2,
  4. Takao Kumada3,
  5. Koji Fukuda1,
  6. Yuto Kato1,
  7. Yuto Kido1,
  8. Yutaro Okuda4 and
  9. Ryuji Nohara1
  1. 1 Federation of National Public Service Personnel Mutual Aid Association Hirakata Kohsai Hospital, Hirakata, Osaka, Japan
  2. 2 IMI Co., Ltd, Koshigaya, Japan
  3. 3 Chest Company Limited, Tokyo, Japan
  4. 4 Hyogo College of Medicine, Nishinomiya, Japan
  1. Correspondence to Dr Miyuki Okuda; ryoheikunn{at}


Introduction Several reports have described the usefulness of a high-flow nasal cannula (HFNC). However, the physiological mechanisms of this system are unclear. In the current study, various methods were used to investigate the physiological mechanisms of an HFNC in healthy volunteers.

Methods The physiological mechanisms of the constant-flow and constant-pressure models of HFNC were studied in 10 healthy volunteers by the oesophageal balloon method, the electrical impedance method and the forced oscillation technique (FOT).

Results The tidal volume (TV) increased markedly during HFNC (off, 30 L/min, 50 L/min: 685.6±236.5 mL, 929.8±434.7 mL, 968.8±451.1 mL). The end-inspiratory oesophageal pressure (EIOP) was not significantly different, but there was a tendency for it to decrease. HFNC 30 L/min and 50 L/min, the increment in TV and the difference in EIOP showed strong negative correlations (p=0.0025, 0.003). The end-expiratory oesophageal pressure (EEOP) increased. The respiratory system reactance at 5 Hz (X5) by FOT decreased significantly. There was a flow rate-dependent EEOP increase, and the positive end-expiratory pressure (PEEP) effect of HFNC was confirmed. There was a correlation between the difference in X5 and the difference in EEOP during HFNC 30 L/min and 50 L/min, with correlation coefficients of 0.534 and 0.404 (p=0.112, 0.281). The amount of change in EEOP and the fluctuation in X5 were positively correlated.

Conclusions The PEEP effect of HFNC was confirmed by the electrical impedance method and FOT. The increment in TV and the difference in EIOP of HFNC showed strong negative correlations.

  • ambulatory oxygen therapy
  • assisted ventilation
  • COPD exacerbations
  • Non invasive ventilation
  • respiratory measurement

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

View Full Text

Statistics from


  • Contributors MO, NT, FK and RN designed the study and wrote the initial draft of the manuscript. KN, TK, YKa, YKi and YO contributed to analysis and interpretation of data and assisted in the preparation of the manuscript. All other authors have contributed to data collection and interpretation and critically reviewed the manuscript. All authors approved the final version of the manuscript and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval Hirakata Kohsai Hospital Institutional Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.