For first time, the 2020 report of GOLD guidelines have incorporated the High Flow Therapy

For first time, the 2020 report of GOLD guidelines have incorporated the High Flow Therapy in the chapter 5: “Management of exacerbations”. This is a historical fact and it is very important that high flow therapy (HFT) appears to be recognized by an organism such as GOLD. It is a pity that GOLD report mentions “high flow therapy” as “high-flow oxygen”. It has been worldwide recognized that this therapy is more than oxygen therapy (HFT a novel treatment rather a more expensive oxygen device- Eur Respir Rev 2017-; HFT is not an oxygen therapy device-Rev Port Pneumol 2015). Even at the present time HFT it is considered as a ventilatory support system.

GOLD report recommend that in patients with acute hypoxemic respiratory failure, HFT may be an alternative to standard oxygen therapy or noninvasive positive pressure ventilation. And a brief review of HFT is performed. So we can read that in observational studies, HFT has been associated with decreased respiratory rate and effort, decreased work of breathing, improved gas exchange, improved lung volume, dynamic compliance, transpulmonary pressures and homogeneity. All these physiologic benefits might positively improve oxygenation and clinical outcome in ARF patients. According to GOLD, studies to date were performed in COPD patients with very severe underlying disease that required supplemental oxygen; a randomized cross-over trial demonstrated that HFT improved oxygenation and ventilation, and decreased hypercarbia. A systematic review of RCTs in patients with acute hypoxemic respiratory failure suggests that HFT tends to reduce intubation rate, but did not meet statistical significance compared with conventional oxygen therapy or NIV, and had no effect on mortality. GOLD report also has discussed the issue of HFT use in stable hypercapnic COPD patients. In this way, GOLD report mentions that several randomized controlled trials have also studied the use of HFT therapy to reduced hypercapnia and improved health-related quality of life in patients with stable hypercapnic COPD. Finally, the report conclude that there is a need for well-designed, randomized, multicenter trials to study the effects of HFT in both acute and chronic hypoxemic/hypercapnic respiratory failure in COPD patients.

Enthusiasts of high-flow therapy are glad that more and more institutions, scientific societies, and agencies, recognize its value and incorporate it into the protocols and clinical guidelines of action.