High-flow nasal cannula oxygen in critically ill adults: do the nose or lungs know there's a difference?

Intra-nasal oxygen was introduced by Arbuthnot Lane in 1907, using rubber nasal catheters. This approach was advocated by Adrian Stokes for use in critically ill victims of phosgene gas warfare during World War I.1 However, placement of rubber catheters into the nasal cavity (and often removal) was quite uncomfortable and required some skill (it makes our eyes water just thinking about the procedure). Nasal catheter use was gradually abandoned and replaced by the minimally invasive nasal cannula, as it was simple to apply and better tolerated. By 1929, Dr Alvan Barach had developed a bifurcated malleable-metal cannula that was held in position by a cloth headband.2 Today’s nasal cannula has evolved to be the most common appliance for oxygen therapy; modern plastics now provide soft intra-nasal prongs. Its low cost and simple technology support administration with minimal training by healthcare providers and patients and their family members. The basic cannula system includes an oxygen flow meter, small-bore connecting tubing attached to either a blind-ended tube with elastic headband or an over-the-ear lariat with under-the-chin adjustment. Permutations of the standard device include: