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HFNC for Hypoxaemic Respiratory Failure — RACP Adult Medicine MCQ

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ModerateRespiratoryHFNC for Hypoxaemic Respiratory FailureRACP Adult Medicine

A 45-year-old woman with pneumonia is hypoxic (SpO₂ 88%) on 6 L nasal cannula. She has no COPD. PaCO₂ is 30 mmHg (appropriate hyperventilation). Respiratory rate is 28/min. She is working hard to breathe but maintaining saturations poorly. What is the most appropriate oxygen delivery device?

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Correct answer: C — High-flow nasal cannula (60 L/min)

HFNC (heated humidified oxygen at 40-60 L/min) is increasingly used for type 1 respiratory failure in pneumonia. The FLORALI trial showed HFNC reduced intubation rates compared to standard oxygen or NIV in de novo hypoxaemic respiratory failure. HFNC generates low-level PEEP, reduces dead space, and matches inspiratory flow demand better than standard masks.

Reference: eTG Respiratory – 2024 – Oxygen Therapy; FLORALI Trial