High-Flow Nasal Cannula Oxygen Therapy in Perioperative Respiratory Care: Application and Prospects

High-flow nasal cannula (HFNC) oxygen therapy is an oxygen delivery technique that provides warmed and humidified high-flow oxygen through a non-sealing nasal cannula. With multiple physiological advantages, HFNC had been increasingly used in perioperative respiratory management. Evidence indicates that HFNC significantly reduces the incidence of hypoxemia and decreases procedural interruptions during procedural sedation. As an updated HFNC technique, transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) had been proved to extend the safe apneic time and promote safety during laryngoscopic examination and endotracheal intubation. In tubeless pharyngeal surgery, it effectively balances the dilemma between a clear surgical field and adequate intraoperative oxygenation. In the postoperative recovery period, HFNC helps to reduce the incidence of postoperative hypoxemia and other postoperative pulmonary complications, and decreases the need for reintubation. HFNC demonstrates broad potential in perioperative respiratory care. However, current evidence is limited by the heterogeneity of oxygen protocols and inconsistent results among studies, especially for high-risk patients. The efficacy of HFNC is difficult to predict, which may lead to intubation delay and limits the application of HFNC. Future research should focus on optimizing clinical application strategies for HFNC, developing reliable efficacy prediction models, and validating these findings through large-sample, multicenter randomized controlled trials to advance perioperative respiratory management toward greater effectiveness and safety.