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Naya Prieto A, López Chang C, Carballosa de Miguel MDP, Fernández Ormaechea MI, Zambrano Chacón MDLÁ, Jiménez Hiscock L, Peces-Barba Romero G, Rodríguez Nieto MJ, Heili Frades SB. High-Flow Oxygen: Respiratory Mechanics in Lung Alveoli of Patients After Acute Respiratory Failure. OPEN RESPIRATORY ARCHIVES 2024; 6:100335. [PMID: 38974018 PMCID: PMC11225900 DOI: 10.1016/j.opresp.2024.100335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/09/2024] Open
Affiliation(s)
- Alba Naya Prieto
- Intermediate Respiratory Care Unit, Pulmonology Department, Fundación Jiménez Díaz University Hospital, Madrid, Spain
- CIBERES, Comunidad de Madrid, Madrid, Spain
- Instituto de Investigación Sanitaria de la Fundación Jiménez Díaz (IIS_FJD), Madrid, Spain
- Réseau Européen en Ventilation Artificialle, REVA Network, Spain
| | - Carlos López Chang
- Intermediate Respiratory Care Unit, Pulmonology Department, Fundación Jiménez Díaz University Hospital, Madrid, Spain
| | - María del Pilar Carballosa de Miguel
- Intermediate Respiratory Care Unit, Pulmonology Department, Fundación Jiménez Díaz University Hospital, Madrid, Spain
- CIBERES, Comunidad de Madrid, Madrid, Spain
- Instituto de Investigación Sanitaria de la Fundación Jiménez Díaz (IIS_FJD), Madrid, Spain
- Réseau Européen en Ventilation Artificialle, REVA Network, Spain
| | - Miren Itziar Fernández Ormaechea
- Intermediate Respiratory Care Unit, Pulmonology Department, Fundación Jiménez Díaz University Hospital, Madrid, Spain
- CIBERES, Comunidad de Madrid, Madrid, Spain
- Instituto de Investigación Sanitaria de la Fundación Jiménez Díaz (IIS_FJD), Madrid, Spain
- Réseau Européen en Ventilation Artificialle, REVA Network, Spain
| | | | - Luis Jiménez Hiscock
- Thoracic Surgery Department, Sanchinarro University Hospital, HM Hospitals Group, Madrid, Spain
| | - Germán Peces-Barba Romero
- Intermediate Respiratory Care Unit, Pulmonology Department, Fundación Jiménez Díaz University Hospital, Madrid, Spain
- CIBERES, Comunidad de Madrid, Madrid, Spain
- Instituto de Investigación Sanitaria de la Fundación Jiménez Díaz (IIS_FJD), Madrid, Spain
- Réseau Européen en Ventilation Artificialle, REVA Network, Spain
| | - María Jesús Rodríguez Nieto
- Intermediate Respiratory Care Unit, Pulmonology Department, Fundación Jiménez Díaz University Hospital, Madrid, Spain
- CIBERES, Comunidad de Madrid, Madrid, Spain
- Instituto de Investigación Sanitaria de la Fundación Jiménez Díaz (IIS_FJD), Madrid, Spain
| | - Sarah Beatriz Heili Frades
- Intermediate Respiratory Care Unit, Pulmonology Department, Fundación Jiménez Díaz University Hospital, Madrid, Spain
- CIBERES, Comunidad de Madrid, Madrid, Spain
- Instituto de Investigación Sanitaria de la Fundación Jiménez Díaz (IIS_FJD), Madrid, Spain
- Réseau Européen en Ventilation Artificialle, REVA Network, Spain
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Colaianni-Alfonso N, Castro I, Cáceres V, Montiel G, Maggiore SM, Vetrugno L. Effect of high-flow nasal cannula at different flow rates on diaphragmatic function in subjects recovering from an acute exacerbation of COPD: a physiological prospective pilot study. JOURNAL OF ANESTHESIA, ANALGESIA AND CRITICAL CARE 2024; 4:37. [PMID: 38915126 PMCID: PMC11197175 DOI: 10.1186/s44158-024-00173-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 06/17/2024] [Indexed: 06/26/2024]
Abstract
BACKGROUND Noninvasive ventilation (NIV) is widely employed as the initial treatment for patients with chronic acute exacerbation of obstructive pulmonary disease (AECOPD). Nevertheless, high-flow nasal cannula (HFNC) has been increasingly utilized and investigated to mitigate the issues associated with NIV. Flow rate may play a significant role in diaphragmatic function among subjects recovering from AECOPD. Based on these observations, we conducted a physiological study to assess the impact of HFNC therapy on diaphragmatic function, as measured by US, respiratory rate (RR), gas exchange, and patient comfort at various flow rates. METHODS A prospective physiological pilot study enrolled subjects with a diagnosis of AECOPD who required NIV for more than 24 h. After stabilization, these subjects underwent a 30-min trial using NIV and HFNC at different sequential flow rates (30-60 L/min). At the end of each trial, diaphragmatic displacement (DD, cm) and diaphragmatic thickness fraction (DTF, %) were measured using ultrasound. Additionally, other physiological variables, such as RR, gas exchange, and patient comfort, were recorded. RESULTS A total of 20 patients were included in the study. DD was no different among trials (p = 0.753). DTF (%) was significantly lower with HFNC-30 L/min compared to HFNC-50 and 60 L/min (p < 0.001 for all comparisons). No significant differences were found in arterial pH and PaCO2 at discontinuation of NIV and at the end of HFNC trials (p > 0.050). During HFNC trials, RR remained unchanged without statistically significant differences (p = 0.611). However, we observed that HFNC improved comfort compared to NIV (p < 0.001 for all comparisons). Interestingly, HFNC at 30 and 40 L/min showed greater comfort during trials. CONCLUSIONS In subjects recovering from AECOPD and receiving HFNC, flows above 40 L/min may not offer additional benefits in terms of comfort and decreased respiratory effort. HFNC could be a suitable alternative to COT during breaks off NIV.
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Affiliation(s)
- Nicolás Colaianni-Alfonso
- Respiratory Intermediate Care Unit, Hospital Juan A. Fernández, Ciudad Autónoma de Buenos Aires, Buenos Aires, C1425, Argentina.
| | - Iván Castro
- Respiratory Intermediate Care Unit, Hospital Juan A. Fernández, Ciudad Autónoma de Buenos Aires, Buenos Aires, C1425, Argentina
| | - Vanesa Cáceres
- Respiratory Intermediate Care Unit, Hospital Juan A. Fernández, Ciudad Autónoma de Buenos Aires, Buenos Aires, C1425, Argentina
| | - Guillermo Montiel
- Respiratory Intermediate Care Unit, Hospital Juan A. Fernández, Ciudad Autónoma de Buenos Aires, Buenos Aires, C1425, Argentina
| | - Salvatore Maurizio Maggiore
- Department of Anesthesiology, Critical Care Medicine and Emergency, Department of Innovative Technologies in Medicine and Dentistry, "G. d'Annunzio" University Chieti-Pescara, Chieti, Italy
| | - Luigi Vetrugno
- Department of Medical, Oral and Biotechnological Sciences, University of G. d' Annunzio, Chieti-Pescara, Italy
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Dartencet C, Abunemeh M, Junot S, Nectoux A, Allaouchiche B, Krafft E, Pouzot-Nevoret C. High flow oxygen therapy versus conventional oxygen therapy in dogs and cats undergoing bronchoscopy and bronchoalveolar lavage: a pilot study. Front Vet Sci 2024; 11:1360017. [PMID: 38855409 PMCID: PMC11157099 DOI: 10.3389/fvets.2024.1360017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 05/13/2024] [Indexed: 06/11/2024] Open
Abstract
Objectives To evaluate the safety and feasibility of high flow oxygen therapy (HFOT), and to record SpO2 and desaturation episodes in dogs and cats receiving HFOT or conventional oxygen therapy (COT) during bronchoscopy ± bronchoalveolar lavage (BAL). Materials and methods Dogs and cats undergoing bronchoscopy ± BAL between January and May 2023 were included in the study. Patients were randomly allocated to two groups: HFOT (HFOT group; two cats and four dogs) and COT (COT group; one cat and five dogs). HFOT and COT were started at the beginning of the bronchoscopy. HFOT was delivered with a gas flow rate of 1 L/kg/min at an FiO2 of 100% and a temperature of 34°C (pediatric mode) or 37°C (adult mode). COT was delivered through the working channel of the bronchoscope at a rate of 1.5 L/min. The safety and feasibility of HFOT were assessed, and peripheral oxygen saturation (SpO2) was measured by pulse oximetry every 30 s throughout the procedure. Measurements and main results HFOT was feasible and safe in both dogs and cats with no complications reported. While there was no significant difference in the number of desaturation episodes (SpO2 < 94%) between the two groups, none of the patients in the HFOT group experienced severe desaturation (SpO2 < 90%). In contrast, two patients in the COT group had an SpO2 < 90%. Mean SpO2 was significantly higher in the HFOT group compared to the COT group at T0 (98% ± 2% vs. 94 ± 2%), T0.5 (98% ± 2% vs. 94% ± 3%) and T1 (98% ± 2% vs. 94% ± 4%). Conclusion To the authors' knowledge, this is the largest study conducted to date using HFOT during bronchoscopy in dogs and cats. Our results suggest that HFOT is feasible and safe during bronchoscopy ± BAL. Furthermore, HFOT may reduce the risk of desaturation episodes in dogs and cats undergoing bronchoscopy and BAL.
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Affiliation(s)
- Camille Dartencet
- Intensive Care Unit (SIAMU), Université de Lyon, VetAgro Sup, Marcy l'Etoile, France
- APCSe, Université de Lyon, VetAgro Sup, Marcy l'Étoile, France
| | - Maha Abunemeh
- Department of Veterinary Anesthesia and Analgesia, Université de Lyon, VetAgro Sup, Marcy l'Étoile, France
| | - Stephane Junot
- APCSe, Université de Lyon, VetAgro Sup, Marcy l'Étoile, France
- Department of Veterinary Anesthesia and Analgesia, Université de Lyon, VetAgro Sup, Marcy l'Étoile, France
| | - Alexandra Nectoux
- Intensive Care Unit (SIAMU), Université de Lyon, VetAgro Sup, Marcy l'Etoile, France
- APCSe, Université de Lyon, VetAgro Sup, Marcy l'Étoile, France
| | - Bernard Allaouchiche
- APCSe, Université de Lyon, VetAgro Sup, Marcy l'Étoile, France
- Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Service de Réanimation, Pierre-Bénite, France
| | - Emilie Krafft
- Small animal medicine, USC1233 RS2GP, INRAe, Université de Lyon, VetAgro Sup, Marcy l'Étoile, France
| | - Celine Pouzot-Nevoret
- Intensive Care Unit (SIAMU), Université de Lyon, VetAgro Sup, Marcy l'Etoile, France
- APCSe, Université de Lyon, VetAgro Sup, Marcy l'Étoile, France
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Kuitunen I, Salmi H, Wärnhjelm E, Näse-Ståhlhammar S, Kiviranta P. High-flow nasal cannula use in pediatric patients for other indications than acute bronchiolitis-a scoping review of randomized controlled trials. Eur J Pediatr 2024; 183:863-874. [PMID: 37962672 PMCID: PMC10912153 DOI: 10.1007/s00431-023-05234-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 09/06/2023] [Accepted: 09/19/2023] [Indexed: 11/15/2023]
Abstract
The objective of the study is to summarize current literature on high-flow nasal cannula (HFNC) use for different indications in pediatric patient excluding acute bronchiolitis and neonatal care. The study design is a systematic scoping review. Pubmed, Scopus, and Web of Science databases were searched in February, 2023. All abstracts and full texts were screened by two independent reviewers. Randomized controlled trials focusing on HFNC use in pediatric patients (age < 18 years) were included. Studies focusing on acute bronchiolitis and neonatal respiratory conditions were excluded. Study quality was assessed by Cochrane risk of bias 2.0 tool. The main outcomes are patient groups and indications, key outcomes, and risk of bias. After screening 1276 abstracts, we included 22 full reports. Risk of bias was low in 11 and high in 5 studies. We identified three patient groups where HFNC has been studied: first, children requiring primary respiratory support for acute respiratory failure; second, perioperative use for either intraprocedural oxygenation or postoperative respiratory support; and third, post-extubation care in pediatric intensive care for other than postoperative patients. Clinical and laboratory parameters were assessed as key outcomes. None of the studies analyzed cost-effectiveness.Conclusion: This systematic scoping review provides an overview of current evidence for HFNC use in pediatric patients. Future studies should aim for better quality and include economic evaluation with cost-effectiveness analysis.Protocol registration: Protocol has been published https://osf.io/a3y46/ .
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Affiliation(s)
- Ilari Kuitunen
- Institute of Clinical Medicine and Department of Pediatrics, University of Eastern Finland, Puijonlaaksontie 2, 70210, Kuopio, Finland.
- Department of Pediatrics, Kuopio University Hospital, Kuopio, Finland.
| | - Heli Salmi
- Department of Pediatrics, Helsinki Childrens Hospital, Helsinki, Finland
| | - Elina Wärnhjelm
- Department of Anesthesiology, Helsinki Childrens Hospital, Helsinki, Finland
| | | | - Panu Kiviranta
- Institute of Clinical Medicine and Department of Pediatrics, University of Eastern Finland, Puijonlaaksontie 2, 70210, Kuopio, Finland
- Finnish Medical Society Duodecim, Helsinki, Finland
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Nagata K, Yokoyama T, Tsugitomi R, Nakashima H, Kuraishi H, Ohshimo S, Mori Y, Sakuraya M, Kagami R, Tanigawa M, Tobino K, Kamo T, Kadowaki T, Koga Y, Ogata Y, Nishimura N, Kondoh Y, Taniuchi S, Shintani A, Tomii K. Continuous positive airway pressure versus high-flow nasal cannula oxygen therapy for acute hypoxemic respiratory failure: A randomized controlled trial. Respirology 2024; 29:36-45. [PMID: 37648252 DOI: 10.1111/resp.14588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 08/16/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND AND OBJECTIVE The relative effectiveness of initial non-invasive respiratory strategies for acute respiratory failure using continuous positive airway pressure (CPAP) or high-flow nasal cannula (HFNC) is unclear. METHODS We conducted a multicenter, open-label, parallel-group randomized controlled trial to compare the efficacy of CPAP and HFNC on reducing the risk of meeting the prespecified criteria for intubation and improving clinical outcomes of acute hypoxemic respiratory failure. The primary endpoint was the time taken to meet the prespecified criteria for intubation within 28 days. RESULTS Eighty-five patients were randomly assigned to the CPAP or HFNC group. Eleven (28.9%) in the CPAP group and twenty (42.6%) in the HFNC group met the criteria for intubation within 28 days. Compared with HFNC, CPAP reduced the risk of meeting the intubation criteria (hazard ratio [HR], 0.327; 95% CI, 0.148-0.724; p = 0.006). There were no significant between-group differences in the intubation rates, in-hospital and 28-day mortality rates, ventilator-free days, duration of the need for respiratory support, or duration of hospitalization for respiratory illness. Pulmonary oxygenation was significantly better in the CPAP group, with significantly lower pH and higher partial pressure of carbon dioxide, but there were no differences in the respiratory rate between groups. CPAP and HFNC were associated with few possibly causal adverse events. CONCLUSION CPAP is more effective than HFNC at reducing the risk of meeting the intubation criteria in patients with acute hypoxemic respiratory failure.
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Affiliation(s)
- Kazuma Nagata
- Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
| | - Toshiki Yokoyama
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto, Aichi, Japan
| | - Ryosuke Tsugitomi
- Department of Pulmonary Medicine, Thoracic Center, St. Luke's International Hospital, Chuo City, Tokyo, Japan
| | - Harunori Nakashima
- Department of Respiratory Medicine, Ogaki Municipal Hospital, Ogaki, Gifu, Japan
| | - Hiroshi Kuraishi
- Department of Pulmonary Medicine, Nagano Red Cross Hospital, Nagano, Nagano, Japan
| | - Shinichiro Ohshimo
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Hiroshima, Japan
| | - Yoshihiro Mori
- Department of Respiratory Medicine, KKR Takamatsu Hospital, Takamatsu, Kagawa, Japan
| | - Masaaki Sakuraya
- Department of Emergency and Intensive Care Medicine, JA Hiroshima General Hospital, Hiroshima, Hiroshima, Japan
| | - Ryogo Kagami
- Department of Pulmonary Medicine, National Hospital Organization Himeji Medical Center, Himeji, Hyogo, Japan
| | - Motoaki Tanigawa
- Department of Respiratory Medicine, Japanese Red Cross Ise Hospital, Ise, Mie, Japan
| | - Kazunori Tobino
- Department of Respiratory Medicine, Iizuka Hospital, Iizuka, Fukuoka, Japan
| | - Tetsuro Kamo
- Department of Respiratory Medicine, Saiseikai Utsunomiya Hospital, Utsunomiya, Tochigi, Japan
| | - Toru Kadowaki
- Department of Pulmonary Medicine, National Hospital Organization Matsue Medical Center, Matsue, Shimane, Japan
| | - Yasutaka Koga
- Advanced Medical Emergency and Critical Care Center, Yamaguchi University Hospital, Ube, Yamaguchi, Japan
| | - Yoshitaka Ogata
- Department of Critical Care Medicine, Yao Tokushukai General Hospital, Yao, Osaka, Japan
| | - Naoki Nishimura
- Department of Pulmonary Medicine, Thoracic Center, St. Luke's International Hospital, Chuo City, Tokyo, Japan
| | - Yasuhiro Kondoh
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto, Aichi, Japan
| | - Satsuki Taniuchi
- Department of Medical Statistics, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Osaka, Japan
| | - Ayumi Shintani
- Department of Medical Statistics, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Osaka, Japan
| | - Keisuke Tomii
- Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
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Mosier JM, Subbian V, Pungitore S, Prabhudesai D, Essay P, Bedrick EJ, Stocking JC, Fisher JM. Noninvasive vs Invasive Respiratory Support for Patients with Acute Hypoxemic Respiratory Failure. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.12.23.23300368. [PMID: 38234784 PMCID: PMC10793521 DOI: 10.1101/2023.12.23.23300368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
Rationale Noninvasive respiratory support modalities are common alternatives to mechanical ventilation for patients with early acute hypoxemic respiratory failure. These modalities include noninvasive positive pressure ventilation, using either continuous or bilevel positive airway pressure, and nasal high flow using a high flow nasal cannula system. However, outcomes data historically compare noninvasive respiratory support to conventional oxygen rather than to mechanical ventilation. Objectives The goal of this study was to compare the outcomes of in-hospital death and alive discharge in patients with acute hypoxemic respiratory failure when treated initially with noninvasive respiratory support compared to patients treated initially with invasive mechanical ventilation. Methods We used a validated phenotyping algorithm to classify all patients with eligible International Classification of Diseases codes at a large healthcare network between January 1, 2018 and December 31, 2019 into noninvasive respiratory support and invasive mechanical ventilation cohorts. The primary outcome was time-to-in-hospital death analyzed using an inverse probability of treatment weighted Cox model adjusted for potential confounders, with estimated cumulative incidence curves. Secondary outcomes included time-to-hospital discharge alive. A secondary analysis was conducted to examine potential differences between noninvasive positive pressure ventilation and nasal high flow. Results During the study period, 3177 patients met inclusion criteria (40% invasive mechanical ventilation, 60% noninvasive respiratory support). Initial noninvasive respiratory support was not associated with a decreased hazard of in-hospital death (HR: 0.65, 95% CI: 0.35 - 1.2), but was associated with an increased hazard of discharge alive (HR: 2.26, 95% CI: 1.92 - 2.67). In-hospital death varied between the nasal high flow (HR 3.27, 95% CI: 1.43 - 7.45) and noninvasive positive pressure ventilation (HR 0.52, 95% CI 0.25 - 1.07), but both were associated with increased likelihood of discharge alive (nasal high flow HR 2.12, 95 CI: 1.25 - 3.57; noninvasive positive pressure ventilation HR 2.29, 95% CI: 1.92 - 2.74). Conclusion These observational data from a large healthcare network show that noninvasive respiratory support is not associated with reduced hazards of in-hospital death but is associated with hospital discharge alive. There are also potential differences between the noninvasive respiratory support modalities.
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Haudebourg AF, Maraffi T, Tuffet S, Le Corvoisier P, Mekontso Dessap A, Carteaux G. Influence of different noninvasive oxygenation support devices on tidal volume. Ann Intensive Care 2023; 13:116. [PMID: 38006434 PMCID: PMC10676331 DOI: 10.1186/s13613-023-01200-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 09/30/2023] [Indexed: 11/27/2023] Open
Abstract
BACKGROUND Multiple devices are available for noninvasive oxygenation support, including non-rebreather oxygen mask (O2-mask), high-flow oxygen through nasal cannula (HFNC), continuous positive airway pressure (CPAP), mask noninvasive ventilation (Mask-NIV) and helmet NIV (Helmet-NIV). As tidal volume is a key determinant of efficacy and safety during ventilatory support, we assessed whether it was influenced by the type of noninvasive oxygenation device. METHODS A bench study using a manikin with a realistic face connected to a lung simulator was performed. Six conditions were assessed: no device, O2-mask, HFNC, CPAP, Mask-NIV and Helmet-NIV. Three respiratory mechanics were simulated (normal, obstructive, restrictive), at three simulated efforts (low, moderate, respiratory distress). Flow was recorded at the lung simulator inlet and mouth pressure into the manikin mouth. The same devices were evaluated on healthy volunteers with tidal volume assessed by electrical impedance tomography (EIT). RESULTS Tidal volume was significantly influenced by oxygenation devices in bench model. As compared to O2-mask, HFNC and CPAP delivered significantly lower tidal volumes (440 ± 352 mL, 414 ± 333 mL and 377 ± 297 mL, respectively), while Mask-NIV or Helmet-NIV were associated with significantly higher tidal volumes (690 ± 321 mL and 652 ± 366 mL, respectively). Tidal volume was strongly correlated with the specific effect of each device on mouth pressure during inspiration: HFNC and CPAP were characterized by a negative PTPmouth (- 0.3 [- 0.8 to - 0.2] and - 0.7 [- 2.2 to - 0.5] cmH2O.sec/cycle, respectively), while Helmet-NIV and Mask-NIV were associated with a positive PTPmouth (4.5 [4.1-4.6] and 6.1 [5.9-7.1] cmH2O.sec/cycle, respectively). Tidal volume was also significantly influenced by oxygenation devices in healthy volunteers, with similar tidal volumes between O2-mask and CPAP (644 [571-764] and 648 [586-770] mL) but higher with HFNC, Mask-NIV and Helmet-NIV (819 [609-918], 1110 [661-1305] and 1086 [833-1243] mL). CONCLUSIONS Tidal volume is significantly influenced by noninvasive oxygenation support devices, with a strong correlation with the pressure variation generated into the mouth during inspiration. NIV was associated with the highest tidal volumes and CPAP with the lowest ones. Clinical studies are needed to clarify the clinical implications of these effects.
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Affiliation(s)
- Anne-Fleur Haudebourg
- Service de Médecine Intensive Réanimation, Assistance Publique-Hôpitaux de Paris, CHU Henri Mondor - Albert Chenevier, 51, Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil Cedex, France.
- Faculté de Santé, Groupe de Recherche Clinique CARMAS, Université Paris Est-Créteil, 94010, Créteil, France.
| | - Tommaso Maraffi
- Service de Réanimation Adultes Et Surveillance Continue, Centre Hospitalier Intercommunal Créteil, 40, Avenue de Verdun, 94000, Créteil, France
| | - Samuel Tuffet
- Service de Médecine Intensive Réanimation, Assistance Publique-Hôpitaux de Paris, CHU Henri Mondor - Albert Chenevier, 51, Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil Cedex, France
- Faculté de Santé, Groupe de Recherche Clinique CARMAS, Université Paris Est-Créteil, 94010, Créteil, France
| | - Philippe Le Corvoisier
- Centre d'Investigation Clinique 1430, Assistance Publique-Hôpitaux de Paris, CHU Henri Mondor - Albert Chenevier, 51, Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil Cedex, France
| | - Armand Mekontso Dessap
- Service de Médecine Intensive Réanimation, Assistance Publique-Hôpitaux de Paris, CHU Henri Mondor - Albert Chenevier, 51, Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil Cedex, France
- Faculté de Santé, Groupe de Recherche Clinique CARMAS, Université Paris Est-Créteil, 94010, Créteil, France
- INSERM U955, Institut Mondor de Recherche Biomédicale, 94010, Créteil, France
| | - Guillaume Carteaux
- Service de Médecine Intensive Réanimation, Assistance Publique-Hôpitaux de Paris, CHU Henri Mondor - Albert Chenevier, 51, Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil Cedex, France
- Faculté de Santé, Groupe de Recherche Clinique CARMAS, Université Paris Est-Créteil, 94010, Créteil, France
- INSERM U955, Institut Mondor de Recherche Biomédicale, 94010, Créteil, France
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Gur I, Zalts R, Dotan Y, Hussain K, Neuberger A, Fuchs E. Combining reservoir mask oxygenation with high-flow nasal cannula in the treatment of hypoxemic respiratory failure among patients with COVID-19 pneumonia: a retrospective cohort study. Acute Crit Care 2023; 38:435-441. [PMID: 37994019 DOI: 10.4266/acc.2023.00451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 08/01/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND Concerns regarding positive-pressure-ventilation for the treatment of coronavirus disease 2019 (COVID-19) hypoxemia led the search for alternative oxygenation techniques. This study aimed to assess one such method, dual oxygenation, i.e., the addition of a reservoir mask (RM) on top of a high-flow nasal cannula (HFNC). METHODS In this retrospective cohort study, the records of all patients hospitalized with COVID-19 during 2020-2022 were reviewed. Patients over the age of 18 years with hypoxemia necessitating HFNC were included. Exclusion criteria were positive-pressure-ventilation for any indication other than hypoxemic respiratory failure, transfer to another facility while still on HFNC and "do-not-intubate/resuscitate" orders. The primary outcome was mortality within 30 days from the first application of HFNC. Secondary outcomes were intubation and admission to the intensive care unit. RESULTS Of 659 patients included in the final analysis, 316 were treated with dual oxygenation and 343 with HFNC alone. Propensity for treatment was estimated based on background diagnoses, laboratories and vital signs upon admission, gender and glucocorticoid dose. Inverse probability of treatment weighted regression including age, body mass index, Sequential Organ Failure Assessment (SOFA) score and respiratory rate oxygenation index showed treatment with dual oxygenation to be associated with lower 30-day mortality (adjusted hazard ratio, 0.615; 95% confidence interval, 0.469-0.809). Differences in the secondary outcomes did not reach statistical significance. CONCLUSIONS Our study suggests that the addition of RM on top of HFNC may be associated with decreased mortality in patients with severe COVID-19 hypoxemia.
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Affiliation(s)
- Ivan Gur
- Department of Internal Medicine, Rambam Medical Center, Haifa, Israel
| | - Ronen Zalts
- Department of Internal Medicine, Rambam Medical Center, Haifa, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - Yaniv Dotan
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - Khitam Hussain
- Department of Internal Medicine, Rambam Medical Center, Haifa, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - Ami Neuberger
- Department of Internal Medicine, Rambam Medical Center, Haifa, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - Eyal Fuchs
- Department of Internal Medicine, Rambam Medical Center, Haifa, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
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Slobod D, Spinelli E, Crotti S, Lissoni A, Galazzi A, Grasselli G, Mauri T. Effects of an asymmetrical high flow nasal cannula interface in hypoxemic patients. Crit Care 2023; 27:145. [PMID: 37072854 PMCID: PMC10111067 DOI: 10.1186/s13054-023-04441-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 04/12/2023] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND Optimal noninvasive respiratory support for patients with hypoxemic respiratory failure should minimize work of breathing without increasing the transpulmonary pressure. Recently, an asymmetrical high flow nasal cannula (HFNC) interface (Duet, Fisher & Paykel Healthcare Ltd), in which the caliber of each nasal prong is different, was approved for clinical use. This system might reduce work of breathing by lowering minute ventilation and improving respiratory mechanics. METHODS We enrolled 10 patients ≥ 18 years of age who were admitted to the Ospedale Maggiore Policlinico ICU in Milan, Italy, and had a PaO2/FiO2 < 300 mmHg during HFNC support with a conventional cannula. We investigated whether the asymmetrical interface, compared to a conventional high flow nasal cannula, reduces minute ventilation and work of breathing. Each patient underwent support with the asymmetrical interface and the conventional interface, applied in a randomized sequence. Each interface was provided at a flow rate of 40 l/min followed by 60 l/min. Patients were continuously monitored with esophageal manometry and electrical impedance tomography. RESULTS Application of the asymmetrical interface resulted in a -13.5 [-19.4 to (-4.5)] % change in minute ventilation at a flow rate of 40 l/min, p = 0.006 and a -19.6 [-28.0 to (-7.5)] % change at 60 l/min, p = 0.002, that occurred despite no change in PaCO2 (35 [33-42] versus 35 [33-43] mmHg at 40 l/min and 35 [32-41] versus 36 [32-43] mmHg at 60 l/min). Correspondingly, the asymmetrical interface lowered the inspiratory esophageal pressure-time product from 163 [118-210] to 140 [84-159] (cmH2O*s)/min at a flow rate of 40 l/min, p = 0.02 and from 142 [123-178] to 117 [90-137] (cmH2O*s)/min at a flow rate of 60 l/min, p = 0.04. The asymmetrical cannula did not have any impact on oxygenation, the dorsal fraction of ventilation, dynamic lung compliance, or end-expiratory lung impedance, suggesting no major effect on PEEP, lung mechanics, or alveolar recruitment. CONCLUSIONS An asymmetrical HFNC interface reduces minute ventilation and work of breathing in patients with mild-to-moderate hypoxemic respiratory failure supported with a conventional interface. This appears to be primarily driven by increased ventilatory efficiency due to enhanced CO2 clearance from the upper airway.
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Affiliation(s)
- Douglas Slobod
- Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy
- Department of Critical Care Medicine, McGill University, Montreal, Canada
| | - Elena Spinelli
- Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy
| | - Stefania Crotti
- Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy
| | - Alfredo Lissoni
- Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy
| | - Alessandro Galazzi
- Department of Healthcare Professions, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giacomo Grasselli
- Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Tommaso Mauri
- Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy.
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
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Vega Pittao ML, Schifino G, Pisani L, Nava S. Home High-Flow Therapy in Patients with Chronic Respiratory Diseases: Physiological Rationale and Clinical Results. J Clin Med 2023; 12:jcm12072663. [PMID: 37048745 PMCID: PMC10094854 DOI: 10.3390/jcm12072663] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 03/30/2023] [Accepted: 03/31/2023] [Indexed: 04/05/2023] Open
Abstract
High-flow therapy (HFT) is the administration of gas flows above 15 L/min. It is a non-invasive respiratory support that delivers heated (up to 38 °C), humidified (100% Relative Humidity, RH; 44 mg H2O/L Absolute Humidity, AH), oxygen-enriched air when necessary, through a nasal cannula or a tracheostomy interface. Over the last few years, the use of HFT in critically ill hypoxemic adults has increased. Although the clinical benefit of home high-flow therapy (HHFT) remains unclear, some research findings would support the use of HHFT in chronic respiratory diseases. The aim of this review is to describe the HFT physiological principles and summarize the published clinical findings. Finally, we will discuss the differences between hospital and home implementation, as well as the various devices available for HHFT application.
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Affiliation(s)
- Maria Laura Vega Pittao
- Alma Mater Studiorum, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40138 Bologna, Italy
- Respiratory and Critical Care Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, 40138 Bologna, Italy
| | - Gioacchino Schifino
- Alma Mater Studiorum, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40138 Bologna, Italy
- Respiratory and Critical Care Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, 40138 Bologna, Italy
| | - Lara Pisani
- Alma Mater Studiorum, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40138 Bologna, Italy
- Respiratory and Critical Care Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, 40138 Bologna, Italy
| | - Stefano Nava
- Alma Mater Studiorum, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40138 Bologna, Italy
- Respiratory and Critical Care Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, 40138 Bologna, Italy
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11
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Li J, Albuainain FA, Tan W, Scott JB, Roca O, Mauri T. The effects of flow settings during high-flow nasal cannula support for adult subjects: a systematic review. Crit Care 2023; 27:78. [PMID: 36855198 PMCID: PMC9974062 DOI: 10.1186/s13054-023-04361-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 02/15/2023] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND During high-flow nasal cannula (HFNC) therapy, flow plays a crucial role in the physiological effects. However, there is no consensus on the initial flow settings and subsequent titration. Thus, we aimed to systematically synthesize the effects of flows during HFNC treatment. METHODS In this systematic review, two investigators independently searched PubMed, Embase, Web of Science, Scopus, and Cochrane for in vitro and in vivo studies investigating the effects of flows in HFNC treatment published in English before July 10, 2022. We excluded studies that investigated the pediatric population (< 18 years) or used only one flow. Two investigators independently extracted the data and assessed the risk of bias. The study protocol was prospectively registered with PROSPERO, CRD42022345419. RESULTS In total, 32,543 studies were identified, and 44 were included. In vitro studies evaluated the effects of flow settings on the fraction of inspired oxygen (FIO2), positive end-expiratory pressure, and carbon dioxide (CO2) washout. These effects are flow-dependent and are maximized when the flow exceeds the patient peak inspiratory flow, which varies between patients and disease conditions. In vivo studies report that higher flows result in improved oxygenation and dead space washout and can reduce work of breathing. Higher flows also lead to alveolar overdistention in non-dependent lung regions and patient discomfort. The impact of flows on different patients is largely heterogeneous. INTERPRETATION Individualizing flow settings during HFNC treatment is necessary, and titrating flow based on clinical findings like oxygenation, respiratory rates, ROX index, and patient comfort is a pragmatic way forward.
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Affiliation(s)
- Jie Li
- Division of Respiratory Care, Department of Cardiopulmonary Sciences, Rush University, 600 S Paulina St, Suite 765, Chicago, IL, 60612, USA.
| | - Fai A. Albuainain
- grid.262743.60000000107058297Division of Respiratory Care, Department of Cardiopulmonary Sciences, Rush University, 600 S Paulina St, Suite 765, Chicago, IL 60612 USA ,grid.411975.f0000 0004 0607 035XDepartment of Respiratory Care, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Wei Tan
- grid.412636.40000 0004 1757 9485Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - J. Brady Scott
- grid.262743.60000000107058297Division of Respiratory Care, Department of Cardiopulmonary Sciences, Rush University, 600 S Paulina St, Suite 765, Chicago, IL 60612 USA
| | - Oriol Roca
- grid.428313.f0000 0000 9238 6887Servei de Medicina Intensiva, Parc Taulí Hospital Universitari, Sabadell, Spain ,grid.413448.e0000 0000 9314 1427Centro de Investigacion Biomedica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain ,grid.7080.f0000 0001 2296 0625Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Tommaso Mauri
- grid.414818.00000 0004 1757 8749Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy ,grid.4708.b0000 0004 1757 2822Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
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12
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Tatkov S, Rees M, Gulley A, van den Heuij LGT, Nilius G. Asymmetrical nasal high flow ventilation improves clearance of CO 2 from the anatomical dead space and increases positive airway pressure. J Appl Physiol (1985) 2023; 134:365-377. [PMID: 36633864 PMCID: PMC9886347 DOI: 10.1152/japplphysiol.00692.2022] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Positive airway pressure that dynamically changes with breathing, and clearance of anatomical dead space are the key mechanisms of noninvasive respiratory support with nasal high flow (NHF). Pressure mainly depends on flow rate and nare occlusion. The hypothesis is that an increase in asymmetrical occlusion of the nares leads to an improvement in dead-space clearance resulting in a reduction in re-breathing. Clearance was investigated with volumetric capnography in an adult upper-airway model, which was ventilated by a lung simulator with entrained carbon dioxide (CO2) at respiratory rates (RR) of 15-45 min-1 and at 18 min-1 with chronic obstructive pulmonary disease (COPD) breathing patterns. Clearance was assessed at NHF of 20-60 L/min with a symmetrical interface (SI) and an asymmetrical interface (AI). CO2 kinetics visualized by infrared spectroscopy and mathematical modeling were used to study the mechanisms of clearance. At a higher RR (35 min-1) and NHF of 60 L/min, clearance in the upper airway was significantly higher with the AI when compared with the SI (29.64 ± 9.96%, P < 0.001), as opposed to at a lower RR (15 min-1) (1.40 ± 6.25%, P > 0.05), (means ± SD). With COPD breathing, clearance by NHF was reduced but significantly improved with the AI by 45.93% relative to the SI at NHF 20 L/min (P < 0.0001). The maximum pressure achieved with the AI was 6.6 cmH2O and NHF was 60 L/min at the end of expiration. Pressure differences between nasal cavities led to the reverse flow observed in the optical model. Asymmetrical NHF increases dead-space clearance by reverse flow through the choanae and accelerates purging of expired gas via the less occluded nare.NEW & NOTEWORTHY The asymmetrical interface generated reverse flow in the nasal cavities and across the choana, which led to unidirectional purging of expired gas from the upper airways. This accelerated the clearance of anatomical dead space and reduced re-breathing while increased resistance to flow resulted in higher positive end-expiratory pressure (PEEP). These findings are relevant to patients with elevated respiratory rates or with expiratory flow limitations where dead-space clearance by NHF can be substantially reduced.
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Affiliation(s)
| | - Monique Rees
- 1Fisher & Paykel Healthcare Ltd., Auckland, New Zealand
| | - Anton Gulley
- 1Fisher & Paykel Healthcare Ltd., Auckland, New Zealand
| | | | - Georg Nilius
- 2Evang. Kliniken Essen-Mitte GmbH, Essen, Germany,3Universität Witten/Herdecke, Witten, Germany
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13
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Cour M, Guérin C, Degivry F, Argaud L, Louis B. Delivery of high flow oxygen through nasal vs. tracheal cannulas: A bench study. Front Med (Lausanne) 2023; 9:1068428. [PMID: 36714103 PMCID: PMC9877620 DOI: 10.3389/fmed.2022.1068428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 12/20/2022] [Indexed: 01/13/2023] Open
Abstract
Background The use of high flow oxygen therapy (HFOT) has significantly escalated during the COVID-19 pandemic. HFOT can be delivered through both dedicated devices and ICU ventilators. HFOT can be administered to a patient via a nasal cannula (NC). In intubated patients, a tracheal cannula (TC) is used instead. In this study, we aim to compare the work of breathing (WOB) using a TC or NC and to explore whether differences exist among HFOT devices. Methods Seven HFOT devices (three dedicated and four ICU ventilators) were connected to a manikin head (Laerdal Medical) through a NC (Optiflow 3S, large size, Fisher and Paykel Healthcare) or a TC (OPT 970 Optiflow+, Fisher and Paykel Healthcare). Each device was also attached to a manikin head that was connected to a lung simulator (ASL5000, Ingmar Medical), set at 40 ml/cmH2O compliance, 10 cmH2O/L/s resistance, and sinusoidal inspiratory effort (muscular pressure 10 cmH2O, rate 30 breaths/min). HFOT was delivered at 40 L/min and at 21% inspired oxygen fraction. The total WOB per breath and its resistive and elastic components were automatically analyzed breath by breath over the last 20 breaths by using Campbell's diagram. Results The WOB and its resistive and elastic components were significantly lower with the TC than with the NC for every device, and systematically lower with the reference device than with others. These differences were, however, very small and may be not clinically relevant. Conclusion The WOB is lower with the TC than with the NC and with the reference device, compared with the most recent devices.
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Affiliation(s)
- Martin Cour
- Service de Médecine Intensive-Réanimation, Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon, France
- Faculté de Médecine Lyon-Est, Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Claude Guérin
- Service de Médecine Intensive-Réanimation, Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon, France
- Faculté de Médecine Lyon-Est, Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Florian Degivry
- Service de Médecine Intensive-Réanimation, Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon, France
| | - Laurent Argaud
- Service de Médecine Intensive-Réanimation, Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon, France
- Faculté de Médecine Lyon-Est, Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Bruno Louis
- Institut Mondor de Recherches Biomédicales, INSERM 955 CNRS 7000, Créteil, France
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14
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Zbiral M, Weber M, König S, Kraft F, Ullrich R, Krenn K. Usefulness and limitations of the acute respiratory distress syndrome definitions in non-intubated patients. A narrative review. Front Med (Lausanne) 2023; 10:1088709. [PMID: 36910485 PMCID: PMC9995400 DOI: 10.3389/fmed.2023.1088709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 02/07/2023] [Indexed: 02/25/2023] Open
Abstract
According to the Berlin Definition of acute respiratory distress syndrome (ARDS), a positive end-expiratory pressure (PEEP) of at least 5 cmH2O is required to diagnose and grade ARDS. While the Berlin consensus statement specifically acknowledges the role of non-invasive ventilation (NIV) in mild ARDS, this stratification has traditionally presumed a mechanically ventilated patient in the context of moderate to severe ARDS. This may not accurately reflect today's reality of clinical respiratory care. NIV and high-flow nasal cannula oxygen therapy (HFNO) have been used for managing of severe forms of acute hypoxemic respiratory failure with growing frequency, including in patients showing pathophysiological signs of ARDS. This became especially relevant during the COVID-19 pandemic. The levels of PEEP achieved with HFNO have been particularly controversial, and the exact FiO2 it achieves is subject to variability. Pinpointing the presence of ARDS in patients receiving HNFO and the severity in those receiving NIV therefore remains methodically problematic. This narrative review highlights the evolution of the ARDS definition in the context of non-invasive ventilatory support and provides an overview of the parallel development of definitions and ventilatory management of ARDS. It summarizes the methodology applied in clinical trials to classify ARDS in non-intubated patients and the respective consequences on treatment. As ARDS severity has significant therapeutic and prognostic consequences, and earlier treatment in non-intubated patients may be beneficial, closing this knowledge gap may ultimately be a relevant step to improve comparability in clinical trial design and outcomes.
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Affiliation(s)
- Martin Zbiral
- Department of Anesthesia, General Intensive Care and Pain Medicine, Medical University of Vienna, Vienna, Austria
| | - Maximilian Weber
- Department of Anesthesia, General Intensive Care and Pain Medicine, Medical University of Vienna, Vienna, Austria
| | - Sebastian König
- Department of Anesthesia, General Intensive Care and Pain Medicine, Medical University of Vienna, Vienna, Austria
| | - Felix Kraft
- Department of Anesthesia, General Intensive Care and Pain Medicine, Medical University of Vienna, Vienna, Austria
| | - Roman Ullrich
- Department of Anesthesia, General Intensive Care and Pain Medicine, Medical University of Vienna, Vienna, Austria.,Department of Anesthesiology and Intensive Care Medicine, AUVA Trauma Center Vienna, Vienna, Austria
| | - Katharina Krenn
- Department of Anesthesia, General Intensive Care and Pain Medicine, Medical University of Vienna, Vienna, Austria
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Corradi F, Brusasco C. The puzzle of non-invasive respiratory support in COVID-19. Minerva Anestesiol 2023; 89:7-9. [PMID: 36745117 DOI: 10.23736/s0375-9393.22.17152-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Francesco Corradi
- Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy -
| | - Claudia Brusasco
- Anesthesia and Intensive Care Unit, E.O. Ospedali Galliera, Genoa, Italy
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16
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Munshi L, Mancebo J, Brochard LJ. Noninvasive Respiratory Support for Adults with Acute Respiratory Failure. N Engl J Med 2022; 387:1688-1698. [PMID: 36322846 DOI: 10.1056/nejmra2204556] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Laveena Munshi
- From the Interdepartmental Division of Critical Care, University of Toronto (L.M., L.J.B.), the Critical Care Department Sinai Health System (L.M.), and Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, Unity Health Toronto (L.J.B.) - all in Toronto; and the Intensive Care Department, Hospital Universitari de La Santa Creu I Sant Pau, Barcelona (J.M.)
| | - Jordi Mancebo
- From the Interdepartmental Division of Critical Care, University of Toronto (L.M., L.J.B.), the Critical Care Department Sinai Health System (L.M.), and Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, Unity Health Toronto (L.J.B.) - all in Toronto; and the Intensive Care Department, Hospital Universitari de La Santa Creu I Sant Pau, Barcelona (J.M.)
| | - Laurent J Brochard
- From the Interdepartmental Division of Critical Care, University of Toronto (L.M., L.J.B.), the Critical Care Department Sinai Health System (L.M.), and Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, Unity Health Toronto (L.J.B.) - all in Toronto; and the Intensive Care Department, Hospital Universitari de La Santa Creu I Sant Pau, Barcelona (J.M.)
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17
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Early identification of acute respiratory distress syndrome in times of the COVID-19 pandemic. JOURNAL OF INTENSIVE MEDICINE 2022; 3:1-3. [PMID: 36785581 PMCID: PMC9596172 DOI: 10.1016/j.jointm.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 09/01/2022] [Accepted: 09/01/2022] [Indexed: 11/06/2022]
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18
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New Questions, Warmings and Answers Related to High Flow Therapy in 2022. Arch Bronconeumol 2022:S0300-2896(22)00523-3. [PMID: 36153213 PMCID: PMC9474422 DOI: 10.1016/j.arbres.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 09/05/2022] [Indexed: 11/23/2022]
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19
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Rittayamai N, Grieco DL, Brochard L. Noninvasive respiratory support in intensive care medicine. Intensive Care Med 2022; 48:1211-1214. [PMID: 35759009 PMCID: PMC9244137 DOI: 10.1007/s00134-022-06762-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 05/25/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Nuttapol Rittayamai
- Division of Respiratory Diseases and Tuberculosis, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Domenico L Grieco
- Department of Emergency, Intensive Care Medicine and Anesthesia, Fondazione Policlinico Universitario AGemelli IRCCS, Rome, Italy.,Istituto di Anestesiologia e Rianimazione, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Laurent Brochard
- Keenan Research Centre, Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada. .,Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
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