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Houssin J, Meister L, Nicollas R, Médale M, Moreddu É. Assessment of high-flow nasal cannula efficacy in humidification of infant airways: A computational fluid dynamics approach. Comput Biol Med 2024; 176:108567. [PMID: 38763065 DOI: 10.1016/j.compbiomed.2024.108567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 04/18/2024] [Accepted: 05/05/2024] [Indexed: 05/21/2024]
Abstract
INTRODUCTION High-flow nasal cannula therapy has garnered significant interest for managing pathologies affecting infants' airways, particularly for humidifying areas inaccessible to local treatments. This therapy promotes mucosal healing during the postoperative period. However, further data are needed to optimize the use of these devices. In vivo measurement of pediatric airway humidification presents a challenge; thus, this study aimed to investigate the airflow dynamics and humidification effects of high-flow nasal cannulas on an infant's airway using computational fluid dynamics. METHODS Two detailed models of an infant's upper airway were reconstructed from CT scans, with high-flow nasal cannula devices inserted at the nasal inlets. The airflow was analyzed, and wall humidification was modeled using a film-fluid approach. RESULTS Air velocities and pressure were very high at the airway inlet but decreased rapidly towards the nasopharynx. Maximum relative humidity-close to 100%-was achieved in the nasopharynx. Fluid film development along the airway was heterogeneous, with condensation primarily occurring in the nasal vestibule and larynx. CONCLUSION This study provides comprehensive models of airway humidification, which pave the way for future studies to assess the impact of surgical interventions on humidification and drug deposition directly at operative sites, such as the nasopharynx or larynx, in infants.
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Affiliation(s)
- Juliette Houssin
- Aix-Marseille Univ, CNRS, IUSTI, Marseille, France; Department of Pediatric Otorhinolaryngology, Head & Neck Surgery, La Timone Children's Hospital, Aix-Marseille Univ, APHM, Marseille, France.
| | | | - Richard Nicollas
- Aix-Marseille Univ, CNRS, IUSTI, Marseille, France; Department of Pediatric Otorhinolaryngology, Head & Neck Surgery, La Timone Children's Hospital, Aix-Marseille Univ, APHM, Marseille, France.
| | - Marc Médale
- Aix-Marseille Univ, CNRS, IUSTI, Marseille, France.
| | - Éric Moreddu
- Aix-Marseille Univ, CNRS, IUSTI, Marseille, France; Department of Pediatric Otorhinolaryngology, Head & Neck Surgery, La Timone Children's Hospital, Aix-Marseille Univ, APHM, Marseille, France.
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Pettenuzzo T, Boscolo A, Pistollato E, Pretto C, Giacon TA, Frasson S, Carbotti FM, Medici F, Pettenon G, Carofiglio G, Nardelli M, Cucci N, Tuccio CL, Gagliardi V, Schiavolin C, Simoni C, Congedi S, Monteleone F, Zarantonello F, Sella N, De Cassai A, Navalesi P. Effects of non-invasive respiratory support in post-operative patients: a systematic review and network meta-analysis. Crit Care 2024; 28:152. [PMID: 38720332 PMCID: PMC11077852 DOI: 10.1186/s13054-024-04924-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 04/21/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Re-intubation secondary to post-extubation respiratory failure in post-operative patients is associated with increased patient morbidity and mortality. Non-invasive respiratory support (NRS) alternative to conventional oxygen therapy (COT), i.e., high-flow nasal oxygen, continuous positive airway pressure, and non-invasive ventilation (NIV), has been proposed to prevent or treat post-extubation respiratory failure. Aim of the present study is assessing the effects of NRS application, compared to COT, on the re-intubation rate (primary outcome), and time to re-intubation, incidence of nosocomial pneumonia, patient discomfort, intensive care unit (ICU) and hospital length of stay, and mortality (secondary outcomes) in adult patients extubated after surgery. METHODS A systematic review and network meta-analysis of randomized and non-randomized controlled trials. A search from Medline, Embase, Scopus, Cochrane Central Register of Controlled Trials, and Web of Science from inception until February 2, 2024 was performed. RESULTS Thirty-three studies (11,292 patients) were included. Among all NRS modalities, only NIV reduced the re-intubation rate, compared to COT (odds ratio 0.49, 95% confidence interval 0.28; 0.87, p = 0.015, I2 = 60.5%, low certainty of evidence). In particular, this effect was observed in patients receiving NIV for treatment, while not for prevention, of post-extubation respiratory failure, and in patients at high, while not low, risk of post-extubation respiratory failure. NIV reduced the rate of nosocomial pneumonia, ICU length of stay, and ICU, hospital, and long-term mortality, while not worsening patient discomfort. CONCLUSIONS In post-operative patients receiving NRS after extubation, NIV reduced the rate of re-intubation, compared to COT, when used for treatment of post-extubation respiratory failure and in patients at high risk of post-extubation respiratory failure.
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Affiliation(s)
- Tommaso Pettenuzzo
- Institute of Anesthesia and Intensive Care, University Hospital of Padua, 13 Via Gallucci, 35121, Padua, Italy
| | - Annalisa Boscolo
- Institute of Anesthesia and Intensive Care, University Hospital of Padua, 13 Via Gallucci, 35121, Padua, Italy
- Department of Medicine, University of Padua, 2 Via Giustiniani, 35128, Padua, Italy
- Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padua, 2 Via Giustiniani, 35128, Padua, Italy
| | - Elisa Pistollato
- Department of Medicine, University of Padua, 2 Via Giustiniani, 35128, Padua, Italy
| | - Chiara Pretto
- Department of Medicine, University of Padua, 2 Via Giustiniani, 35128, Padua, Italy
| | | | - Sara Frasson
- Department of Medicine, University of Padua, 2 Via Giustiniani, 35128, Padua, Italy
| | | | - Francesca Medici
- Department of Medicine, University of Padua, 2 Via Giustiniani, 35128, Padua, Italy
| | - Giovanni Pettenon
- Department of Medicine, University of Padua, 2 Via Giustiniani, 35128, Padua, Italy
| | - Giuliana Carofiglio
- Department of Medicine, University of Padua, 2 Via Giustiniani, 35128, Padua, Italy
| | - Marco Nardelli
- Department of Medicine, University of Padua, 2 Via Giustiniani, 35128, Padua, Italy
| | - Nicolas Cucci
- Department of Medicine, University of Padua, 2 Via Giustiniani, 35128, Padua, Italy
| | - Clara Letizia Tuccio
- Department of Medicine, University of Padua, 2 Via Giustiniani, 35128, Padua, Italy
| | - Veronica Gagliardi
- Department of Medicine, University of Padua, 2 Via Giustiniani, 35128, Padua, Italy
| | - Chiara Schiavolin
- Department of Medicine, University of Padua, 2 Via Giustiniani, 35128, Padua, Italy
| | - Caterina Simoni
- Department of Medicine, University of Padua, 2 Via Giustiniani, 35128, Padua, Italy
| | - Sabrina Congedi
- Department of Medicine, University of Padua, 2 Via Giustiniani, 35128, Padua, Italy
| | - Francesco Monteleone
- Department of Medicine, University of Padua, 2 Via Giustiniani, 35128, Padua, Italy
| | - Francesco Zarantonello
- Institute of Anesthesia and Intensive Care, University Hospital of Padua, 13 Via Gallucci, 35121, Padua, Italy
| | - Nicolò Sella
- Institute of Anesthesia and Intensive Care, University Hospital of Padua, 13 Via Gallucci, 35121, Padua, Italy
| | - Alessandro De Cassai
- Institute of Anesthesia and Intensive Care, University Hospital of Padua, 13 Via Gallucci, 35121, Padua, Italy
| | - Paolo Navalesi
- Institute of Anesthesia and Intensive Care, University Hospital of Padua, 13 Via Gallucci, 35121, Padua, Italy.
- Department of Medicine, University of Padua, 2 Via Giustiniani, 35128, Padua, Italy.
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Trabalza Marinucci B, Fiorelli S, Siciliani A, Menna C, Tiracorrendo M, Massullo D, Venuta F, Rendina EA, Ciccone AM, D’Andrilli A, Ibrahim M, Maurizi G. New Insight into Laryngo-Tracheal Surgery: High-Flow Oxygen Therapy to Prevent Early Complications after Surgery. J Pers Med 2024; 14:456. [PMID: 38793037 PMCID: PMC11122413 DOI: 10.3390/jpm14050456] [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: 03/14/2024] [Revised: 04/09/2024] [Accepted: 04/23/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND Early post-operative airway management after laryngo-tracheal surgery is crucial. Acute respiratory failure due to glottis' edema may occur, requiring reintubation. This can prolong ventilatory assistance, jeopardizing anastomosis. To date, only judicious steroid administration and fluid management are available to avoid more invasive procedures. High-flow oxygen therapy (HFOT) is a noninvasive O2 support method providing humidification, warmed air, and Positive End-Expiratory Pressure (AIRVO2). No data about HFOT use to prevent early complications after laryngo-tracheal surgery are reported in the literature. METHODS Between September 2020 and September 2022, 107 consecutive patients who underwent laryngo-tracheal surgery received HFOT (Group A). Data and long-term results were compared with those of 80 patients operated between September 2018 and August 2020 (Group B), when HFOT was not available. All patients were operated in a single center. No pre- or post-operative settings changed, except for HFOT introduction. We analyzed and compared the risk for "delayed" reintubation (unexpected reintubation within the first 24-48 h after extubating/laryngeal mask removal) in the two groups. RESULTS No patients reported HFOT-related adverse events. The control group (B) presented "delayed" reintubation in 37% (p = 0.027), intensive care unit admission in 67% (p = 0.005) and longer hospital stay (p = 0.001) compared to the HFOT group (A). The minor complications' rate was 3% in both group and overall mortality was 0%. Re-stenosis was described in 4.6% of the HFOT group, without a statistically significant difference (p = 0.7006). CONCLUSIONS Our study is the first to investigate HFOT use in patients undergoing laryngo-tracheal surgery, potentially representing a consistent innovation in the peri-operative management of these patients. With the limitation of a retrospective series, we would suggest HFOT use for preventing post-operative reintubation rate, possibly reducing ICU admissions and hospital stays.
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Affiliation(s)
- Beatrice Trabalza Marinucci
- Thoracic Surgery, Sant’Andrea, Hospital, La Sapienza University, 00189 Rome, Italy; (A.S.); (C.M.); (M.T.); (E.A.R.); (A.M.C.); (A.D.); (M.I.); (G.M.)
| | - Silvia Fiorelli
- Anesthesiology and Intensive Care, Sant’Andrea Hospital, La Sapienza University, 00189 Rome, Italy; (S.F.); (D.M.)
| | - Alessandra Siciliani
- Thoracic Surgery, Sant’Andrea, Hospital, La Sapienza University, 00189 Rome, Italy; (A.S.); (C.M.); (M.T.); (E.A.R.); (A.M.C.); (A.D.); (M.I.); (G.M.)
| | - Cecilia Menna
- Thoracic Surgery, Sant’Andrea, Hospital, La Sapienza University, 00189 Rome, Italy; (A.S.); (C.M.); (M.T.); (E.A.R.); (A.M.C.); (A.D.); (M.I.); (G.M.)
| | - Matteo Tiracorrendo
- Thoracic Surgery, Sant’Andrea, Hospital, La Sapienza University, 00189 Rome, Italy; (A.S.); (C.M.); (M.T.); (E.A.R.); (A.M.C.); (A.D.); (M.I.); (G.M.)
| | - Domenico Massullo
- Anesthesiology and Intensive Care, Sant’Andrea Hospital, La Sapienza University, 00189 Rome, Italy; (S.F.); (D.M.)
| | - Federico Venuta
- Thoracic Surgery Policlinico Umberto I, La Sapienza University, 00186 Rome, Italy
| | - Erino Angelo Rendina
- Thoracic Surgery, Sant’Andrea, Hospital, La Sapienza University, 00189 Rome, Italy; (A.S.); (C.M.); (M.T.); (E.A.R.); (A.M.C.); (A.D.); (M.I.); (G.M.)
| | - Anna Maria Ciccone
- Thoracic Surgery, Sant’Andrea, Hospital, La Sapienza University, 00189 Rome, Italy; (A.S.); (C.M.); (M.T.); (E.A.R.); (A.M.C.); (A.D.); (M.I.); (G.M.)
| | - Antonio D’Andrilli
- Thoracic Surgery, Sant’Andrea, Hospital, La Sapienza University, 00189 Rome, Italy; (A.S.); (C.M.); (M.T.); (E.A.R.); (A.M.C.); (A.D.); (M.I.); (G.M.)
| | - Mohsen Ibrahim
- Thoracic Surgery, Sant’Andrea, Hospital, La Sapienza University, 00189 Rome, Italy; (A.S.); (C.M.); (M.T.); (E.A.R.); (A.M.C.); (A.D.); (M.I.); (G.M.)
| | - Giulio Maurizi
- Thoracic Surgery, Sant’Andrea, Hospital, La Sapienza University, 00189 Rome, Italy; (A.S.); (C.M.); (M.T.); (E.A.R.); (A.M.C.); (A.D.); (M.I.); (G.M.)
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Ferrer M, De Pascale G, Tanzarella ES, Antonelli M. Severe Community-Acquired Pneumonia: Noninvasive Mechanical Ventilation, Intubation, and HFNT. Semin Respir Crit Care Med 2024; 45:169-186. [PMID: 38604188 DOI: 10.1055/s-0043-1778140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
Severe acute respiratory failure (ARF) is a major issue in patients with severe community-acquired pneumonia (CAP). Standard oxygen therapy is the first-line therapy for ARF in the less severe cases. However, respiratory supports may be delivered in more severe clinical condition. In cases with life-threatening ARF, invasive mechanical ventilation (IMV) will be required. Noninvasive strategies such as high-flow nasal therapy (HFNT) or noninvasive ventilation (NIV) by either face mask or helmet might cover the gap between standard oxygen and IMV. The objective of all the supporting measures for ARF is to gain time for the antimicrobial treatment to cure the pneumonia. There is uncertainty regarding which patients with severe CAP are most likely to benefit from each noninvasive support strategy. HFNT may be the first-line approach in the majority of patients. While NIV may be relatively contraindicated in patients with excessive secretions, facial hair/structure resulting in air leaks or poor compliance, NIV may be preferable in those with increased work of breathing, respiratory muscle fatigue, and congestive heart failure, in which the positive pressure of NIV may positively impact hemodynamics. A trial of NIV might be considered for select patients with hypoxemic ARF if there are no contraindications, with close monitoring by an experienced clinical team who can intubate patients promptly if they deteriorate. In such cases, individual clinician judgement is key to choose NIV, interface, and settings. Due to the paucity of studies addressing IMV in this population, the protective mechanical ventilation strategies recommended by guidelines for acute respiratory distress syndrome can be reasonably applied in patients with severe CAP.
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Affiliation(s)
- Miquel Ferrer
- Unitat de Vigilancia Intensiva Respiratoria, Servei de Pneumologia, Hospital Clinic de Barcelona, Institut d'Investigacions Biomediques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
- Departament de Medicina, Universitat de Barcelona, Barcelona, Spain
- Centro de Investigacion Biomedica En Red-Enfermedades Respiratorias (CIBERES-CB060628), Barcelona, Spain
| | - Gennaro De Pascale
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy
- Dipartimento di Scienze dell'Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Eloisa S Tanzarella
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy
- Dipartimento di Scienze dell'Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Massimo Antonelli
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy
- Dipartimento di Scienze dell'Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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Xie P, Wu Z, Zha B, Xu L, Shen S, Zhuang H, Wei H. Risk factors for pharyngalgia and xerostomia undergoing supraglottic jet oxygenation and ventilation in gastrointestinal endoscopy: a retrospective study. Sci Rep 2023; 13:21949. [PMID: 38081892 PMCID: PMC10713572 DOI: 10.1038/s41598-023-49473-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 12/08/2023] [Indexed: 12/18/2023] Open
Abstract
Supraglottic jet oxygenation/ventilation (SJOV) can reduce hypoxemia in sedated endoscopy but may increase minor side effects like pharyngalgia and xerostomia. This study aimed to identify risk factors for pharyngalgia/xerostomia with SJOV during gastrointestinal endoscopy. From January 1 to December 31, 2021, 5313 patients with propofol sedation and SJOV underwent gastrointestinal endoscopy or removal of gastrointestinal polyps was analyzed retrospectively. Data included patient characteristics, operation details, postoperative adverse events, and potential risk factors for postoperative adverse events. Parameters considered as potential risk factors were identified based on study results published previously and based on the researcher's idea and clinical experience. The patient factors and the incidence of pharyngalgia/xerostomia at 30 min post-procedure were assessed. Descriptive statistics were calculated using SPSS software. Evaluation potential risk factors using univariate and multivariate logistic regression. Pharyngalgia/xerostomia occurred in 18.7% of patients at 30 min after procedure. A multivariable analysis showed that procedure time and pharyngalgia/xerostomia within 2 weeks were independent risk factors. Procedure time had the strongest association with postoperative pharyngalgia/xerostomia (OR, 8.09 [95% CI, 4.197-6.312]). No factors were significantly associated with hypoxemia risk (1.7% incidence). There were no barotrauma or other serious morbidity or mortality. Procedure duration and recent pharyngalgia/xerostomia increased risk of pharyngalgia/xerostomia with SJOV during endoscopy. Limiting SJOV duration may reduce side effects in susceptible patients. No predictors of hypoxemia were identified.
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Affiliation(s)
- Ping Xie
- Department of Anesthesiology, 910th Hospital of PLA, Quanzhou, 362000, China
| | - Zhiyun Wu
- Department of Anesthesiology, 910th Hospital of PLA, Quanzhou, 362000, China
| | - Benjun Zha
- Department of Anesthesiology, 910th Hospital of PLA, Quanzhou, 362000, China.
| | - Li Xu
- Department of Anesthesiology, 910th Hospital of PLA, Quanzhou, 362000, China
| | - Shanyi Shen
- Department of Anesthesiology, 910th Hospital of PLA, Quanzhou, 362000, China
| | - Haibin Zhuang
- Department of Anesthesiology, 910th Hospital of PLA, Quanzhou, 362000, China
| | - Huafeng Wei
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
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Smith J, Plaat F. Use of high-flow nasal oxygen for pregnant women with COVID-19 in the labour ward setting. Int J Obstet Anesth 2023; 56:103919. [PMID: 37625989 DOI: 10.1016/j.ijoa.2023.103919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 05/22/2023] [Accepted: 07/19/2023] [Indexed: 08/27/2023]
Abstract
The presentation and management of SARS-CoV-2 (COVID-19) infection in the obstetric population is affected by the hormonal and mechanical changes of pregnancy. The increased oxygen demands in pregnancy in the face of conventional oxygen therapy, risks of tracheal intubation and discomfort from non-invasive positive pressure ventilation all support the use of high-flow nasal oxygen (HFNO) as an alternative therapy. The lack of published guidance for the use of HFNO has led to the development of local-level guidance based on expert consensus. More evidence exploring the use of HFNO therapy in the pregnant population is required to assist in developing clinical guidelines.
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Affiliation(s)
- J Smith
- Queen Charlottes and Chelsea Hospital, London, UK.
| | - F Plaat
- Queen Charlottes and Chelsea Hospital, London, UK
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Lee T, Shinn HK, Kim NE, Kim D. Application of high-flow nasal cannula oxygen therapy in patient with pulmonary edema following cesarean-section under combined spinal-epidural anesthesia: A case report. Medicine (Baltimore) 2023; 102:e34140. [PMID: 37390235 PMCID: PMC10313262 DOI: 10.1097/md.0000000000034140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 06/08/2023] [Indexed: 07/02/2023] Open
Abstract
BACKGROUND High-flow nasal cannula (HFNC), which overcomes the disadvantages of the existing low flow mask, is an efficient method that can immediately provide a high volume of heated oxygen to the patient.[1] Therefore, this case reports a case in which HFNC was applied to a pregnant with acute respiratory failure. CASE A 37-year-old woman pregnant (GA 30 + 5 weeks) with twin was diagnosed with preeclampsia. It was decided to perform an emergency Cesarean-section under combined spinal-epidural technique worsening respiratory failure. After delivery, maternal dyspnea was not alleviated applying of O28 L/min via facial mask. Thus, high-flow nasal cannula (HFNC) oxygen therapy was applied (60 L/min, partial pressure of oxygen (FiO2) 80%) and SpO2 subsequently rose to 98% and the patient's dyspnea was resolved. CONCLUSIONS HFNC is a safe device that can effectively provide oxygen to pregnant with acute respiratory failure.
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Affiliation(s)
- Taeil Lee
- Department of Anesthesiology and Pain Medicine, Inha University, Incheon, South Korea
| | - Helen Ki Shinn
- Department of Anesthesiology and Pain Medicine, Inha University, Incheon, South Korea
| | - Na Eun Kim
- Department of Anesthesiology and Pain Medicine, Inha University, Incheon, South Korea
| | - Doyeon Kim
- Department of Anesthesiology and Pain Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, South Korea
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Ni Z, Zhou Y, Tang N, Yu H, Liang Z. Comparison of actual performance in humidification among different high-flow nasal cannula devices: a bench study. Front Med (Lausanne) 2023; 10:1209977. [PMID: 37359006 PMCID: PMC10288384 DOI: 10.3389/fmed.2023.1209977] [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: 04/21/2023] [Accepted: 05/19/2023] [Indexed: 06/28/2023] Open
Abstract
Background The physiological effects of HFNC devices are closely related to temperature and humidity. HFNC devices from different manufacturers may have varied performances. It is unclear whether there are differences in the humidification performance of different HFNC devices and the degree of differences. Methods Four integrated HFNC devices (AIRVO 2, Fisher & Paykel Healthcare, Auckland, New Zealand; TNI softFlow 50, TNI Medical AG, Würzburg, Germany; HUMID-BH, RESPIRACARE, Shenyang, China; OH-70C, Micomme, Hunan, China) and a ventilator with an HFNC module (bellavista 1000, Imtmedical, Buchs, Switzerland) were evaluated using their matching circuits. The dew point temperature was set at 31, 34, and 37°C (set-DP). In MR850, it was set to non-invasive mode (34°C/-3°C) and invasive mode (40°C/-3°C), respectively. At each level of set-DP, the flow was set from 20 L/min up to its maximum set limit at a gradient of 5 L/min or 10 L/min. After stabilization, the dew point temperature, temperature, relative humidity, and flow rate of the delivered gas from the cannulas were recorded. Results There were significant differences in actual-DP among these devices at any set-DP (p < 0.001). The actual-DP of OH-70C and TNI softFlow 50 was lower than set-DP, and the difference between the actual-DP and the set-DP of these two devices increased with the increase of set-DP. AIRVO 2, bellavista 1000 (MR850), and HUMID-BH can provide the nominal humidity at 37°C. The actual-DP increased with the increase of set-flow under each set-DP in AIRVO 2, TNI softFlow 50 and bellavista 1000 (MR850), but decreased when the set-flow was greater than 60 L/min. The actual-T of the delivered gas was higher than actual-DP in all devices and was higher than set-DP in AIRVO 2 and HUMID-BH. Conclusion Set-flow, set-DP, and types of devices will affect the actual temperature and humidity of the delivered gas. AIRVO 2, bellavista 1000 (MR850), and HUMID-BH can provide the nominal humidity at 37°C and may be more suitable for tracheotomy patients. The flow rate over 60 L/min should be set with caution.
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Jalil Y, Ferioli M, Dres M. The COVID-19 Driving Force: How It Shaped the Evidence of Non-Invasive Respiratory Support. J Clin Med 2023; 12:jcm12103486. [PMID: 37240592 DOI: 10.3390/jcm12103486] [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: 02/11/2023] [Revised: 05/03/2023] [Accepted: 05/12/2023] [Indexed: 05/28/2023] Open
Abstract
During the COVID-19 pandemic, the use of non-invasive respiratory support (NIRS) became crucial in treating patients with acute hypoxemic respiratory failure. Despite the fear of viral aerosolization, non-invasive respiratory support has gained attention as a way to alleviate ICU overcrowding and reduce the risks associated with intubation. The COVID-19 pandemic has led to an unprecedented increased demand for research, resulting in numerous publications on observational studies, clinical trials, reviews, and meta-analyses in the past three years. This comprehensive narrative overview describes the physiological rationale, pre-COVID-19 evidence, and results of observational studies and randomized control trials regarding the use of high-flow nasal oxygen, non-invasive mechanical ventilation, and continuous positive airway pressure in adult patients with COVID-19 and associated acute hypoxemic respiratory failure. The review also highlights the significance of guidelines and recommendations provided by international societies and the need for further well-designed research to determine the optimal use of NIRS in treating this population.
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Affiliation(s)
- Yorschua Jalil
- INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, 75006 Paris, France
- Service de Médecine Intensive-Réanimation (Département "R3S"), AP-HP. Sorbonne Université, Hôpital Pitié-Salpêtrière, 75013 Paris, France
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago 8331150, Chile
- Departamento de Ciencias de la Salud, Carrera de Kinesiología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago 8331150, Chile
| | - Martina Ferioli
- INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, 75006 Paris, France
- Service de Médecine Intensive-Réanimation (Département "R3S"), AP-HP. Sorbonne Université, Hôpital Pitié-Salpêtrière, 75013 Paris, France
- Respiratory and Critical Care Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
- Department of Clinical, Integrated and Experimental Medicine (DIMES), Alma Mater Studiorum University of Bologna, 40136 Bologna, Italy
| | - Martin Dres
- INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, 75006 Paris, France
- Service de Médecine Intensive-Réanimation (Département "R3S"), AP-HP. Sorbonne Université, Hôpital Pitié-Salpêtrière, 75013 Paris, France
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10
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Home High-Flow Oxygen Therapy Should Be Considered in Patients With COPD and Chronic Respiratory Failure. Arch Bronconeumol 2023; 59:5-6. [PMID: 36402702 DOI: 10.1016/j.arbres.2022.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 10/11/2022] [Indexed: 11/09/2022]
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11
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Long-Term Domiciliary High-Flow Nasal Therapy in Patients with Bronchiectasis: A Preliminary Retrospective Observational Case-Control Study. J Clin Med 2022; 11:jcm11247323. [PMID: 36555939 PMCID: PMC9782624 DOI: 10.3390/jcm11247323] [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: 10/27/2022] [Revised: 12/01/2022] [Accepted: 12/06/2022] [Indexed: 12/14/2022] Open
Abstract
High-flow nasal therapy (HFNT) provides several pathophysiological benefits in chronic respiratory disorders. We aimed to evaluate the effectiveness of long-term HFNT in patients with bronchiectasis (BE). METHODS This is a retrospective bicentric case-control study of outpatients with BE on optimized medical treatment with a severe exacerbation requiring hospitalization in the previous year. Patients on long-term home HFNT (cases) and patients on optimized medical treatment alone (controls) were matched by age, sex, bronchiectasis severity index, and exacerbations in the previous year. Data on BE exacerbations, hospitalizations/year, mucus features, respiratory symptoms, and pulmonary function were collected. The primary outcome was the change from baseline in the exacerbation rates at 12 months between groups. RESULTS 20 patients in the HFNT group and 20 controls were included. A significant reduction in exacerbations [-1.9 (-2.8 to -0.9), p = 0.0005] and hospitalizations [-0.7 (-1.1 to -0.3), p = 0.0006] was found in the HFNT group vs controls. A slight improvement in pulmonary function [FEV1% +6,1% (+1% to +11.3%) (p = 0.0219), FVC% +4.6% (+0.8% to +8.3%) (p = 0.0188) and FEF25-75% +13.4 (+11 to +15.9) (p = 0.0189) was also found in the HFNT group compared to controls. CONCLUSIONS In this preliminary study, long-term domiciliary HFNT improved the clinical course of patients with BE.
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12
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Mehmood R, Mansoor Z, Atanasov GP, Cheian A, Davletova A, Patel A, Ahmed D. High-Flow Nasal Oxygenation and Its Applicability in COVID Patients. SN COMPREHENSIVE CLINICAL MEDICINE 2022; 4:49. [PMID: 35128319 PMCID: PMC8801314 DOI: 10.1007/s42399-022-01132-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 01/26/2022] [Indexed: 11/24/2022]
Abstract
High-flow nasal oxygenation (HFNO) is a type of oxygen therapy that provides humidified and heated oxygen through a nasal cannula at much higher flow rates than standard oxygen therapy, while also allowing control over the fraction of inspired oxygen (FIO2). Compared to standard oxygen therapy, it is much more comfortable for the patient and seems to alleviate most of the problems associated with standard oxygen therapy, such as dry nose, dry throat and nasal pain. It also provides a variety of benefits that can reduce the incidence of escalating treatment and initiating mechanical ventilation in COVID patients with acute hypoxemic respiratory failure (AHRF). This article provides an overview of HFNO and its current applications in COVID patients during the pandemic.
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Affiliation(s)
- Raafay Mehmood
- First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Zainab Mansoor
- First Faculty of Medicine, Charles University, Prague, Czech Republic
| | | | - Alexei Cheian
- First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Alina Davletova
- First Faculty of Medicine, Charles University, Prague, Czech Republic
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13
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Veenstra P, Veeger NJGM, Koppers RJH, Duiverman ML, van Geffen WH. High-flow nasal cannula oxygen therapy for admitted COPD-patients. A retrospective cohort study. PLoS One 2022; 17:e0272372. [PMID: 36197917 PMCID: PMC9534431 DOI: 10.1371/journal.pone.0272372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 07/18/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The use of High-flow nasal cannula (HFNC) is increasing in admitted COPD-patients and could provide a step in between non-invasive ventilation (NIV) and standard oxygen supply. Recent studies demonstrated that HFNC is capable of facilitating secretion removal and reduce the work of breathing. Therefore, it might be of advantage in the treatment of acute exacerbations of COPD (AECOPD). No randomized trials have assessed this for admitted COPD-patients on a regular ward and only limited data from non-randomized studies is available. OBJECTIVES The aim of our study was to identify the reasons to initiate treatment with HFNC in a group of COPD-patients during an exacerbation, further identify those most likely to benefit from HFNC treatment and to find factors associated with treatment success on the pulmonary ward. MATERIAL AND METHODS This retrospective study included COPD-patients admitted to the pulmonary ward and treated with HFNC from April 2016 until April 2019. Only patients admitted with severe acute exacerbations were included. Patients who had an indication for NIV-treatment where treated with NIV and were included only if they subsequently needed HFNC, e.g. when they did not tolerate NIV. Known asthma patients were excluded. RESULTS A total of 173 patients were included. Stasis of sputum was the indication most reported to initiate HFNC-treatment. Treatment was well tolerated in 83% of the patients. Cardiac and vascular co-morbidities were significantly associated with a smaller chance of successful treatment (Respectively OR = 0.435; p = 0.013 and OR = 0.493;p = 0.035). Clinical assessment judged HFNC-treatment to be successful in 61% of the patients. Furthermore, in-hospital treatment with NIV was associated with a higher chance of HFNC failure afterwards (OR = 0.439; p = 0.045). CONCLUSION This large retrospective study showed that HFNC-treatment in patients with an AECOPD was initiated most often for sputum stasis as primary reason. Factors associated with improved outcomes of HFNC-treatment was the absence of vascular and/or cardiac co-morbidities and no need for in-hospital NIV-treatment.
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Affiliation(s)
- Pieter Veenstra
- Department of Respiratory Medicine, Medical Center Leeuwarden, Leeuwarden, Netherlands
| | - Nic J. G. M. Veeger
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Ralph J. H. Koppers
- Department of Respiratory Medicine, Medical Center Leeuwarden, Leeuwarden, Netherlands
| | - Marieke L. Duiverman
- Department of Pulmonary Diseases/Home Mechanical Ventilation, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Wouter H. van Geffen
- Department of Respiratory Medicine, Medical Center Leeuwarden, Leeuwarden, Netherlands
- * E-mail:
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14
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Impellizzeri P, Nolasco S, Campisi R, Cipolla A, Borgese A, Alia S, Crimi N, Crimi C. Acute and long-term management of severe bronchiectasis with high flow nasal therapy: A case report. Monaldi Arch Chest Dis 2022; 93. [PMID: 35929643 DOI: 10.4081/monaldi.2022.2333] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 08/01/2022] [Indexed: 11/22/2022] Open
Abstract
Bronchiectasis (BE) is a long-term, chronic lung condition featured by widened and scarred airways. These can alter the physiological mucociliary clearance, making it difficult to clear mucus and microorganisms, leading to frequent exacerbations. High flow nasal therapy (HFNT) is a noninvasive respiratory support that delivers heated and humidified gas eventually enriched with oxygen, through a nasal cannula. Humidification is crucial for adequate airways mucociliary clearance, improving ciliary function and consequently reducing airways inflammation and recurrent infections. HFNT has been mostly used in patients with acute hypoxemic respiratory failure and in selected patients with chronic respiratory failure due to COPD. Still, evidence about its use in acute and long-term home setting in patients with clinically relevant BE are lacking. We report a case of severe widespread BE, already on top medical therapy and pulmonary rehabilitation, still suffering from difficult mucus expectoration and recurrent exacerbations, who has been additionally treated with HFNT, both in hospital and domiciliary, reporting significant improvements on relevant clinical and patient-centered outcomes. Thus, HFNT may confer additional benefits as an add-on treatment of patients with severe BE and respiratory failure.
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Affiliation(s)
| | - Santi Nolasco
- Department of Clinical and Experimental Medicine, University of Catania.
| | - Raffaele Campisi
- Respiratory Medicine Unit, Policlinico "G. Rodolico - San Marco" University Hospital, Catania.
| | - Antonino Cipolla
- Department of Clinical and Experimental Medicine, University of Catania.
| | - Alba Borgese
- Department of Clinical and Experimental Medicine, University of Catania.
| | - Stefano Alia
- Respiratory Medicine Unit, Policlinico "G. Rodolico - San Marco" University Hospital, Catania, Italy.
| | - Nunzio Crimi
- Department of Clinical and Experimental Medicine, University of Catania.
| | - Claudia Crimi
- Respiratory Medicine Unit, Policlinico "G. Rodolico - San Marco" University Hospital, Catania.
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15
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Transnasal Humidified Rapid Insufflation Ventilatory Exchange (THRIVE) in type 1 thyroplasty. Am J Otolaryngol 2022; 43:103574. [DOI: 10.1016/j.amjoto.2022.103574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 07/31/2022] [Indexed: 11/22/2022]
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16
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Feng Z, Zhang L, Yu H, Su X, Shuai T, Zhu L, Chen D, Liu J. High-Flow Nasal Cannula Oxygen Therapy versus Non-Invasive Ventilation for AECOPD Patients After Extubation: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Int J Chron Obstruct Pulmon Dis 2022; 17:1987-1999. [PMID: 36065316 PMCID: PMC9440713 DOI: 10.2147/copd.s375107] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 08/22/2022] [Indexed: 11/23/2022] Open
Abstract
Objective To evaluate the clinical efficacy of high-flow nasal oxygen therapy (HFNC) and non-invasive ventilation (NIV) in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) after extubation. Research Methods This systematic review and meta-analysis was conducted following the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) statements. The primary outcome measures analyzed included: reintubation rate, mortality, complication rate, and ICU length of stay. Results Eight studies were included, with a total of 612 subjects, including 297 in the HFNC group and 315 in the NIV group. The effect of HFNC and NIV on the reintubation rate of AECOPD patients after extubation, RR (1.49 [95% CI,0.95 to 2.33], P = 0.082). Subgroup analysis with or without hypercapnia according to the included AECOPD population, with hypercapnia, RR (0.69 [95% CI,0.33 to 1.44], P=0.317), without hypercapnia, RR (2.61 [95% CI,1.41 to 4.83], P=0.002). Mortality, RR (0.92 [95% CI,0.56 to 1.52], P = 0.752). ICU length of stay, MD (−0.44 [95% CI,-1.01 to 0.13], P = 0.132). Complication rate, RR (0.22 [95% CI,0.13 to 0.39], P = 0.000). After subgroup analysis, the reintubation rate of HFNC and NIV has no statistical difference in patients with hypercapnia, but NIV can significantly reduce the reintubation rate in patients without hypercapnia. In the outcome measures of complication rate, HFNC significantly reduced complication rate compared with NIV. In mortality and ICU length of stay, analysis results showed that HFNC and NIV were not statistically different. Conclusion According to the available evidence, the application of HFNC can be used as an alternative treatment for NIV after extubation in AECOPD patients with hypercapnia, but in the patients without hypercapnia, HFNC is less effective than NIV.
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Affiliation(s)
- Zhouzhou Feng
- The First Clinical Medical College, Lanzhou University, Lanzhou City, Gansu Province, People’s Republic of China
| | - Lu Zhang
- The First Clinical Medical College, Lanzhou University, Lanzhou City, Gansu Province, People’s Republic of China
| | - Haichuan Yu
- The First Clinical Medical College, Lanzhou University, Lanzhou City, Gansu Province, People’s Republic of China
| | - Xiaojie Su
- The First Clinical Medical College, Lanzhou University, Lanzhou City, Gansu Province, People’s Republic of China
| | - Tiankui Shuai
- The First Clinical Medical College, Lanzhou University, Lanzhou City, Gansu Province, People’s Republic of China
| | - Lei Zhu
- The First Clinical Medical College, Lanzhou University, Lanzhou City, Gansu Province, People’s Republic of China
| | - De Chen
- The First Clinical Medical College, Lanzhou University, Lanzhou City, Gansu Province, People’s Republic of China
| | - Jian Liu
- The First Clinical Medical College, Lanzhou University, Lanzhou City, Gansu Province, People’s Republic of China
- Correspondence: Jian Liu, The first clinical medical college, Lanzhou University, Lanzhou City, Gansu Province, People’s Republic of China, Email
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17
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Wang BC, Lion RP, Avesar M, Abdala J, Deming DD, Wilson CG. Comparison of Local and Systemic Inflammation During Invasive Versus Noninvasive Ventilation in Rats. J Interferon Cytokine Res 2022; 42:343-348. [PMID: 35704907 DOI: 10.1089/jir.2022.0040] [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] [Indexed: 11/12/2022] Open
Abstract
The impact of noninvasive ventilation (NIV) on local and systemic inflammation is poorly characterized, particularly when compared with invasive mechanical ventilation (IMV). We sought to quantify the local and systemic inflammatory response of these 2 respiratory treatments in rats with lipopolysaccharide (LPS)-induced lung injury (LPS-injured) and healthy rats. Animals were subjected to 4 h of NIV or IMV treatments at noninjurious settings, or 4 h of control treatment in which healthy or LPS-injured animals remained spontaneously breathing under isoflurane anesthesia with no respiratory support. Cytokines were then quantified in the serum and lung tissue by multiplex enzyme-linked immunosorbent assay. Contrary to our hypothesis, there were no significant differences in cytokine levels in serum or lung when comparing the NIV- and IMV-treated groups; this was true in both LPS-injured and healthy rats. However, within the LPS-injured group, pulmonary levels of interleukin (IL)-1α, IL-6, and tumor necrosis factor α were significantly lower in the NIV-treated group than in control but not in the IMV-treated group compared with control. We conclude that NIV, unlike IMV, could attenuate local inflammation.
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Affiliation(s)
- Billy C Wang
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, OSF Children's Hospital of Illinois, Peoria, Illinois, USA
| | - Richard P Lion
- Department of Pediatrics, Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin/Dell Children's Medical Center, University of Texas Dell Medical School, Austin, Texas, USA
| | - Michael Avesar
- Division of Pediatric Critical Care Medicine, Loma Linda University Children's Hospital, Loma Linda, California, USA
| | - Jonathan Abdala
- Lawrence D. Longo, MD Center for Perinatal Biology, Loma Linda University School of Medicine, Loma Linda, California, USA
| | - Douglas D Deming
- Division of Neonatology, Loma Linda University Children's Hospital, Loma Linda, California, USA
| | - Christopher G Wilson
- Lawrence D. Longo, MD Center for Perinatal Biology, Loma Linda University School of Medicine, Loma Linda, California, USA
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18
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Nolasco S, Manti S, Leonardi S, Vancheri C, Spicuzza L. High-Flow Nasal Cannula Oxygen Therapy: Physiological Mechanisms and Clinical Applications in Children. Front Med (Lausanne) 2022; 9:920549. [PMID: 35721052 PMCID: PMC9203852 DOI: 10.3389/fmed.2022.920549] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 05/09/2022] [Indexed: 11/13/2022] Open
Abstract
High-flow nasal cannula (HFNC) oxygen therapy has rapidly become a popular modality of respiratory support in pediatric care. This is undoubtedly due to its ease of use and safety, which allows it to be used in a wide variety of settings, ranging from pediatric intensive care to patients' homes. HFNC devices make it possible to regulate gas flow and temperature, as well as allowing some nebulized drugs to be administered, features very useful in children, in which the balance between therapeutic effectiveness and adherence to treatment is pivotal. Although the physiological effects of HFNC are still under investigation, their mechanisms of action include delivery of fixed concentration of oxygen, generation of positive end-expiratory pressure, reduction of the work of breathing and clearance of the nasopharyngeal dead space, while providing optimal gas conditioning. Nevertheless, current evidence supports the use of HFNC mainly in moderate-to-severe bronchiolitis, whereas for asthma exacerbations and breath sleeping disorders there is a lack of randomized controlled trials comparing HFNC to continuous positive airway pressure (CPAP) and non-invasive ventilation (NIV), which are essentials for the identification of response and non-response predictors. In this regard, the development of clinical guidelines for HFNC, including flow settings, indications, and contraindications is urgently needed.
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Affiliation(s)
- Santi Nolasco
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
- *Correspondence: Santi Nolasco
| | - Sara Manti
- Pediatric Pulmonology Unit, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Salvatore Leonardi
- Pediatric Pulmonology Unit, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Carlo Vancheri
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Lucia Spicuzza
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
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19
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Girault C, Boyer D, Jolly G, Carpentier D, Béduneau G, Frat JP. Principes de fonctionnement, effets physiologiques et aspects pratiques de l’oxygénothérapie à haut débit. Rev Mal Respir 2022; 39:455-468. [DOI: 10.1016/j.rmr.2022.03.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 03/27/2022] [Indexed: 12/29/2022]
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20
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Crimi C, Pierucci P, Renda T, Pisani L, Carlucci A. High-Flow Nasal Cannula and COVID-19: A Clinical Review. Respir Care 2022; 67:227-240. [PMID: 34521762 PMCID: PMC9993935 DOI: 10.4187/respcare.09056] [Citation(s) in RCA: 48] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
During the coronavirus disease 2019 (COVID-19) pandemic, noninvasive respiratory support has played a central role in managing patients affected by moderate-to-severe acute hypoxemic respiratory failure, despite inadequate scientific evidence to support its usage. High-flow nasal cannula (HFNC) treatment has gained popularity because of its effectiveness in delivering a high fraction of humidified oxygen, which improves ventilatory efficiency and the respiratory pattern, as well as its reported high tolerability, ease of use, and application outside of ICUs. Nevertheless, the risk of infection transmission to health-care workers has raised some concerns about its use in the first wave of the pandemic outbreak, with controversial recommendations provided by different scientific societies. This narrative review provides an overview of the recent evidence on the physiologic rationale, risks, and benefits of using HFNC instead of conventional oxygen therapy and other types of noninvasive respiratory support devices, such as continuous positive airway pressure and noninvasive ventilation in patients affected by COVID-19 pneumonia with associated acute hypoxemic respiratory failure. It also summarizes the available evidence with regard to the clinical use of HFNC during the current pandemic and its reported outcomes, and highlights the risks of bioaerosol dispersion associated with HFNC use.
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Affiliation(s)
- Claudia Crimi
- Respiratory Medicine Unit, "Policlinico-Vittorio Emanuele-San Marco," University Hospital, Catania, Italy.
| | - Paola Pierucci
- Respiratory Medicine Unit, Policlinico "Aldo Moro" University Hospital, Bari, Italy
| | - Teresa Renda
- Respiratory and Critical Care Unit, Cardio-thoracic and Vascular Department, Careggi Teaching Hospital, Florence, Italy
| | - Lara Pisani
- Respiratory and Critical Care Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, University Hospital Sant'Orsola-Malpighi, Bologna, Italy
- Department of Clinical, Integrated and Experimental Medicine, Alma Mater Studiorum University, Bologna, Italy
| | - Annalisa Carlucci
- Department of Medicine and Surgery, Università Insubria, Varese-Como, Italy
- Pulmonary Rehabilitation Unit, Istituti Clinici Scientifici Maugeri, Pavia, Italy
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21
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Esteban-Zubero E, García-Muro C, Alatorre-Jiménez MA, Johal V, López-García CA, Marín-Medina A. High Flow Nasal Cannula Therapy in the Emergency Department: Main Benefits in Adults, Pediatric Population and against COVID-19: A Narrative Review. ACTA MEDICA (HRADEC KRALOVE, CZECH REPUBLIC) 2022; 65:45-52. [DOI: 10.14712/18059694.2022.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
This review aims to summarize the literature’s main results about high flow nasal cannula therapy (HFNC) HFNC benefits in the Emergency Department (ED) in adults and pediatrics, including new Coronavirus Disease (COVID-19). HFNC has recently been established as the usual treatment in the ED to provide oxygen support. Its use has been generalized due to its advantages over traditional oxygen therapy devices, including decreased nasopharyngeal resistance, washing out of the nasopharyngeal dead space, generation of positive pressure, increasing alveolar recruitment, easy adaptation due to the humidification of the airways, increased fraction of inspired oxygen and improved mucociliary clearance. A wide range of pathologies has been studied to evaluate the potential benefits of HFNC; some examples are heart failure, pneumonia, chronic pulmonary obstructive disease, asthma, and bronchiolitis. The regular use of this oxygen treatment is not established yet due to the literature’s controversial results. However, several authors suggest that it could be useful in several pathologies that generate acute respiratory failure. Consequently, the COVID-19 irruption has generated the question of HFNC as a safety and effective treatment. Our results suggested that HFNC seems to be a useful tool in the ED, especially in patients affected by acute hypoxemic respiratory failure, acute heart failure, pneumonia, bronchiolitis, asthma and acute respiratory distress syndrome in patients affected by COVID-19. Its benefits in hypercapnic respiratory failure are more discussed, being only observed benefits in patients with mild-moderate disease. These results are based in clinical as well as cost-effectiveness outcomes. Future studies with largest populations are required to confirm these results as well as establish a practical guideline to use this device.
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22
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Chao KY, Chien YH, Mu SC. High-flow nasal cannula in children with asthma exacerbation: A review of current evidence. Paediatr Respir Rev 2021; 40:52-57. [PMID: 33771473 DOI: 10.1016/j.prrv.2021.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 12/24/2020] [Accepted: 01/14/2021] [Indexed: 10/22/2022]
Abstract
Asthma is the commonest obstructive airway disease and the leading cause of morbidity in children. In the pediatric population, acute exacerbations of asthma are a frequent cause of presentations and hospital admissions. An acute asthma exacerbation is potentially life-threatening; it is predominantly treated using conventional oxygen therapy with bronchodilators and systemic corticosteroids. The treatment of those who do not respond to conventional therapy is escalated to noninvasive positive pressure ventilation (NIPPV) before invasive ventilation. Although NIPPV has demonstrated benefits and safety, it still has limitations such as treatment intolerance caused mainly by discomfort and complications. High-flow oxygen therapy administered through a nasal cannula (HFNC) provides respiratory support with adequate airway humidity and has demonstrated safety and benefits in clinical practice. In the present review, we discuss HFNC and variations in HFNC use, focusing on its feasibility and current evidence of using it on children with asthma exacerbations.
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Affiliation(s)
- Ke-Yun Chao
- Department of Respiratory Therapy, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City, Taiwan; School of Physical Therapy, Graduate Institute of Rehabilitation Sciences, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Hsuan Chien
- Department of Pediatrics, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Shu-Chi Mu
- Department of Pediatrics, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan; School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan.
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23
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Delorme M, Bouchard PA, Simard S, Lellouche F. Hygrometric Performances of Different High-Flow Nasal Cannula Devices: Bench Evaluation and Clinical Tolerance. Respir Care 2021; 66:1720-1728. [PMID: 34548410 PMCID: PMC9993542 DOI: 10.4187/respcare.09085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND High-flow nasal cannula (HFNC) is increasingly used for the management of respiratory failure. Settings include [Formula: see text], total gas flow, and temperature target. Resulting absolute humidity (AH) at the nasal cannula may affect clinical tolerance, and optimal settings with respect to hygrometry remain poorly documented. METHODS A bench study was designed to assess AH delivered by 4 HFNC devices (Optiflow, Airvo 2, Precision Flow, and Hydrate) according to flow, ambient temperature, and other available settings. Clinical tolerance of different levels of hygrometry (20, 30, and 40 mg H2O/L) was evaluated in 15 healthy volunteers. RESULTS With [Formula: see text] set at 1.0, normal ambient temperature, and settings made accordingly to the manufacturers' recommendations, mean ± SD AH was 42.2 ± 3.1, 39.5 ± 1.8, 35.7 ± 2.0, and 32.9 ± 2.7 mg H2O/L for the Airvo 2, Optiflow, Hydrate, and Precision Flow, respectively, (P < .001). AH dropped from -3.5 to -10.7 mg H2O/L (P <. 001) with high ambient temperature, except for the Precision Flow. Increasing flow did not significantly affect AH except for the Precision Flow (from 36.4 ± 1.6 to 29.8 ± 0.2 mg H2O/L at 10 and 40 L/min, respectively, [P < .001]). The lowest AH was encountered with the Optiflow set with noninvasive ventilation (NIV) mode, without compensation algorithm, and at high ambient temperature (14.2 ± 1.5 mg H2O/L). In studied subjects, AH significantly affected breathing comfort, reduced from 7.0 ± 1.0 to 3.0 ± 2.0 at 40 and 20 mg H2O/L, respectively, (P < .001). Comfort was similar at 30 and 40 mg H2O/L. CONCLUSIONS When used according to manufacturer's recommendations and at normal ambient temperature, all the HFNC devices evaluated achieved satisfactory hygrometric output with respect to breathing comfort evaluated in healthy subjects (≥ 30 mg H2O/L). Substantial differences exist between devices, and optimal knowledge of their working principles is required as inappropriate usage may dramatically alter efficacy and clinical tolerance.
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Affiliation(s)
- Mathieu Delorme
- Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec, Canada. Mr Delorme is affiliated with the Université Paris-Saclay, UVSQ, ERPHAN,Versailles, France
| | - Pierre-Alexandre Bouchard
- Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec, Canada. Mr Delorme is affiliated with the Université Paris-Saclay, UVSQ, ERPHAN,Versailles, France
| | - Serge Simard
- Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec, Canada. Mr Delorme is affiliated with the Université Paris-Saclay, UVSQ, ERPHAN,Versailles, France
| | - François Lellouche
- Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec, Canada. Mr Delorme is affiliated with the Université Paris-Saclay, UVSQ, ERPHAN,Versailles, France.
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24
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Oczkowski S, Ergan B, Bos L, Chatwin M, Ferrer M, Gregoretti C, Heunks L, Frat JP, Longhini F, Nava S, Navalesi P, Uğurlu AO, Pisani L, Renda T, Thille AW, Winck JC, Windisch W, Tonia T, Boyd J, Sotgiu G, Scala R. ERS Clinical Practice Guidelines: High-flow nasal cannula in acute respiratory failure. Eur Respir J 2021; 59:13993003.01574-2021. [PMID: 34649974 DOI: 10.1183/13993003.01574-2021] [Citation(s) in RCA: 82] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 08/13/2021] [Indexed: 11/05/2022]
Abstract
BACKGROUND High-flow nasal cannula (HFNC) has become a frequently used non-invasive form of respiratory support in acute settings, however evidence supporting its use has only recently emerged. These guidelines provide evidence-based recommendations for the use of HFNC alongside other noninvasive forms of respiratory support in adults with acute respiratory failure (ARF). MATERIALS AND METHODOLOGY The European Respiratory Society Task Force panel included expert clinicians and methodologists in pulmonology and intensive care medicine. The Task Force used the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) methods to summarize evidence and develop clinical recommendations for the use of HFNC alongside conventional oxygen therapy (COT) and non-invasive ventilation (NIV) for the management of adults in acute settings with ARF. RESULTS The Task Force developed 8 conditional recommendations, suggesting using: 1) HFNC over COT in hypoxemic ARF, 2) HFNC over NIV in hypoxemic ARF, 3)HFNC over COT during breaks from NIV, 4) either HFNC or COT in post-operative patients at low risk of pulmonary complications, 5) either HFNC or NIV in post-operative patients at high risk of pulmonary complications, 6) HFNC over COT in non-surgical patients at low risk of extubation failure, 7) NIV over HFNC for patients at high risk of extubation failure unless there are relative or absolute contraindications to NIV, 8) trialling NIV prior to use of HFNC in patients with chronic obstructive pulmonary disease (COPD) and hypercapnic ARF. CONCLUSIONS HFNC is a valuable intervention in adults with ARF. These conditional recommendations can assist clinicians in choosing the most appropriate form of non-invasive respiratory support to provide to patients in different acute settings.
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Affiliation(s)
- Simon Oczkowski
- Department of Medicine, Division of Critical Care, McMaster University, Hamilton, Ontario, Canada.,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.,co-first authors
| | - Begüm Ergan
- Department of Pulmonary and Critical Care, Dokuz Eylul University School of Medicine, Izmir, Turkey.,co-first authors
| | - Lieuwe Bos
- Department of Intensive Care & Laboratory of Experimental Intensive Care and Anesthesiology (LEICA), Amsterdam UMC, location Academic Medical Center, Amsterdam.,Respiratory Medicine, Amsterdam UMC, location Academic Medical Center, Amsterdam, The Netherlands
| | - Michelle Chatwin
- Academic and Clinical Department of Sleep and Breathing and NIHR Respiratory Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust, Sydney Street, London, UK
| | - Miguel Ferrer
- Dept of Pneumology, Respiratory Institute, Hospital Clinic, IDIBAPS, University of Barcelona and CIBERES, Barcelona, Spain
| | - Cesare Gregoretti
- Department of Surgical, Oncological and Oral Science University of Palermo, Palermo, Italy.,G.Giglio Institute, Cefalu', Italy
| | - Leo Heunks
- Department of Intensive Care Medicine, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands
| | - Jean-Pierre Frat
- Centre Hospitalier Universitaire de Poitiers, Médecine Intensive Réanimation, Poitiers, France.,INSERM Centre d'Investigation Clinique 1402 ALIVE, Université de Poitiers, Poitiers, France
| | - Federico Longhini
- Anesthesia and Intensive Care Unit, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Stefano Nava
- Alma Mater Studiorum University of Bologna, Dept of Clinical, Integrated and Experimental Medicine (DIMES), Bologna, Italy.,IRCCS Azienda Ospedaliero-Universitaria di Bologna, University Hospital Sant'Orsola-Malpighi - Respiratory and Critical Care Unit, Bologna, Italy
| | - Paolo Navalesi
- Anesthesia and Intensive Care, Padua University Hospital, University Hospital, Padua, Italy.,Department of Medicine -DIMED, University of Padua, Italy
| | | | - Lara Pisani
- Alma Mater Studiorum University of Bologna, Dept of Clinical, Integrated and Experimental Medicine (DIMES), Bologna, Italy.,IRCCS Azienda Ospedaliero-Universitaria di Bologna, University Hospital Sant'Orsola-Malpighi - Respiratory and Critical Care Unit, Bologna, Italy
| | - Teresa Renda
- Cardiothoracic and Vascular Department, Respiratory and Critical Care Unit, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy
| | - Arnaud W Thille
- Centre Hospitalier Universitaire de Poitiers, Médecine Intensive Réanimation, Poitiers, France.,INSERM Centre d'Investigation Clinique 1402 ALIVE, Université de Poitiers, Poitiers, France
| | | | - Wolfram Windisch
- Cologne Merheim Hospital, Dept of Pneumology, Kliniken der Stadt Köln, gGmbH, Witten/Herdecke University, Faculty of Health/School of Medicine, Köln, Germany
| | - Thomy Tonia
- Institute of Social and Preventive Medicine, University of Bern, Switzterland
| | - Jeanette Boyd
- European Lung Foundation (ELF), Sheffield, United Kingdom
| | - Giovanni Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical, Experimental Sciences, University of Sassari, Sassari, Italy
| | - Raffaele Scala
- Pulmonology and Respiratory Intensive Care Unit, Cardio-Thoraco-Neuro-vascular and Methabolic Department, Usl Toscana Sudest, S Donato Hospital, Arezzo, Italy.
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25
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Nasal High-Flow during Exercise in Patients with COPD: A Systematic Review and Meta-Analysis. Ann Am Thorac Soc 2021; 19:291-302. [PMID: 34644515 DOI: 10.1513/annalsats.202104-436sr] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Rationale Several studies have evaluated the effect of nasal high flow (NHF) to enhance exercise performance and tolerance in patients with COPD, however results are disparate. Objective The aim of this systematic review and meta-analysis was to assess the effect of NHF as an adjuvant to exercise training on functional exercise capacity in patients with COPD. Method An electronic search was carried out in the following databases: Pubmed, CENTRAL, PEDro, ScienceDirect, Web of Science, OpenGrey, ClinicalTrials.gov, European Respiratory Society and American Thoracic Society databases. Two authors independently selected relevant randomized trials (parallel group or cross-over design), extracted data, assessed the risk of bias and rated the quality of the evidence. Results Eleven studies were included, involving 408 participants (8 full papers and 3 conference abstracts). Most studies had a high risk of bias or other methodological limitations. The use of NHF during a single session increased functional exercise capacity (SMD 0.36 (95% CI 0.03 to 0.69) p=0.03, heterogeneity (I² 83 %)). When conference abstracts were included in the pooled analysis, the estimated effect did not change (p=0.006). The use of NHF throughout a pulmonary rehabilitation programme (parallel group RCTs) increased functional exercise capacity at 4 to 12 weeks compared with those who trained without NHF (SMD 0.34 (95% CI 0.00 to 0.68) p=0.05, heterogeneity (I² 18%)). Conclusion There is very low to low quality evidence that NHF improves functional exercise capacity. Patient responses to NHF therapy were highly variable and heterogeneous, with benefits ranging from clinically trivial to worthwhile. Registration (www.crd.york.ac.uk/prospero: CRD42021221550).
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26
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Ramesh M, Thomovsky E, Johnson P. Conventional versus high-flow oxygen therapy in dogs with lower airway injury. CANADIAN JOURNAL OF VETERINARY RESEARCH = REVUE CANADIENNE DE RECHERCHE VETERINAIRE 2021; 85:241-250. [PMID: 34602728 PMCID: PMC8451709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 05/02/2021] [Indexed: 06/13/2023]
Abstract
Dogs with lower airway pathology that present in respiratory distress often receive oxygen therapy as the first line of treatment regardless of the underlying cause. Conventional "low-flow" systems deliver oxygen with a maximum flow rate of 15 L/minute. Traditionally, when an animal's respiratory status does not improve with conventional oxygen therapy and treatments for underlying disease, options might be limited to either intubation and mechanical ventilation or humane euthanasia. High-flow oxygen therapy (HFOT) has been gaining popularity in veterinary medicine as an alternative route of oxygen supplementation for animals that require support beyond conventional therapy. High-flow oxygen therapy can supply a mixture of air and oxygen via a heated and humidified circuit. It is user friendly and can be used in an environment in which mechanical ventilation is unavailable. This review article is written for emergency doctors and general practitioners who lack access to mechanical ventilation. This article briefly reviews pertinent respiratory physiology, traditional oxygen supplementation techniques, the physiology of HFOT, and the limited evidence available in veterinary medicine regarding the use of HFOT, its applications, and limitations. Guidelines for the use of HFOT are suggested and HFOT is compared to conventional therapy.
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Affiliation(s)
- Meera Ramesh
- Department of Veterinary Clinical Sciences, Purdue University College of Veterinary Medicine, 625 Harrison Street, West Lafayette, Indiana, USA
| | - Elizabeth Thomovsky
- Department of Veterinary Clinical Sciences, Purdue University College of Veterinary Medicine, 625 Harrison Street, West Lafayette, Indiana, USA
| | - Paula Johnson
- Department of Veterinary Clinical Sciences, Purdue University College of Veterinary Medicine, 625 Harrison Street, West Lafayette, Indiana, USA
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27
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Kodera T, Takatera A, Morisawa T, Yonetani M. Pharyngeal pressure due to high-flow nasal cannula devices in preterm infants. Pediatr Int 2021; 63:1212-1217. [PMID: 33533081 DOI: 10.1111/ped.14630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 01/14/2021] [Accepted: 02/01/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND In infants, a high-flow nasal cannula (HFNC) generates continuous positive pressure on the upper airway. This study aimed to evaluate the association between pharyngeal pressure and flow rate, and the association between pharyngeal pressure and bodyweight for two types of HFNC devices commonly used in preterm infants: the Optiflow Junior, hereafter "FP" (Fisher & Paykel, Auckland, New Zealand), and the Precision Flow, hereafter "VT" (Vapotherm, Exeter, NH, USA). METHODS Pharyngeal pressure measurements were performed in 12 preterm infants who received HFNC support. Flow rates of 1 to 4 L/kg/min were studied. RESULTS The median weight at the time of measurement was 1,290 g (range, 953-1,932 g). The FP was used in eight infants and the VT in four. In both of the groups, the flow rate and pharyngeal pressure appeared to be positively correlated except for the premature cannula in the FP group. At a flow rate of ≥2 L/kg/min, there was a positive correlation between the bodyweight and pharyngeal pressure in infants with premature and neonatal cannulas in the FP group. Conversely, at the same flow rate, there was a negative correlation between the bodyweight and pharyngeal pressure in infants with a SOLO cannula in the VT group. CONCLUSIONS In preterm infants, the flow rate and pharyngeal pressure were positively correlated in many HFNC cannulas. However, the pharyngeal pressure and bodyweight appeared to be positively and negatively correlated in the FP and VT groups, respectively. Future studies with larger sample sizes should further investigate this issue.
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Affiliation(s)
- Takayuki Kodera
- Department of Pediatrics, Kakogawa Central City Hospital, Kakogawa, Hyogo, Japan.,Department of Pediatrics, Kurashiki Central Hospital, Okayama, Hyogo, Japan
| | - Akihiro Takatera
- Department of Pediatrics, Kakogawa Central City Hospital, Kakogawa, Hyogo, Japan
| | - Takeshi Morisawa
- Department of Pediatrics, Kakogawa Central City Hospital, Kakogawa, Hyogo, Japan
| | - Masahiko Yonetani
- Department of Pediatrics, Kakogawa Central City Hospital, Kakogawa, Hyogo, Japan
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28
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Kovatis KZ, Locke RG, Mackley AB, Subedi K, Shaffer TH. Adjustment of high flow nasal cannula rates using real-time work of breathing indices in premature infants with respiratory insufficiency. J Perinatol 2021; 41:1711-1717. [PMID: 33664469 PMCID: PMC8867510 DOI: 10.1038/s41372-021-00977-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 12/03/2020] [Accepted: 01/28/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To assess the feasibility of real-time monitoring of work of breathing (WOB) indices and the impact of adjusting HFNC flow on breathing synchrony and oxygen stability in premature infants. STUDY DESIGN A prospective, observational study of infants stable on HFNC. The flow adjusted per predetermined algorithm. Respiratory inductive plethysmography (RIP) noninvasively measured WOB. A high-resolution pulse oximeter collected oxygen saturation and heart rate data. Summary statistics and mixed linear models were used. RESULTS Baseline data for 32 infants, final analysis of 21 infants. Eighty-one percent with abnormal WOB. Sixty-two percent demonstrated 20% improvement in WOB. For infants with gestational age <28 weeks, an incremental increase in HFNC flow rate decreased WOB (p < 0.001) and improved oxygen saturation and stability (p < 0.01). CONCLUSIONS Premature infants do not receive optimal support on HFNC. The use of a real-time feedback system to adjust HFNC is feasible and improves WOB, oxygen saturation, and oxygen stability. This technology may improve the utility of HFNC in premature infants.
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Affiliation(s)
- Kelley Z Kovatis
- Department of Neonatology, ChristianaCare, Newark, DE, United States.
- Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States.
| | - Robert G Locke
- Department of Neonatology, ChristianaCare, Newark, DE, United States
- Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States
| | - Amy B Mackley
- Department of Neonatology, ChristianaCare, Newark, DE, United States
| | - Keshab Subedi
- Value Institute, ChristianaCare, Newark, DE, United States
| | - Thomas H Shaffer
- Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States
- Nemours Biomedical Research, Alfred I. DuPont Hospital for Children, Wilmington, DE, United States
- Lewis Katz School of Medicine, Temple University, Philadelphia, PA, United States
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29
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Singh A, Khanna P, Sarkar S. High-Flow Nasal Cannula, a Boon or a Bane for COVID-19 Patients? An Evidence-Based Review. CURRENT ANESTHESIOLOGY REPORTS 2021; 11:101-106. [PMID: 33679254 PMCID: PMC7921283 DOI: 10.1007/s40140-021-00439-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2021] [Indexed: 01/08/2023]
Abstract
PURPOSE OF REVIEW This review instantiates the efficacy and safety of HFNC in the context of COVID-19 pandemic. RECENT FINDINGS Globally, the healthcare system is facing an unprecedented crisis of resources due to the 2019 novel coronavirus disease (COVID-19) pandemic. Fever, cough, dyspnea, myalgia, fatigue, and pneumonia are the most common symptoms associated with it. The incidence of invasive mechanical ventilation in ICU patients ranges from 29.1 to 89.9%. Supplemental oxygen therapy is the main stay treatment for managing hypoxemic respiratory failure. The high-flow nasal cannula (HFNC) is a novel non-invasive strategy for better oxygenation and ventilation in critically ill patients. In this grim scenario, a reduction in mechanical ventilation by means of HFNC is of prime interest. SUMMARY HFNC is considered an aerosol-generating intervention with the risk of viral aerosolization with a concern of potential nosocomial transmission of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2). However, there is no consensus regarding the use of HFNC in novel coronavirus-infected pneumonia (NCIP). HFNC seems to be an effective and safe treatment modality in acute respiratory failure with optimal settings and selection of ideal patients.
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Affiliation(s)
- Abhishek Singh
- Department of Anaesthesia, Pain Medicine and Critical Care, All India Institute of Medical Sciences (AIIMS), Ansari Nagar, New Delhi, 110029 India
| | - Puneet Khanna
- Department of Anaesthesia, Pain Medicine and Critical Care, All India Institute of Medical Sciences (AIIMS), Ansari Nagar, New Delhi, 110029 India
| | - Soumya Sarkar
- Department of Anaesthesia, Pain Medicine and Critical Care, All India Institute of Medical Sciences (AIIMS), Ansari Nagar, New Delhi, 110029 India
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30
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Li XY, Tang X, Wang R, Yuan X, Zhao Y, Wang L, Li HC, Chu HW, Li J, Mao WP, Wang YJ, Tian ZH, Liu JH, Luo Q, Sun B, Tong ZH. High-Flow Nasal Cannula for Chronic Obstructive Pulmonary Disease with Acute Compensated Hypercapnic Respiratory Failure: A Randomized, Controlled Trial. Int J Chron Obstruct Pulmon Dis 2020; 15:3051-3061. [PMID: 33262584 PMCID: PMC7699989 DOI: 10.2147/copd.s283020] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 11/16/2020] [Indexed: 11/23/2022] Open
Abstract
Introduction Currently, there is a lack of evidence on the utilization of high-flow nasal cannula (HFNC) in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) accompanied by hypercapnic respiratory failure. We aimed to explore the efficacy and safety of HFNC compared with conventional oxygen therapy (COT) in such patients. Methods This was a prospective, randomized, controlled trial. Patients with AECOPD with a baseline arterial blood gas pH ≥7.35, PaO2 <60 mmHg, and PaCO2 >45 mmHg were enrolled. The primary endpoint was treatment failure, which needs mechanical ventilation. Results A total of 320 patients were randomized to either the HFNC group (n = 160) or the COT group (n = 160). Sixteen (10.0%) patients in the HFNC group had treatment failure during hospitalization, which was significantly lower than the COT group figure of 31 (19.4%) patients (p = 0.026). Twenty-four hours after recruitment, the PaCO2 of the HFNC group was lower than that of the COT group (54.1 ± 9.79 mmHg vs 56.9 ± 10.1 mmHg, p = 0.030). PaCO2 higher than 59 mmHg after HFNC for 24 h was identified as an independent risk factor for treatment failure [OR 1.078, 95% CI 1.006–1.154, p = 0.032]. Conclusion In AECOPD patients with acute compensated hypercapnic respiratory failure, HFNC improved the prognosis compared with COT. Therefore, HFNC might be considered for first-line oxygen therapy in select patients. Trial Registration Number ClinicalTrials.Gov: NCT02439333.
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Affiliation(s)
- Xu-Yan Li
- Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, People's Republic of China.,Beijing Institute of Respiratory Medicine, Beijing, People's Republic of China.,Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing, People's Republic of China.,Beijing Engineering Research Centre for Diagnosis and Treatment of Respiratory and Critical Care Medicine (Beijing Chao-Yang Hospital), Beijing, People's Republic of China
| | - Xiao Tang
- Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, People's Republic of China.,Beijing Institute of Respiratory Medicine, Beijing, People's Republic of China.,Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing, People's Republic of China.,Beijing Engineering Research Centre for Diagnosis and Treatment of Respiratory and Critical Care Medicine (Beijing Chao-Yang Hospital), Beijing, People's Republic of China
| | - Rui Wang
- Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, People's Republic of China.,Beijing Institute of Respiratory Medicine, Beijing, People's Republic of China.,Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing, People's Republic of China.,Beijing Engineering Research Centre for Diagnosis and Treatment of Respiratory and Critical Care Medicine (Beijing Chao-Yang Hospital), Beijing, People's Republic of China
| | - Xue Yuan
- Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, People's Republic of China.,Beijing Institute of Respiratory Medicine, Beijing, People's Republic of China.,Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing, People's Republic of China.,Beijing Engineering Research Centre for Diagnosis and Treatment of Respiratory and Critical Care Medicine (Beijing Chao-Yang Hospital), Beijing, People's Republic of China
| | - Yu Zhao
- Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, People's Republic of China.,Beijing Institute of Respiratory Medicine, Beijing, People's Republic of China.,Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing, People's Republic of China.,Beijing Engineering Research Centre for Diagnosis and Treatment of Respiratory and Critical Care Medicine (Beijing Chao-Yang Hospital), Beijing, People's Republic of China
| | - Li Wang
- Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, People's Republic of China.,Beijing Institute of Respiratory Medicine, Beijing, People's Republic of China.,Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing, People's Republic of China.,Beijing Engineering Research Centre for Diagnosis and Treatment of Respiratory and Critical Care Medicine (Beijing Chao-Yang Hospital), Beijing, People's Republic of China
| | - Hai-Chao Li
- Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, People's Republic of China.,Beijing Institute of Respiratory Medicine, Beijing, People's Republic of China.,Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing, People's Republic of China.,Beijing Engineering Research Centre for Diagnosis and Treatment of Respiratory and Critical Care Medicine (Beijing Chao-Yang Hospital), Beijing, People's Republic of China
| | - Hui-Wen Chu
- Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, People's Republic of China.,Beijing Institute of Respiratory Medicine, Beijing, People's Republic of China.,Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing, People's Republic of China.,Beijing Engineering Research Centre for Diagnosis and Treatment of Respiratory and Critical Care Medicine (Beijing Chao-Yang Hospital), Beijing, People's Republic of China
| | - Jie Li
- Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital-West Branch, Beijing, People's Republic of China
| | - Wen-Ping Mao
- Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital-West Branch, Beijing, People's Republic of China
| | - Yu-Jun Wang
- Department of Respiratory and Critical Care Medicine, Beijing Huai-Rou Hospital of University of Chinese Academy of Science, Beijing, People's Republic of China
| | - Zhan-Hong Tian
- Department of Respiratory and Critical Care Medicine, Beijing Huai-Rou Hospital of University of Chinese Academy of Science, Beijing, People's Republic of China
| | - Jian-Hua Liu
- Department of Respiratory and Critical Care Medicine, Beijing Huai-Rou Hospital of University of Chinese Academy of Science, Beijing, People's Republic of China
| | - Qin Luo
- Department of Respiratory Neurology, Cancer Hospital of Xinjiang Medical University, Urumqi, Xinjiang Uygur Autonomous Region, People's Republic of China
| | - Bing Sun
- Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, People's Republic of China.,Beijing Institute of Respiratory Medicine, Beijing, People's Republic of China.,Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing, People's Republic of China.,Beijing Engineering Research Centre for Diagnosis and Treatment of Respiratory and Critical Care Medicine (Beijing Chao-Yang Hospital), Beijing, People's Republic of China
| | - Zhao-Hui Tong
- Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, People's Republic of China.,Beijing Institute of Respiratory Medicine, Beijing, People's Republic of China.,Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing, People's Republic of China.,Beijing Engineering Research Centre for Diagnosis and Treatment of Respiratory and Critical Care Medicine (Beijing Chao-Yang Hospital), Beijing, People's Republic of China
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31
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Klotz D, Seifert V, Baumgartner J, Teufel U, Fuchs H. High-flow nasal cannula vs standard respiratory care in pediatric procedural sedation: A randomized controlled pilot trial. Pediatr Pulmonol 2020; 55:2706-2712. [PMID: 32696598 DOI: 10.1002/ppul.24975] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 07/08/2020] [Accepted: 07/17/2020] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Respiratory instability is frequently observed during pediatric procedural sedation. The aim of this trial was to estimate the impact of high-flow nasal cannula (HFNC) therapy on respiratory stability during sedation for upper gastrointestinal tract endoscopy in children. METHODS Prospective randomized controlled non-blinded single-center pilot trial. Children were randomly allocated to receive either HFNC (2 L/kg/min) or low-flow nasal oxygen cannula (LFNC, standard care). FiO2 was titrated to maintain SpO2 94% to 98% in both groups. Primary outcome was the number of events of respiratory instability defined by prespecified criteria (hypoxia, hypercapnia, apnea). Secondary outcomes included type and duration of events, number of interventions to regain respiratory stability and cumulative doses of medication. RESULTS Fifty children (mean age, 12.3 ± 3.1 years) were enrolled and treated with HFNC (n = 25) or LFNC (n = 25). Patient and intervention characteristics were not different in the two study groups, including total oxygen flow rate. Mean (SD) number of respiratory events in the HFNC group was 2.0 ± 1.9 events compared to 2.0 ± 1.4 events in the LFNC group (P = .65; 95% CI of difference, -1.0 to 1.0). There was no difference for any secondary outcome criteria, percentage of patients for any outcome criteria and no difference in the number of respiratory events or airway management maneuvers per patient between treatment groups. CONCLUSIONS HFNC did not increase respiratory stability in sedated children undergoing upper gastrointestinal tract endoscopy compared to LFNC.
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Affiliation(s)
- Daniel Klotz
- Division of Neonatology and Pediatric Intensive Care Medicine, Center for Pediatrics and Adolescent Medicine, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Viktor Seifert
- Division of Neonatology and Pediatric Intensive Care Medicine, Center for Pediatrics and Adolescent Medicine, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jana Baumgartner
- Division of Neonatology and Pediatric Intensive Care Medicine, Center for Pediatrics and Adolescent Medicine, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Ulrike Teufel
- Department of Gastroenterology, Center for Pediatrics and Adolescent Medicine, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Hans Fuchs
- Division of Neonatology and Pediatric Intensive Care Medicine, Center for Pediatrics and Adolescent Medicine, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Vasan A, Weekes R, Connacher W, Sieker J, Stambaugh M, Suresh P, Lee DE, Mazzei W, Schlaepfer E, Vallejos T, Petersen J, Merritt S, Petersen L, Friend J. MADVent: A low-cost ventilator for patients with COVID-19. ACTA ACUST UNITED AC 2020; 3:e10106. [PMID: 32838208 PMCID: PMC7300530 DOI: 10.1002/mds3.10106] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 05/25/2020] [Accepted: 05/26/2020] [Indexed: 01/08/2023]
Abstract
The COVID‐19 pandemic has produced critical shortages of ventilators worldwide. There is an unmet need for rapidly deployable, emergency‐use ventilators with sufficient functionality to manage COVID‐19 patients with severe acute respiratory distress syndrome. Here, we show the development and validation of a simple, portable and low‐cost ventilator that may be rapidly manufactured with minimal susceptibility to supply chain disruptions. This single‐mode continuous, mandatory, closed‐loop, pressure‐controlled, time‐terminated emergency ventilator offers robust safety and functionality absent in existing solutions to the ventilator shortage. Validated using certified test lungs over a wide range of compliances, pressures, volumes and resistances to meet U.S. Food and Drug Administration standards of safety and efficacy, an Emergency Use Authorization is in review for this system. This emergency ventilator could eliminate controversial ventilator rationing or splitting to serve multiple patients. All design and validation information is provided to facilitate ventilator production even in resource‐limited settings.
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Affiliation(s)
- Aditya Vasan
- Medically Advanced Devices Laboratory Center for Medical Devices Department of Mechanical and Aerospace Engineering Jacobs School of Engineering and Department of Surgery School of Medicine University of California San Diego La Jolla CA 92093 USA
| | - Reiley Weekes
- Medically Advanced Devices Laboratory Center for Medical Devices Department of Mechanical and Aerospace Engineering Jacobs School of Engineering and Department of Surgery School of Medicine University of California San Diego La Jolla CA 92093 USA
| | - William Connacher
- Medically Advanced Devices Laboratory Center for Medical Devices Department of Mechanical and Aerospace Engineering Jacobs School of Engineering and Department of Surgery School of Medicine University of California San Diego La Jolla CA 92093 USA
| | - Jeremy Sieker
- School of Medicine University of California San Diego La Jolla CA 92093 USA
| | - Mark Stambaugh
- Qualcomm Institute University of California San Diego La Jolla CA 92093 USA
| | - Preetham Suresh
- Department of Anaesthesiology School of Medicine University of California San Diego La Jolla CA 92093 USA
| | - Daniel E Lee
- Department of Anaesthesiology and Department of Paediatrics School of Medicine University of California San Diego La Jolla CA 92093 USA
| | - William Mazzei
- Department of Anaesthesiology School of Medicine University of California San Diego La Jolla CA 92093 USA
| | | | - Theodore Vallejos
- Department of Respiratory Care School of Medicine University of California San Diego La Jolla CA 92093 USA
| | - Johan Petersen
- Department of Anaesthesiology School of Medicine University of California San Diego La Jolla CA 92093 USA
| | - Sidney Merritt
- Department of Anaesthesiology School of Medicine University of California San Diego La Jolla CA 92093 USA
| | - Lonnie Petersen
- Medically Advanced Devices Laboratory Center for Medical Devices Department of Mechanical and Aerospace Engineering Jacobs School of Engineering and Department of Radiology School of Medicine University of California San Diego La Jolla CA 92093 USA
| | - James Friend
- Medically Advanced Devices Laboratory Center for Medical Devices Department of Mechanical and Aerospace Engineering Jacobs School of Engineering and Department of Surgery School of Medicine University of California San Diego La Jolla CA 92093 USA
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Zhu Y, Mosko JJ, Chidekel A, Wolfson MR, Shaffer TH. Effects of xenon gas on human airway epithelial cells during hyperoxia and hypothermia. J Neonatal Perinatal Med 2020; 13:469-476. [PMID: 32444566 PMCID: PMC7836053 DOI: 10.3233/npm-190364] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Hypothermia with xenon gas has been used to reduce brain injury and disability rate after perinatal hypoxia-ischemia. We evaluated xenon gas therapy effects in an in vitro model with or without hypothermia on cultured human airway epithelial cells (Calu-3). METHODS Calu-3 monolayers were grown at an air-liquid interface and exposed to one of the following conditions: 1) 21% FiO2 at 37°C (control); 2) 45% FiO2 and 50% xenon at 37°C; 3) 21% FiO2 and 50% xenon at 32°C; 4) 45% FiO2 and 50% xenon at 32°C for 24 hours. Transepithelial resistance (TER) measurements were performed and apical surface fluids were collected and assayed for total protein, IL-6, and IL-8. Three monolayers were used for immunofluorescence localization of zonula occludens-1 (ZO-1). The data were analyzed by one-way ANOVA. RESULTS TER decreased at 24 hours in all treatment groups. Xenon with hyperoxia and hypothermia resulted in greatest decrease in TER compared with other groups. Immunofluorescence localization of ZO-1 (XY) showed reduced density of ZO-1 rings and incomplete ring-like staining in the 45% FiO2- 50% xenon group at 32°C compared with other groups. Secretion of total protein was not different among groups. Secretion of IL-6 in 21% FiO2 with xenon group at 32°C was less than that of the control group. The secretion of IL-8 in 45% FiO2 with xenon at 32°C was greater than that of other groups. CONCLUSION Hyperoxia and hypothermia result in detrimental epithelial cell function and inflammation over 24-hour exposure. Xenon gas did not affect cell function or reduce inflammation.
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Affiliation(s)
- Y Zhu
- Center for Pediatric Lung Research, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE
| | - J J Mosko
- Center for Pediatric Lung Research, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE
| | - A Chidekel
- Center for Pediatric Lung Research, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE.,Department of Pediatrics, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE
| | - M R Wolfson
- Departments of Physiology and Pediatrics, Department of Thoracic Medicine and Surgery, CENTRe: Collaborative for Environmental and Neonatal Therapeutics Research, Center for Inflammation and Translational Clinical Lung Research, Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - T H Shaffer
- Center for Pediatric Lung Research, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE.,Departments of Physiology and Pediatrics, Department of Thoracic Medicine and Surgery, CENTRe: Collaborative for Environmental and Neonatal Therapeutics Research, Center for Inflammation and Translational Clinical Lung Research, Lewis Katz School of Medicine at Temple University, Philadelphia, PA
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Bruni A, Garofalo E, Cammarota G, Murabito P, Astuto M, Navalesi P, Luzza F, Abenavoli L, Longhini F. High Flow Through Nasal Cannula in Stable and Exacerbated Chronic Obstructive Pulmonary Disease Patients. Rev Recent Clin Trials 2020; 14:247-260. [PMID: 31291880 DOI: 10.2174/1574887114666190710180540] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 06/19/2019] [Accepted: 06/20/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND High-Flow through Nasal Cannula (HFNC) is a system delivering heated humidified air-oxygen mixture at a flow up to 60 L/min. Despite increasing evidence in hypoxemic acute respiratory failure, a few is currently known in chronic obstructive pulmonary disease (COPD) patients. OBJECTIVE To describe the rationale and physiologic advantages of HFNC in COPD patients, and to systematically review the literature on the use of HFNC in stable and exacerbated COPD patients, separately. METHODS A search strategy was launched on MEDLINE. Two authors separately screened all potential references. All (randomized, non-randomized and quasi-randomized) trials dealing with the use of HFNC in both stable and exacerbated COPD patients in MEDLINE have been included in the review. RESULTS Twenty-six studies have been included. HFNC: 1) provides heated and humidified airoxygen admixture; 2) washes out the anatomical dead space of the upper airway; 3) generates a small positive end-expiratory pressure; 4) guarantees a more stable inspired oxygen fraction, as compared to conventional oxygen therapy (COT); and 5) is more comfortable as compared to both COT and non-invasive ventilation (NIV). In stable COPD patients, HFNC improves gas exchange, the quality of life and dyspnea with a reduced cost of muscle energy expenditure, compared to COT. In exacerbated COPD patients, HFNC may be an alternative to NIV (in case of intolerance) and to COT at extubation or NIV withdrawal. CONCLUSION Though evidence of superiority still lacks and further studies are necessary, HFNC might play a role in the treatment of both stable and exacerbated COPD patients.
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Affiliation(s)
- Andrea Bruni
- Department of Medical and Surgical Sciences, Intensive Care Unit, University Hospital Mater Domini, Magna Graecia University, Catanzaro, Italy
| | - Eugenio Garofalo
- Department of Medical and Surgical Sciences, Intensive Care Unit, University Hospital Mater Domini, Magna Graecia University, Catanzaro, Italy
| | - Gianmaria Cammarota
- Anesthesia and Intensive Care, "Maggiore della Carita" Hospital, Novara, Italy
| | - Paolo Murabito
- Department of Anesthesia and Intensive Care, A.O.U. "Policlinico -Vittorio Emanuele", Catania, Italy
| | - Marinella Astuto
- Department of Anesthesia and Intensive Care, A.O.U. "Policlinico -Vittorio Emanuele", Catania, Italy
| | - Paolo Navalesi
- Department of Medical and Surgical Sciences, Intensive Care Unit, University Hospital Mater Domini, Magna Graecia University, Catanzaro, Italy
| | - Francesco Luzza
- Department of Health Sciences, University of Catanzaro "Magna Graecia", Viale Europa, 88100 Catanzaro, Italy
| | - Ludovico Abenavoli
- Department of Health Sciences, University of Catanzaro "Magna Graecia", Viale Europa, 88100 Catanzaro, Italy
| | - Federico Longhini
- Department of Medical and Surgical Sciences, Intensive Care Unit, University Hospital Mater Domini, Magna Graecia University, Catanzaro, Italy
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Vézina K, Dipchand AI, Narang I. High-flow nasal cannula for the treatment of life-threatening plastic bronchitis. Pediatr Pulmonol 2020; 55:E1-E2. [PMID: 32068971 DOI: 10.1002/ppul.24695] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 02/01/2020] [Indexed: 11/10/2022]
Abstract
Plastic bronchitis (PB) is characterized by the formation of bronchial casts. It most frequently occurs in children with congenital heart disease, particularly post-Fontan procedure. Several medical and surgical therapies have been described in the literature with variable success. To our knowledge, this is the first time that overnight use of home high-flow nasal cannula is reported as a therapy to prevent recurrence of bronchial cast production in a child with PB post-Fontan.
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Affiliation(s)
- Kevin Vézina
- Division of Respiratory Medicine, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Anne I Dipchand
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Indra Narang
- Division of Respiratory Medicine, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
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High-Flow Nasal Cannula: A Promising Oxygen Therapy for Patients with Severe Bronchial Asthma Complicated with Respiratory Failure. Can Respir J 2020; 2020:2301712. [PMID: 32211084 PMCID: PMC7054795 DOI: 10.1155/2020/2301712] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 01/14/2020] [Accepted: 01/20/2020] [Indexed: 11/29/2022] Open
Abstract
Severe bronchial asthma complicated with respiratory failure, a common critical illness in respiratory medicine, may be life-threatening. High-flow nasal cannula (HFNC) is a novel oxygen therapy technique developed in recent years. HFNC was applied in this study for treating adult patients with severe bronchial asthma complicated with respiratory failure. Its efficacy was analyzed comparatively to conventional oxygen therapy (COT). HFNC and COT were randomly performed based on conventional treatment. The HFNC group was similar to COT-treated patients in terms of response rate, with no significant difference in efficacy between the two groups. In patients with bronchial asthma, effectively increased PO2 and reduced PCO2 were observed after treatment in both groups. However, HFNC was more efficient than COT in elevating PO2 in patients with severe bronchial asthma complicated with respiratory failure, while no statistically significant difference in PCO2 reduction was found between the two groups. Heart rate (HR) and respiratory rate (RR) between the two groups on admission (0 h) and at 2, 8, 24, and 48 h after admission were compared. Both indicators significantly decreased with time. No significant differences in HR and RR were found between the groups at 0, 2, and 8 h after admission. However, these indicators were significantly lower in the HFNC group compared with the COT group at 24 and 48 h after admission. HFNC could significantly elevate PO2 and reduce HR and RR. Thus, it is a promising option for patients with severe bronchial asthma complicated with respiratory failure.
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Bush D, Juliano C, Laitman BM, Londino A, Spencer C. A Comprehensive, Multidisciplinary Approach to the Evaluation of the Neonatal Airway. CURRENT PEDIATRICS REPORTS 2019. [DOI: 10.1007/s40124-019-00199-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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High Flow Nasal Cannula: A Game Changer in Airway Surgery. Indian J Otolaryngol Head Neck Surg 2019; 71:299-303. [PMID: 31559194 DOI: 10.1007/s12070-019-01717-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 07/11/2019] [Indexed: 10/26/2022] Open
Abstract
High flow nasal cannula (HFNC) delivers humidified oxygen at high flow. Its use during airway procedures has many advantages. The study was done to determine the duration of apnea time, safety and compatibility with laser, while using HFNC during airway procedures. A prospective study was done at a tertiary care hospital between March 2017 and August 2017 on 16 patients. HFNC was used during airway surgeries for various pathologies. There were 11 males and 5 females. The patient age ranged from 4 days to 28 years. HFNC provided an unobstructed view of the surgical field, laser could be used safely, there was an increase in the apnea window, and post-operative symptoms like throat irritation and cough were infrequent. Usage of HFNC provides an unobstructed view of the surgical field and reduces post-operative discomfort. It helps in difficult airway situations by optimizing oxygenation and increasing the apnea time.
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Physiopathological rationale of using high-flow nasal therapy in the acute and chronic setting: A narrative review. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2019. [DOI: 10.1016/j.tacc.2019.02.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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40
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Chen DY, Zee ED, Gildengorin G, Fong EW. A pilot study of heated and humidified low flow oxygen therapy: An assessment in infants with mild and moderate bronchiolitis (HHOT AIR study). Pediatr Pulmonol 2019; 54:620-627. [PMID: 30887708 DOI: 10.1002/ppul.24267] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 12/19/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND Heated and humidified high flow nasal cannula oxygen therapy has been used in children with severe bronchiolitis. No data exists in children with mild to moderate bronchiolitis requiring lower flows of heated and humidified oxygen therapy. METHODS We conducted a prospective, randomized pilot study of standard dry oxygen (control) versus heated and humidified low flow nasal cannula (HHLFNC), <4 liters per minute (LPM) oxygen, (treatment) in healthy children ≤24 months old with bronchiolitis. Clinical assessments were made using Respiratory Distress Assessment Instrument (RDAI), respiratory rate (RR), and oxygen saturation. RESULTS Thirty-two children were enrolled (16 participants in each group). There was no significant difference in mean RDAI over time between groups. There was a significant difference in mean RDAI over time within control group, at hour 12, and treatment group, at hour 1, compared to baseline. RDAI in the treatment group was overall lower over time compared to control group. There was no significant difference in mean RR over time between or within groups, between mean length of stay and duration of oxygen requirement. Subgroup analyses showed lower RDAI in subjects that had RSV infection, male gender, and non-black race. CONCLUSIONS The use of HHLFNC oxygen therapy may provide more comfort and may result in more rapid improvements in RDAI compared to standard dry oxygen therapy over time. HHFLNC is safe and well tolerated compared to standard dry oxygen. Larger studies are needed to assess the clinical efficacy of HHLFNC oxygen therapy.
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Affiliation(s)
- Diana Y Chen
- Department of Pediatrics, Division of Pediatric Pulmonology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Eric D Zee
- Department of Pediatrics, Division of Pulmonology, Stanford University School of Medicine, Palo Alto, California
| | - Ginny Gildengorin
- Department of Statistics, UCSF Benioff Children's Hospital, Oakland, California
| | - Edward W Fong
- Department of Pediatrics, Section of Pediatric Pulmonology, Kapiolani Medical Center for Women and Children, Honolulu, Hawaii
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Jing G, Li J, Hao D, Wang T, Sun Y, Tian H, Fu Z, Zhang Y, Wang X. Comparison of high flow nasal cannula with noninvasive ventilation in chronic obstructive pulmonary disease patients with hypercapnia in preventing postextubation respiratory failure: A pilot randomized controlled trial. Res Nurs Health 2019; 42:217-225. [PMID: 30887549 DOI: 10.1002/nur.21942] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 01/11/2019] [Accepted: 02/22/2019] [Indexed: 12/27/2022]
Abstract
High flow nasal cannula (HFNC) has been shown to improve extubation outcomes in patients with hypoxemia, but the role of HFNC in weaning patients with chronic obstructive pulmonary disease (COPD) with hypercapnia from invasive ventilation is unclear. We compared the effects of HFNC to noninvasive ventilation (NIV) on postextubation vital signs and arterial blood gases (ABGs) among patients with COPD. Other outcomes included comfort scores, need for bronchoscopy, use of pulmonary medications, and chest physiotherapy. Forty-two COPD patients who had persistent hypercapnia at extubation were assigned randomly to receive HFNC (22) or NIV (20). Twenty patients in each group were enrolled for per-protocol analysis with regard to primary outcomes. Vital signs and ABGs before extubation were similar between groups. At 3 hr after extubation, pH in the NIV group was lower than HFNC group (7.42 ± 0.06 vs. 7.45 ± 0.05, p = 0.01). At 24 hr after extubation, patients' mean arterial pressure (82.97 ± 9.04 vs. 92.06 ± 11.11 mmHg, p = 0.05) and pH (7.42 ± 0.05 vs. 7.46 ± 0.03, p = 0.05) in the NIV group were lower than in the HFNC group. No significant differences were found at 48 hr after extubation. In the HFNC group, comfort scores were better (3.55 ± 2.01 vs. 5.15 ± 2.28, p = 0.02) and fewer patients needed bronchoscopy for secretion management within 48 hr after extubation (2/22 vs. 9/20, p = 0.03). HFNC is a potential alternative to NIV to wean hypercapnic COPD patients with regard to vital signs and ABGs, HFNC improved patients' comfort and secretion clearance.
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Affiliation(s)
- Guoqiang Jing
- Department of Pulmonary and Critical Care Medicine, Binzhou Medical University Hospital, Binzhou Medical University, Binzhou, China
| | - Jie Li
- Department of Cardiopulmonary Sciences, Division of Respiratory Care, Rush University Medical Center, Chicago, Illinois
| | - Dong Hao
- Department of Pulmonary and Critical Care Medicine, Binzhou Medical University Hospital, Binzhou Medical University, Binzhou, China
| | - Tao Wang
- Department of Pulmonary and Critical Care Medicine, Binzhou Medical University Hospital, Binzhou Medical University, Binzhou, China
| | - Yunliang Sun
- Department of Pulmonary and Critical Care Medicine, Binzhou Medical University Hospital, Binzhou Medical University, Binzhou, China
| | - Huanhuan Tian
- Department of Pulmonary and Critical Care Medicine, Binzhou Medical University Hospital, Binzhou Medical University, Binzhou, China
| | - Zhong Fu
- Department of Pulmonary and Critical Care Medicine, Binzhou Medical University Hospital, Binzhou Medical University, Binzhou, China
| | - Yuewei Zhang
- Department of Pulmonary and Critical Care Medicine, Binzhou Medical University Hospital, Binzhou Medical University, Binzhou, China
| | - Xiaozhi Wang
- Department of Pulmonary and Critical Care Medicine, Binzhou Medical University Hospital, Binzhou Medical University, Binzhou, China
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Myers S, Dinga P, Anderson M, Schubert C, Mlotha R, Phiri A, Colbourn T, McCollum ED, Mwansambo C, Kazembe P, Lang HJ. Use of bubble continuous positive airway pressure (bCPAP) in the management of critically ill children in a Malawian paediatric unit: an observational study. BMJ Open Respir Res 2019; 6:e000280. [PMID: 30956794 PMCID: PMC6424262 DOI: 10.1136/bmjresp-2018-000280] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 10/27/2018] [Accepted: 11/16/2018] [Indexed: 12/19/2022] Open
Abstract
Introduction In low-resource countries, respiratory failure is associated with a high mortality risk among critically ill children. We evaluated the role of bubble continuous positive airway pressure (bCPAP) in the routine care of critically ill children in Lilongwe, Malawi. Methods We conducted an observational study between 26 February and 15 April 2014, in an urban paediatric unit with approximately 20 000 admissions/year (in-hospital mortality <5% approximately during this time period). Modified oxygen concentrators or oxygen cylinders provided humidified bCPAP air/oxygen flow. Children up to the age of 59 months with signs of severe respiratory dysfunction were recruited. Survival was defined as survival during the bCPAP-treatment and during a period of 48 hours following the end of the bCPAP-weaning process. Results 117 children with signs of respiratory failure were included in this study and treated with bCPAP. Median age: 7 months. Malaria rapid diagnostic tests were positive in 25 (21%) cases, 15 (13%) had severe anaemia (Hb < 7.0 g/dL); 55 (47%) children had multiorgan failure (MOF); 22 (19%) children were HIV-infected/exposed. 28 (24%) were severely malnourished. Overall survival was 79/117 (68%); survival was 54/62 (87%) in children with very severe pneumonia (VSPNA) but without MOF. Among the 19 children with VSPNA (single-organ failure (SOF)) and negative HIV tests, all children survived. Survival rates were lower in children with MOF (including shock) (45%) as well as in children with severe malnutrition (36%) and proven HIV infection or exposure (45%). Conclusion Despite the limitations of this study, the good outcome of children with signs of severe respiratory dysfunction (SOF) suggests that it is feasible to use bCPAP in the hospital management of critically ill children in resource-limited settings. The role of bCPAP and other forms of non-invasive ventilatory support as a part of an improved care package for critically ill children with MOF at tertiary and district hospital level in low-resource countries needs further evaluation. Critically ill children with nutritional deficiencies and/or HIV infection/exposure need further study to determine bCPAP efficacy.
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Affiliation(s)
| | | | - Margot Anderson
- United States Peace Corps, Washington, DC, USA.,Malawian College of Medicine, Lilongwe, Malawi
| | - Charles Schubert
- Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio, USA.,Division of Emergency Medicine, Cincinnati Children Hospital Medical Center, Cincinnati, Ohio, USA
| | | | - Ajib Phiri
- Malawian College of Medicine, Lilongwe, Malawi
| | - Tim Colbourn
- University College London Institute for Global Health, London, UK
| | | | | | - Peter Kazembe
- Baylor College of Medicine, Children Clinical Centre of Excellence, Lilongwe, Malawi
| | - Hans-Joerg Lang
- Malawian College of Medicine, Lilongwe, Malawi.,Centre for International Migration and Development (CIM)/German International Cooperation (GIZ), Eschborn, Germany
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Lodeserto FJ, Lettich TM, Rezaie SR. High-flow Nasal Cannula: Mechanisms of Action and Adult and Pediatric Indications. Cureus 2018; 10:e3639. [PMID: 30740281 PMCID: PMC6358040 DOI: 10.7759/cureus.3639] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
The use of the heated and humidified high-flow nasal cannula has become increasingly popular in the treatment of patients with respiratory failure through all age groups. This article will examine the main mechanisms of actions attributed to the use of the high-flow nasal cannula and review the indications in adult and pediatric populations (outside of the neonatal period). It is unclear which of the mechanisms of action is the most important, but it may depend on the cause of the patient’s respiratory failure. This article describes the mechanism of action in an easy to remember mnemonic (HIFLOW); Heated and humidified, meets Inspiratory demands, increases Functional residual capacity (FRC), Lighter, minimizes Oxygen dilution, and Washout of pharyngeal dead space. We will also examine some of the main indications for its use in both the adult and pediatric age groups. The data for the use of high-flow nasal cannula is growing, and currently, some of the main adult indications include hypoxemic respiratory failure due to pneumonia, post-extubation, pre-oxygenation prior to intubation, acute pulmonary edema, and use in patients who are "do not resuscitate or intubate". The main pediatric indication is in infants with bronchiolitis, but other indications are being studied, such as its use in asthma, croup, pneumonia, transport of a critically ill child, and post-extubation.
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Affiliation(s)
| | | | - Salim R Rezaie
- Emergency Medicine, Methodist Hospital, San Antonio, USA
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45
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Wang J, Lee KP, Chong SL, Loi M, Lee JH. High flow nasal cannula in the emergency department: indications, safety and effectiveness. Expert Rev Med Devices 2018; 15:929-935. [PMID: 30426800 DOI: 10.1080/17434440.2018.1548276] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Heated humidified high flow nasal cannula therapy (HHHFNCT) is emerging as a popular non-invasive mode of respiratory support in adults and children. In recent years, its use has extended beyond the intensive care unit to other clinical areas. This review aims to explore the mechanism of action, indications, safety, and effectiveness of HHHFNCT use in the Emergency Department (ED). AREAS COVERED The mechanism of action of HHHFNCT, as well as its use in adult and pediatric ED will be discussed in this review. EXPERT COMMENTARY While there exists increasing enthusiasm in the use of HHHFNCT in the ED, constant monitoring of the patients and an experienced assessment of their response to treatment are critical and may require additional manpower deployment, which may be challenging, in the busy ED environment. Our experience with the use of HHHFNCT in children is still growing. Continual research in this area remains crucial in helping us better understand the patient types and conditions managed in ED that would most benefit from this device.
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Affiliation(s)
- Justin Wang
- a Paediatric Intensive Care Unit , Royal Brompton Hospital , London , UK
| | - Khai Pin Lee
- b Children's Emergency , KK Women's and Children's Hospital , Singapore , Singapore
| | - Shu-Ling Chong
- b Children's Emergency , KK Women's and Children's Hospital , Singapore , Singapore
| | - Mervin Loi
- c Children's Intensive Care Unit , KK Women's and Children's Hospital , Singapore , Singapore
| | - Jan Hau Lee
- c Children's Intensive Care Unit , KK Women's and Children's Hospital , Singapore , Singapore
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Frat JP, Coudroy R, Thille AW. Non-invasive ventilation or high-flow oxygen therapy: When to choose one over the other? Respirology 2018; 24:724-731. [PMID: 30406954 DOI: 10.1111/resp.13435] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 10/03/2018] [Accepted: 10/11/2018] [Indexed: 12/20/2022]
Abstract
It has been found that high-flow oxygen therapy (HFOT) can reduce mortality of patients admitted to intensive care unit (ICU) for de novo acute respiratory failure (ARF) as compared to non-invasive ventilation (NIV). HFOT might therefore be considered as a first-line strategy of oxygenation in these patients. The beneficial effects of HFOT may be explained by its good tolerance and by physiological characteristics including delivery of high FiO2 , positive end expiratory pressure (PEEP) effect and continuous dead space washout contributing to decreased work of breathing. In contrast, NIV should be used cautiously in patients with de novo ARF due to high tidal volumes promoted by pressure support and that may potentially worsen pre-existing lung injury. Although recent studies have reported no benefit and even deleterious effects of NIV in immunocompromised patients with ARF, the experts have recommended its use as a first-line strategy. In patients with acute-on-chronic respiratory failure and respiratory acidosis, it has been clearly shown that NIV is the best strategy of oxygenation. However, HFOT seems able to reverse respiratory acidosis and further studies are needed to evaluate whether HFOT could represent an alternative to standard oxygen. Although NIV is recommended to treat ARF in post-operative patients or to prevent post-extubation respiratory failure in ICU, recent large-scale randomized studies suggest that HFOT could be equivalent to NIV. While recent recommendations have been established from studies comparing NIV with standard oxygen, new studies are needed to compare NIV versus HFOT in order to better define the appropriate indications for both treatments.
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Affiliation(s)
- Jean-Pierre Frat
- Médecine Intensive Réanimation, CHU de Poitiers, Poitiers, France.,CIC-1402 ALIVE, INSERM, Poitiers, France.,Faculté de Médecine et de Pharmacie de Poitiers, Université de Poitiers, Poitiers, France
| | - Rémi Coudroy
- Médecine Intensive Réanimation, CHU de Poitiers, Poitiers, France.,CIC-1402 ALIVE, INSERM, Poitiers, France.,Faculté de Médecine et de Pharmacie de Poitiers, Université de Poitiers, Poitiers, France
| | - Arnaud W Thille
- Médecine Intensive Réanimation, CHU de Poitiers, Poitiers, France.,CIC-1402 ALIVE, INSERM, Poitiers, France.,Faculté de Médecine et de Pharmacie de Poitiers, Université de Poitiers, Poitiers, France
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Flink RC, van Kaam AH, de Jongh FH. A humidifier in the invasive mode during noninvasive respiratory support could increase condensation and thereby impair airway patency. Acta Paediatr 2018; 107:1888-1892. [PMID: 29723923 DOI: 10.1111/apa.14383] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 03/20/2018] [Accepted: 04/26/2018] [Indexed: 11/28/2022]
Abstract
AIM Humidifying noninvasively ventilated preterm infants is critical to prevent dehydration of respiratory mucosa, but over-humidification can result in impaired airway patency and lung mechanics. This neonatal bench study investigated the humidity delivered using invasive and noninvasive humidification modes during nasal continuous positive airway pressure. METHODS The study was conducted at the neonatal intensive care unit of Emma Children's Hospital, the Netherlands, in March 2014. A mannequin was connected to a CareFusion Infant Flow SiPAP system, combined with a Fisher & Paykel MR850 humidifier and a Carefusion Infant Flow LP Generator. We measured the temperature, relative humidity and absolute humidity at the humidification chamber's expiratory port and at the patient's mask. RESULTS The absolute humidity at the mask was 35-40 mg H2 O/L at 38-39°C (relative humidity 74-80%) for the invasive mode of the humidifier and 23-27 mg H2 O/L at 34-35°C (relative humidity 63-70%) for the noninvasive mode. The absolute humidities exceeded the recommended values for the invasive mode of the humidifier, but not the noninvasive mode, and could be associated with increased condensation. CONCLUSION The absolute humidity delivered by the humidifier in invasive mode could be associated with increased condensation, which has been associated with airway impairment.
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Affiliation(s)
- Rutger C. Flink
- Department of Neonatology; Academic Medical Center; Emma Children's Hospital; Amsterdam the Netherlands
- Med-E Link; Amsterdam the Netherlands
| | - Anton H. van Kaam
- Department of Neonatology; Academic Medical Center; Emma Children's Hospital; Amsterdam the Netherlands
| | - Frans H. de Jongh
- Department of Neonatology; Academic Medical Center; Emma Children's Hospital; Amsterdam the Netherlands
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Lee MK, Choi J, Park B, Kim B, Lee SJ, Kim SH, Yong SJ, Choi EH, Lee WY. High flow nasal cannulae oxygen therapy in acute-moderate hypercapnic respiratory failure. CLINICAL RESPIRATORY JOURNAL 2018; 12:2046-2056. [DOI: 10.1111/crj.12772] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Revised: 08/28/2017] [Accepted: 01/26/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Myoung Kyu Lee
- Department of Internal Medicine; Yonsei University Wonju College of Medicine; Wonju Gangwon South Korea
| | - Jaehwa Choi
- Department of Internal Medicine; Yonsei University Wonju College of Medicine; Wonju Gangwon South Korea
| | - Bonil Park
- Department of Internal Medicine; Yonsei University Wonju College of Medicine; Wonju Gangwon South Korea
| | - Bumjoon Kim
- Department of Internal Medicine; Yonsei University Wonju College of Medicine; Wonju Gangwon South Korea
| | - Seok Jeong Lee
- Department of Internal Medicine; Yonsei University Wonju College of Medicine; Wonju Gangwon South Korea
| | - Sang-Ha Kim
- Department of Internal Medicine; Yonsei University Wonju College of Medicine; Wonju Gangwon South Korea
| | - Suk Joong Yong
- Department of Internal Medicine; Yonsei University Wonju College of Medicine; Wonju Gangwon South Korea
| | - Eun Hee Choi
- Institute of Lifestyle Medicine; Yonsei University Wonju College of Medicine; Wonju Gangwon South Korea
| | - Won-Yeon Lee
- Department of Internal Medicine; Yonsei University Wonju College of Medicine; Wonju Gangwon South Korea
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Attia GA, Bediwy AS, Ashour RM. Comparison between the effect of heated and humidified high-flow nasal oxygen and conventional oxygen during acute hypoxemic respiratory failure. THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2017. [DOI: 10.4103/1687-8426.211399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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