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Pantazopoulos I, Boutlas S, Mavrovounis G, Papalampidou A, Papagiannakis N, Kontou M, Bibaki E, Athanasiou N, Meletis G, Gourgoulianis K, Zakynthinos S, Ischaki E. Nasal high flow or noninvasive ventilation? navigating hypercapnic COPD exacerbation treatment: A randomized noninferiority clinical trial. Respir Med 2024; 232:107762. [PMID: 39111544 DOI: 10.1016/j.rmed.2024.107762] [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: 06/06/2024] [Revised: 07/29/2024] [Accepted: 08/04/2024] [Indexed: 08/10/2024]
Abstract
BACKGROUND Noninvasive ventilation (NIV) has been the cornerstone for managing acute exacerbations of COPD (AECOPD) with hypercapnic respiratory failure. Nasal high flow (NHF) oxygen therapy has emerged as a potential alternative, offering a more tolerable modality with promising outcomes. The aim of the present study was to evaluate whether NHF respiratory support is noninferior to NIV with respect to treatment failure, in patients with mild-to-moderate hypercapnic AECOPD. METHODS In this multi-center, randomized, noninferiority trial, 105 patients with AECOPD and respiratory failure type II were enrolled. Participants were randomly assigned to receive either NHF therapy or NIV. The primary endpoint was the frequency of treatment failure, defined as the need for intubation and invasive mechanical ventilation or a switch to the alternative treatment group. Secondary endpoints included changes in respiratory parameters, patient comfort indicators, and the occurrence of complications. RESULTS The findings revealed no significant difference in the primary outcome between the groups, with a treatment failure rate of 19.6 % (10 out of 51) in the NHF group and 14.8 % (8 out of 54) in the NIV group. Interestingly, NHF users reported significantly lower levels of dyspnea and discomfort at multiple follow-up points. Despite the differences in patient comfort, respiratory parameters such as respiratory rate, arterial blood gases, and use of accessory muscles of respiration showed no significant disparities between the groups throughout the study period. CONCLUSIONS NHF therapy was similar to NIV in preventing treatment failure among patients with hypercapnic AECOPD, offering a viable alternative with enhanced comfort. TRIAL REGISTRATION The study was prospectively registered in ClinicalTrials.gov (Identifier: NCT03466385) on March 15, 2018.
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Affiliation(s)
- Ioannis Pantazopoulos
- Department of Emergency Medicine, University of Thessaly, 41500, Greece; Department of Respiratory Medicine, University of Thessaly, 41500, Greece
| | - Stylianos Boutlas
- Department of Respiratory Medicine, University of Thessaly, 41500, Greece
| | | | - Athanasia Papalampidou
- First Department of Critical Care Medicine and Pulmonary Services, National and Kapodistrian University of Athens, Evangelismos Hospital, Athens, 10676, Greece
| | - Nikolaos Papagiannakis
- First Department of Neurology, Eginition Hospital, National and Kapodistrian University of Athens, 11528, Greece
| | - Marina Kontou
- Department of Emergency Medicine, University of Thessaly, 41500, Greece
| | - Eleni Bibaki
- Department of Respiratory Medicine, Venizeleio General Hospital, Heraklion, 71409, Greece
| | - Nikolaos Athanasiou
- Department of Respiratory Medicine, Evangelismos Hospital, Athens, 10676, Greece
| | - Georgios Meletis
- Department of Respiratory Medicine, Venizeleio General Hospital, Heraklion, 71409, Greece
| | | | - Spyros Zakynthinos
- First Department of Critical Care Medicine and Pulmonary Services, National and Kapodistrian University of Athens, Evangelismos Hospital, Athens, 10676, Greece
| | - Eleni Ischaki
- First Department of Critical Care Medicine and Pulmonary Services, National and Kapodistrian University of Athens, Evangelismos Hospital, Athens, 10676, Greece
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Girault C, Artaud-Macari E, Jolly G, Carpentier D, Cuvelier A, Béduneau G. [High-flow nasal oxygen therapy and hypercapnic acute respiratory failure]. Rev Mal Respir 2024; 41:498-507. [PMID: 38926023 DOI: 10.1016/j.rmr.2024.06.002] [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: 04/05/2024] [Accepted: 05/23/2024] [Indexed: 06/28/2024]
Abstract
Humidified high-flow nasal oxygen therapy (HFNO) has, in recent years, come to assume a key role in the management of hypoxemic acute respiratory failure (ARF). While non-invasive ventilation (NIV) currently represents the first-line ventilatory strategy in patients exhibiting hypercapnic ARF, the operating principles and physiological effects of HFNO could be interesting and useful in the initial management of hypercapnic ARF and/or after extubation, particularly in acute exacerbations of chronic obstructive pulmonary disease. Under these conditions, HFNO could be used either alone continuously or in combination with NIV during breaks in spontaneous breathing, depending on the severity and etiology of the underlying hypercapnic ARF.
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Affiliation(s)
- C Girault
- Service de médecine intensive et réanimation, GRHVN UR-3830, CHU-hôpitaux de Rouen, Normandie univ, 76000 Rouen, France.
| | - E Artaud-Macari
- Service de pneumologie, oncologie thoracique et soins intensifs respiratoires, GRHVN UR-3830, CHU-hôpitaux de Rouen, Normandie univ, 76000 Rouen, France
| | - G Jolly
- Service de médecine intensive et réanimation, CHU-hôpitaux de Rouen, 76000 Rouen, France
| | - D Carpentier
- Service de médecine intensive et réanimation, CHU-hôpitaux de Rouen, 76000 Rouen, France
| | - A Cuvelier
- Service de pneumologie, oncologie thoracique et soins intensifs respiratoires, GRHVN UR-3830, CHU-hôpitaux de Rouen, Normandie univ, 76000 Rouen, France
| | - G Béduneau
- Service de médecine intensive et réanimation, GRHVN UR-3830, CHU-hôpitaux de Rouen, Normandie univ, 76000 Rouen, France
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LoMauro A, De Luca A, Scarpazza P, Aliverti A. In Vivo Measurement of Tidal Volume During Non-invasive Respiratory Support by Continuous-Flow Helmet CPAP. Ann Biomed Eng 2024; 52:2546-2555. [PMID: 38886251 PMCID: PMC11329575 DOI: 10.1007/s10439-024-03545-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 05/08/2024] [Indexed: 06/20/2024]
Abstract
Recently, the interest in the Helmet interface during non-invasive respiratory support (NIRS) has increased due to the COVID-19 pandemic. During NIRS, positive end-expiratory pressure (PEEP) can be given as continuous positive airway pressure (CPAP), which maintains a positive airway pressure throughout the whole respiratory cycle with Helmet as an interface (H-CPAP). The main disadvantage of the H-CPAP is the inability to measure tidal volume (VT). Opto-electronic plethysmography (OEP) is a non-invasive technique that is not sensitive to gas compression/expansion inside the helmet. OEP acquisitions were performed on 28 healthy volunteers (14 females and 14 males) at baseline and during Helmet CPAP. The effect of posture (semi-recumbent vs. prone), flow (50 vs. 60 L/min), and PEEP (0 vs. 5 vs. 10 cmH2O) on the ventilatory and thoracic-abdominal pattern and the operational volumes were investigated. Prone position limited vital capacity, abdominal expansion and chest wall recruitment. A constant flow of 60 L/min reduced the need for the subject to ventilate while having a slight recruitment effect (100 mL) in the semi-recumbent position. A progressive increasing recruitment was found with higher PEEP but limited by the prone position. It is possible to accurately measure tidal volume during H-CPAP to deliver non-invasive ventilatory support using opto-electronic plethysmography during different clinical settings.
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Affiliation(s)
- A LoMauro
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, P.zza L. da Vinci, 32, 20133, Milan, Italy.
| | - A De Luca
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, P.zza L. da Vinci, 32, 20133, Milan, Italy
| | - P Scarpazza
- Pneumology Unit, Ospedale Civile, Vimercate, Milan, Italy
| | - A Aliverti
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, P.zza L. da Vinci, 32, 20133, Milan, Italy
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Pantazopoulos I, Mavrovouni G. Probing the efficacy of high-flow nasal cannula in the treatment of acute exacerbations of COPD with acute-moderate hypercapnic respiratory failure. Crit Care 2024; 28:264. [PMID: 39103951 DOI: 10.1186/s13054-024-05050-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2024] [Accepted: 07/31/2024] [Indexed: 08/07/2024] Open
Affiliation(s)
- Ioannis Pantazopoulos
- Department of Emergency Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41110, Larissa, Greece
| | - Georgios Mavrovouni
- Department of Emergency Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41110, Larissa, Greece.
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5
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Nay MA, Auvet A. Place of high-flow nasal oxygen in nonoperating room anesthesia. Curr Opin Anaesthesiol 2024; 37:421-426. [PMID: 38841990 DOI: 10.1097/aco.0000000000001383] [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: 06/07/2024]
Abstract
PURPOSE OF REVIEW This article aims to assess the utility of high-flow nasal oxygen (HFNO) therapy in nonoperating room anesthesia (NORA) settings. RECENT FINDINGS The number of procedural interventions under deep sedation in NORA is still increasing. Administration of oxygen is recommended to prevent hypoxemia and is usually delivered with standard oxygen through nasal cannula or a face mask. HFNO is a simple alternative with a high warmed humidified flow (ranging from 30 to 70 l/min) with a precise fraction inspired of oxygen (ranging from 21 to 100%). Compared to standard oxygen, HFNO has demonstrated efficacy in reducing the incidence of hypoxemia and the need for airway maneuvers. Research on HFNO has primarily focused on its application in gastrointestinal endoscopy procedures. Yet, it has also shown promising results in various other procedural interventions including bronchoscopy, cardiology, and endovascular procedures. However, the adoption of HFNO prompted considerations regarding cost-effectiveness and environmental impact. SUMMARY HFNO emerges as a compelling alternative to conventional oxygen delivery methods for preventing hypoxemia during procedural interventions in NORA. However, its utilization should be reserved for patients at moderate-to-high risk to mitigate the impact of cost and environmental factors.
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Affiliation(s)
- Mai-Anh Nay
- Médecine Intensive Réanimation, Centre Hospitalier Universitaire d'Orléans, Orléans
| | - Adrien Auvet
- Réanimation médico-chirurgicale, Centre hospitalier de Dax, Dax, France
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Colaianni-Alfonso N, Toledo A, Montiel G, Castro-Sayat M, Crimi C, Vetrugno L. High-flow nasal cannula and in-line aerosolised bronchodilator delivery during severe exacerbation of asthma in adults: a feasibility observational study. Anaesth Crit Care Pain Med 2024; 43:101414. [PMID: 39089455 DOI: 10.1016/j.accpm.2024.101414] [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: 05/13/2024] [Revised: 07/02/2024] [Accepted: 07/19/2024] [Indexed: 08/04/2024]
Abstract
BACKGROUND Asthma is a common chronic respiratory disease affecting 1-29% of the population in different countries. Exacerbations represent a change in symptoms and lung function from the patient's usual condition that requires emergency department (ED) admission. Recently, the use of a High-Flow Nasal Cannula (HFNC) plus an in-line vibrating mesh nebulizer (VMN) for aerosol drug delivery has been advocated in clinical practice. Thus, this pilot observational study aims to investigate the feasibility of HFNC treatment with VMN for in-line bronchodilator delivery in patients with severe asthma. METHODS This study was conducted from May 2022 to May 2023. Subjects ≥18 years old with a previous diagnosis of asthma who were admitted to the ED during severe exacerbation were included. The primary endpoint was the change in peak expiratory flow ratio (PEFR) after 2-h of treatment with bronchodilator delivered by HFNC with in-line VMN. Additional outcomes were changes in forced expiratory volume in 1 s (FEV1) and clinical variables before treatment. RESULTS 30 patients, mean age of 43 (SD ± 16) years, mostly female (67%) were studied. A significant change in PEFR (147 ± 31 L/m vs. 220 ± 38 L/m; p < 0.001) was observed after treatment with HFNC and in-line VMN with significant improvement in clinical variables. And no subjects required invasive mechanical ventilation (IMV) during the study. CONCLUSIONS HFNC treatment with in-line VMN for bronchodilator delivery appears feasible and safe for patients with severe asthma exacerbation. These preliminary promising results should be confirmed with appropriately large-designed studies.
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Affiliation(s)
- Nicolás Colaianni-Alfonso
- Respiratory Intermediate Care Unit, Hospital Juan A. Fernández, Ciudad Autónoma de Buenos Aires, Argentina.
| | - Ada Toledo
- Respiratory Intermediate Care Unit, Hospital Juan A. Fernández, Ciudad Autónoma de Buenos Aires, Argentina
| | - Guillermo Montiel
- Respiratory Intermediate Care Unit, Hospital Juan A. Fernández, Ciudad Autónoma de Buenos Aires, Argentina
| | - Mauro Castro-Sayat
- Respiratory Intermediate Care Unit, Hospital Juan A. Fernández, Ciudad Autónoma de Buenos Aires, Argentina
| | - Claudia Crimi
- Respiratory Medicine Unit, Policlinico "G. Rodolico-San Marco" University Hospital, Catania, Italy; Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Luigi Vetrugno
- Department of Medical, Oral and Biotechnological Sciences, University of G. d' Annunzio, Chieti-Pescara, Italy.
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Estenssoro E, González I, Plotnikow GA. Post-pandemic acute respiratory distress syndrome: A New Global Definition with extension to lower-resource regions. Med Intensiva 2024; 48:272-281. [PMID: 38644108 DOI: 10.1016/j.medine.2024.01.011] [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: 01/24/2024] [Accepted: 01/27/2024] [Indexed: 04/23/2024]
Abstract
Acute respiratory distress syndrome (ARDS), first described in 1967, is characterized by acute respiratory failure causing profound hypoxemia, decreased pulmonary compliance, and bilateral CXR infiltrates. After several descriptions, the Berlin definition was adopted in 2012, which established three categories of severity according to hypoxemia (mild, moderate and severe), specified temporal aspects for diagnosis, and incorporated the use of non-invasive ventilation. The COVID-19 pandemic led to changes in ARDS management, focusing on continuous monitoring of oxygenation and on utilization of high-flow oxygen therapy and lung ultrasound. In 2021, a New Global Definition based on the Berlin definition of ARDS was proposed, which included a category for non-intubated patients, considered the use of SpO2, and established no particular requirement for oxygenation support in regions with limited resources. Although debates persist, the continuous evolution seeks to adapt to clinical and epidemiological needs, and to the search of personalized treatments.
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Affiliation(s)
- Elisa Estenssoro
- Escuela de Gobierno en Salud, Ministerio de Salud, Buenos Aires, Argentina; Facultad de Ciencias Médicas, Universidad Nacional de La Plata, Buenos Aires, Argentina.
| | - Iván González
- Servicio de Rehabilitación, Área de Kinesiología Crítica, Hospital Británico de Buenos Aires, CABA, Argentina
| | - Gustavo A Plotnikow
- Servicio de Rehabilitación, Área de Kinesiología Crítica, Hospital Británico de Buenos Aires, CABA, Argentina; Facultad de Medicina y Ciencias de la Salud, Universidad Abierta Interamericana, Argentina
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8
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Roca O, Li J, Mauri T. High-flow nasal cannula: evolving practices and novel clinical and physiological insights. Intensive Care Med 2024; 50:758-761. [PMID: 38573402 DOI: 10.1007/s00134-024-07386-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 03/06/2024] [Indexed: 04/05/2024]
Affiliation(s)
- Oriol Roca
- Servei de Medicina Intensiva, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Institut de Recerca Part Taulí-I3PT, Parc del Taulí 1, 08028, Sabadell, Spain.
- Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain.
- Ciber Enfermedades Respiratorias (Ciberes), Instituto de Salud Carlos III, Madrid, Spain.
| | - Jie Li
- Division of Respiratory Care, Department of Cardiopulmonary Sciences, Rush University, 600 S Paulina St, Suite 765, Chicago, IL, 60612, USA
| | - Tommaso Mauri
- Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
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9
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Pota V, Coppolino F, Auricchio A, Cardella F, Del Prete M, Scalvenzi A, Sansone P, Passavanti MB, Pace MC. Noninvasive respiratory support with high-flow nasal cannula in endoscopic surgery in a patient with Legionella Pneumophila pneumonia: a case report. Perioper Med (Lond) 2024; 13:29. [PMID: 38632664 PMCID: PMC11025197 DOI: 10.1186/s13741-024-00385-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 04/04/2024] [Indexed: 04/19/2024] Open
Affiliation(s)
- Vincenzo Pota
- Anaesthesia, Intensive Care and Pain Medicine, Dept. of Women, Child, General and Specialistic Surgery, University of Campania "L. Vanvitelli,", Naples, Italy.
| | - Francesco Coppolino
- Anaesthesia, Intensive Care and Pain Medicine, Dept. of Women, Child, General and Specialistic Surgery, University of Campania "L. Vanvitelli,", Naples, Italy
| | - Annamaria Auricchio
- Dept. of Translational Medical Sciences, University of Campania "L. Vanvitelli,", Naples, Italy
| | - Francesca Cardella
- Dept. of Translational Medical Sciences, University of Campania "L. Vanvitelli,", Naples, Italy
| | - Maurizio Del Prete
- Anaesthesia, Intensive Care and Pain Medicine, Dept. of Women, Child, General and Specialistic Surgery, University of Campania "L. Vanvitelli,", Naples, Italy
| | - Antonio Scalvenzi
- Anaesthesia, Intensive Care and Pain Medicine, Dept. of Women, Child, General and Specialistic Surgery, University of Campania "L. Vanvitelli,", Naples, Italy
| | - Pasquale Sansone
- Anaesthesia, Intensive Care and Pain Medicine, Dept. of Women, Child, General and Specialistic Surgery, University of Campania "L. Vanvitelli,", Naples, Italy
| | - Maria Beatrice Passavanti
- Anaesthesia, Intensive Care and Pain Medicine, Dept. of Women, Child, General and Specialistic Surgery, University of Campania "L. Vanvitelli,", Naples, Italy
| | - Maria Caterina Pace
- Anaesthesia, Intensive Care and Pain Medicine, Dept. of Women, Child, General and Specialistic Surgery, University of Campania "L. Vanvitelli,", Naples, Italy
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Deana C, Vecchiato M, Bellocchio F, Tullio A, Martino A, Ziccarelli A, Patruno V, Pascolo M, Bassi F, Pontoni M, Raimondi P, Cereser L, Vetrugno L, Petri R, Uzzau A. High flow nasal oxygen vs. conventional oxygen therapy over respiratory oxygenation index after esophagectomy: an observational study. J Thorac Dis 2024; 16:997-1008. [PMID: 38505084 PMCID: PMC10944724 DOI: 10.21037/jtd-23-1176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 12/06/2023] [Indexed: 03/21/2024]
Abstract
Background Postoperative pulmonary complications after esophagectomy still represent a matter of concern. High flow nasal cannula (HFNC) early after major abdominal and thoracic surgery has demonstrated some advantages over conventional oxygen therapy. Data about respiratory effect of HFNC after esophagectomy is scarce. The primary aim of this study is to investigate if the early use of HFNC after esophagectomy could enhance patients' postoperative respiratory oxygenation (ROX) index and, ultimately, reduce postoperative pneumonia. Methods In this single center retrospective study all patients undergoing to esophagectomy for cancer from May 2020 to November 2022 were evaluated. Historical cohort (HC) received postoperative oxygen supplementation with Venturi mask or nasal goggles, and a cohort was put under HFNC (HFNC cohort). ROX index, blood gas analysis, radiological atelectasis score (RAS), post-operative complications' data and information on hospital stay have been collected and analyzed. Results Seventy-one patients were included for the final statistical analysis, 31 in the HFNC and 40 in the HC cohort. Mean age was 64±10 years and body mass index (BMI) was 26 [24-29] kg/m2. ROX index was higher in the HFNC patients than in the HC, 20.8 [16.7-25.9] vs. 14.9 [10.8-18.2] (P<0.0001). In the HFNC cohort patients, pH was higher, 7.42 [7.40-7.44] vs. 7.39 [7.37-7.43] than HC, while PaCO2 was lower in HFNC cohort compared with HC, 39 [36-41] vs. 42 [39-45] mmHg, respectively (P=0.01). RAS was similar between the two cohorts of patients, 1.5±0.98 vs. 1.4±1.04 in the HFNC and the HC cohort, respectively (P=0.611). Lower acute respiratory failure (ARF) rate was recorded among HFNC than HC cohort, 0% vs. 13% respectively, P=0.06. No difference in pneumonia frequency between two cohorts was shown. Conclusions HFNC improved the ROX index after esophagectomy through significant respiratory rate reduction. This tool should be considered for early respiratory support after extubation in this category of patients, not only as a rescue therapy for ARF, but also to optimize early postoperative respiratory function. Whether this will improve patients' outcomes requires further large randomized controlled trials.
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Affiliation(s)
- Cristian Deana
- Anesthesia and Intensive Care Department, Health Integrated Agency of Friuli Centrale, Udine, Italy
| | - Massimo Vecchiato
- Department of Surgery, Health Integrated Agency of Friuli Centrale, Udine, Italy
| | | | - Annarita Tullio
- Hygiene and Clinical Epidemiology Unit, Health Integrated Agency of Friuli Centrale, Udine, Italy
| | - Antonio Martino
- Department of Surgery, Health Integrated Agency of Friuli Centrale, Udine, Italy
| | - Antonio Ziccarelli
- Department of Surgery, Health Integrated Agency of Friuli Centrale, Udine, Italy
| | - Vincenzo Patruno
- Pulmonology Unit, Cardiothoracic Department, Health Integrated Agency of Friuli Centrale, Udine, Italy
| | - Marika Pascolo
- Department of Surgery, Health Integrated Agency of Friuli Centrale, Udine, Italy
| | - Flavio Bassi
- Anesthesia and Intensive Care Department, Health Integrated Agency of Friuli Centrale, Udine, Italy
| | - Marta Pontoni
- Pulmonology Unit, Cardiothoracic Department, Health Integrated Agency of Friuli Centrale, Udine, Italy
| | - Paola Raimondi
- Pulmonology Unit, Cardiothoracic Department, Health Integrated Agency of Friuli Centrale, Udine, Italy
| | - Lorenzo Cereser
- Institute of Radiology, Department of Medicine, University of Udine, Udine, Italy
| | - Luigi Vetrugno
- Department of Anesthesiology, Critical Care Medicine and Emergency, SS. Annunziata Hospital, Chieti, Italy
- Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, Chieti, Italy
| | - Roberto Petri
- Department of Surgery, Health Integrated Agency of Friuli Centrale, Udine, Italy
| | - Alessandro Uzzau
- Department of Surgery, Health Integrated Agency of Friuli Centrale, Udine, Italy
- Department of Medical Area, University of Udine, Udine, Italy
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Okano H, Yamamoto R, Iwasaki Y, Irimada D, Konno D, Tanaka T, Oishi T, Nawa H, Yano A, Taniguchi H, Otawara M, Matsuoka A, Yamauchi M. External validation of the HACOR score and ROX index for predicting treatment failure in patients with coronavirus disease 2019 pneumonia managed on high-flow nasal cannula therapy: a multicenter retrospective observational study in Japan. J Intensive Care 2024; 12:7. [PMID: 38360681 PMCID: PMC10870626 DOI: 10.1186/s40560-024-00720-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 02/07/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND The HACOR score for predicting treatment failure includes vital signs and acid-base balance factors, whereas the ROX index only considers the respiratory rate, oxygen saturation, and fraction of inspired oxygen (FiO2). We aimed to externally validate the HACOR score and ROX index for predicting treatment failure in patients with coronavirus disease 2019 (COVID-19) on high-flow nasal cannula (HFNC) therapy in Japan. METHODS This retrospective, observational, multicenter study included patients, aged ≥ 18 years, diagnosed with COVID-19 and treated with HFNC therapy between January 16, 2020, and March 31, 2022. The HACOR score and ROX index were calculated at 2, 6, 12, 24, and 48 h after stating HFNC therapy. The primary outcome was treatment failure (requirement for intubation or occurrence of death within 7 days). We calculated the area under the receiver operating characteristic curve (AUROC) and assessed the diagnostic performance of these indicators. The 2-h time-point prediction was considered the primary analysis and that of other time-points as the secondary analysis. We also assessed 2-h time-point sensitivity and specificity using previously reported cutoff values (HACOR score > 5, ROX index < 2.85). RESULTS We analyzed 300 patients from 9 institutions (median age, 60 years; median SpO2/FiO2 ratio at the start of HFNC therapy, 121). Within 7 days of HFNC therapy, treatment failure occurred in 127 (42%) patients. The HACOR score and ROX index at the 2-h time-point exhibited AUROC discrimination values of 0.63 and 0.57 (P = 0.24), respectively. These values varied with temporal changes-0.58 and 0.62 at 6 h, 0.70 and 0.68 at 12 h, 0.68 and 0.69 at 24 h, and 0.75 and 0.75 at 48 h, respectively. The 2-h time-point sensitivity and specificity were 18% and 91% for the HACOR score, respectively, and 3% and 100% for the ROX index, respectively. Visual calibration assessment revealed well calibrated HACOR score, but not ROX index. CONCLUSIONS In COVID-19 patients receiving HFNC therapy in Japan, the predictive performance of the HACOR score and ROX index at the 2-h time-point may be inadequate. Furthermore, clinicians should be mindful of time-point scores owing to the variation of the models' predictive performance with the time-point. Trial registration UMIN (registration number: UMIN000050024, January 13, 2023).
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Affiliation(s)
- Hiromu Okano
- Department of Critical Care Medicine, St. Luke's International Hospital, 9-1 Akashi-Cho, Chuo-Ku, Tokyo, 104-8560, Japan
- Department of Social Medical Sciences, Graduate School of Medicine, International University of Health and Welfare, 4-1-26 Akasaka, Minato-Ku, Tokyo, 107-8402, Japan
| | - Ryohei Yamamoto
- Center for Innovative Research for Communities and Clinical Excellence (CIRC2LE), Fukushima Medical University, Fukushima, 960-1295, Japan.
| | - Yudai Iwasaki
- Department of Anesthesiology and Perioperative Medicine, Tohoku University Graduate School of Medicine, 1-1 Seiryo-Machi, Aoba-Ku, Sendai City, Miyagi, 980-8574, Japan
| | - Daisuke Irimada
- Department of Anesthesiology and Perioperative Medicine, Tohoku University Graduate School of Medicine, 1-1 Seiryo-Machi, Aoba-Ku, Sendai City, Miyagi, 980-8574, Japan
| | - Daisuke Konno
- Department of Anesthesiology and Perioperative Medicine, Tohoku University Graduate School of Medicine, 1-1 Seiryo-Machi, Aoba-Ku, Sendai City, Miyagi, 980-8574, Japan
| | - Taku Tanaka
- Department of Emergency and Critical Care Medicine, Nagoya University Graduate School of Medicine, Tsurumai-Cho 65, Syowa-Ku, Nagoya City, Aichi, 466-8550, Japan
| | - Takatoshi Oishi
- Department of Emergency and Critical Care Medicine, Jichi Medical University Saitmta Medical Center, 1-847, Amanuma-Cho, Oomiya-Ku, Saitama City, Saitama, 330-8503, Japan
| | - Hiroki Nawa
- Department of Intensive Care Medicine, Kameda Medical Center, 929 Higashi-Cho, Kamogawa, Chiba, 296-8602, Japan
| | - Akihiko Yano
- Department of General Medicine, Kochi Health Sciences Center, 2125-1 Ike, Kochi City, Kochi, 781-8555, Japan
| | - Hiroaki Taniguchi
- Department of Traumatology and Critical Care Medicine, National Defense Medical College Hospital, Namiki 3-2, Tokorozawa City, Saitama, 359-8513, Japan
| | - Masayuki Otawara
- Emergency and Critical Care Center, Tokyo Metropolitan Hiroo Hospital, 2-34-10 Ebisu, Shibuya-Ku, Tokyo, 150-0013, Japan
| | - Ayaka Matsuoka
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, Saga University, Saga City, Saga, 849-8501, Japan
| | - Masanori Yamauchi
- Department of Anesthesiology and Perioperative Medicine, Tohoku University Graduate School of Medicine, 1-1 Seiryo-Machi, Aoba-Ku, Sendai City, Miyagi, 980-8574, Japan
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12
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Gallardo A, Vivanco Aravena P, Ramírez-Santana M, Sepúlveda Barisich P. Is the flow rate the missing link in the evolution of clinical outcome of patients using high-flow nasal cannula? J Crit Care 2024; 79:154443. [PMID: 37826998 DOI: 10.1016/j.jcrc.2023.154443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 09/26/2023] [Accepted: 09/30/2023] [Indexed: 10/14/2023]
Affiliation(s)
- Adrián Gallardo
- Servicio de Kinesiología, Cuidados Respiratorios, Sanatorio Clínica Modelo de Morón, Morón, Buenos Aires, Argentina; Kinesiology Department, Respiratory Care, Moron Model Clinic, Morón, Buenos Aires, Argentina.
| | - Paulina Vivanco Aravena
- Unidad de Cuidados Intensivos, Hospital de Urgencia y Asistencia Pública, Santiago de Chile, Chile; Intensive Care Unit, Emergency and Public Assistance Hospital, Santiago de Chile, Chile
| | - Muriel Ramírez-Santana
- Departamento de Salud Pública, Facultad de Medicina, Universidad Católica del Norte, Coquimbo, Chile; Public Health Department, School of Medicine, Northern Catholic University, Coquimbo, Chile
| | - Patrick Sepúlveda Barisich
- Servicio de Medicina Física y Rehabilitación, Hospital San Juan de Dios, La Serena, Chile; Physical Medicine and Rehabilitation Department, San Juan de Dios Hospital, La Serena, Chile
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13
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Li J, Deng N, He WJA, Yang C, Liu P, Albuainain FA, Ring BJ, Miller AG, Rotta AT, Guglielmo RD, Milési C. The effects of flow settings during high-flow nasal cannula oxygen therapy for neonates and young children. Eur Respir Rev 2024; 33:230223. [PMID: 38537946 PMCID: PMC10966474 DOI: 10.1183/16000617.0223-2023] [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: 10/30/2023] [Accepted: 01/18/2024] [Indexed: 07/23/2024] Open
Abstract
BACKGROUND During neonatal and paediatric high-flow nasal cannula therapy, optimising the flow setting is crucial for favourable physiological and clinical outcomes. However, considerable variability exists in clinical practice regarding initial flows and subsequent adjustments for these patients. Our review aimed to summarise the impact of various flows during high-flow nasal cannula treatment in neonates and children. METHODS Two investigators independently searched PubMed, Embase, Web of Science, Scopus and Cochrane for in vitro and in vivo studies published in English before 30 April 2023. Studies enrolling adults (≥18 years) or those using a single flow setting were excluded. Data extraction and risk of bias assessments were performed independently by two investigators. The study protocol was prospectively registered with PROSPERO (CRD42022345419). RESULTS 38 406 studies were identified, with 44 included. In vitro studies explored flow settings' effects on airway pressures, humidity and carbon dioxide clearance; all were flow-dependent. Observational clinical studies consistently reported that higher flows led to increased pharyngeal pressure and potentially increased intrathoracic airway pressure (especially among neonates), improved oxygenation, and reduced respiratory rate and work of breathing up to a certain threshold. Three randomised controlled trials found no significant differences in treatment failure among different flow settings. Flow impacts exhibited significant heterogeneity among different patients. CONCLUSION Individualising flow settings in neonates and young children requires consideration of the patient's peak inspiratory flow, respiratory rate, heart rate, tolerance, work of breathing and lung aeration for optimal care.
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Affiliation(s)
- Jie Li
- Department of Cardiopulmonary Sciences, Division of Respiratory Care, Rush University, Chicago, IL, USA
- These authors contributed equally
| | - Ni Deng
- Department of Respiratory Care, West China Hospital of Sichuan University, Chengdu, China
- These authors contributed equally
| | - Wan Jia Aaron He
- School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
- These authors contributed equally
| | - Cui Yang
- Department of Pediatric Intensive Care Unit, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
- These authors contributed equally
| | - Pan Liu
- Department of Pediatric Intensive Care Unit, Children's Hospital of Fudan University, National Center for Children's Health, Shanghai, China
- These authors contributed equally
| | - Fai A Albuainain
- Department of Cardiopulmonary Sciences, Division of Respiratory Care, Rush University, Chicago, IL, USA
- Department of Respiratory Care, College of Applied Medical Sciences, Imam Abdulrahman bin Faisal University, Jubail, Saudi Arabia
| | - Brian J Ring
- Department of Surgery, Division of Trauma and Critical Care, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Andrew G Miller
- Division of Pediatric Critical Care Medicine, Duke University Medical Center, Durham, NC, USA
- Respiratory Care Services, Duke University Medical Center, Durham, NC, USA
| | - Alexandre T Rotta
- Division of Pediatric Critical Care Medicine, Duke University Medical Center, Durham, NC, USA
| | - Robert D Guglielmo
- Division of Pediatric Critical Care, Department of Pediatrics, Loma Linda University Children's Hospital, Loma Linda, CA, USA
- Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Christophe Milési
- Pediatric Intensive Care Unit, University of Montpellier I, Montpellier, France
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14
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Crimi C, Cortegiani A. High-Flow Nasal Therapy in Acute and Chronic Respiratory Failure: Past, Present, and Future. J Clin Med 2023; 12:jcm12072666. [PMID: 37048749 PMCID: PMC10095482 DOI: 10.3390/jcm12072666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 03/20/2023] [Indexed: 04/07/2023] Open
Abstract
High-flow nasal therapy (HFNT) was introduced into clinical practice in the early 2000s as a form of noninvasive respiratory support (NIRS) [...]
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Affiliation(s)
- Claudia Crimi
- Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy
- Respiratory Medicine Unit, Policlinico “G. Rodolico-San Marco” University Hospital, 95123 Catania, Italy
| | - Andrea Cortegiani
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of Palermo, 90127 Palermo, Italy
- Department of Anesthesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, University of Palermo, 90127 Palermo, Italy
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15
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Yang H, Huang D, Luo J, Liang Z, Li J. The use of high-flow nasal cannula in patients with chronic obstructive pulmonary disease under exacerbation and stable phases: A systematic review and meta-analysis. Heart Lung 2023; 60:116-126. [PMID: 36965283 DOI: 10.1016/j.hrtlng.2023.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 02/04/2023] [Accepted: 02/19/2023] [Indexed: 03/27/2023]
Abstract
BACKGROUND High-flow nasal cannula (HFNC) has been increasingly utilized in patients with chronic obstructive pulmonary disease (COPD); however, the effects on reducing the need for intubation or reintubation remain unclear. OBJECTIVES We aimed to investigate whether HFNC therapy was superior to conventional oxygen therapy (COT) or noninvasive ventilation (NIV) in patients with COPD. METHODS A literature search was performed in electronic databases until October 1st, 2022. The primary outcome was the need for intubation/reintubation. All analyses were performed using R (version 4.0.3) and STATA SE (version 15.1). RESULTS When HFNC therapy was compared with NIV in patients with COPD under initial respiratory support and postextubation, no significant differences were found in the risk of intubation (RR 0.84, 95% CI 0.36 to 1.98) and reintubation (RR 1.35, 95% CI 0.73 to 2.50). Compared to NIV, HFNC therapy did not decrease the partial pressure of carbon dioxide or increase the partial pressure of oxygen to the fraction of inspired oxygen. However, HFNC therapy was associated with a lower incidence of skin breakdown (RR 0.52, 95% CI 0.39 to 0.69) and a higher comfort score (SMD 0.90, 95% CI 0.60 to 1.20) than NIV. When HFNC therapy was compared with COT during initial respiratory treatment for COPD exacerbation, a lower risk of treatment failure was found (RR 0.58, 95% CI 0.37 to 0.89). When HFNC therapy was compared with long-term oxygen therapy, quality of life (measured by SGRQ-C) was significantly improved (SMD -0.42, 95% CI -0.69 to -0.14). CONCLUSION HFNC therapy might be used as an alternative to NIV for COPD exacerbation with mild-moderate hypercapnia under close monitoring and is a potential domiciliary treatment for stable COPD.
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Affiliation(s)
- Huan Yang
- Department of Respiratory and Critical Care Medicine, West China School of Medicine and West China Hospital, Sichuan University, China
| | - Dong Huang
- Department of Respiratory and Critical Care Medicine, West China School of Medicine and West China Hospital, Sichuan University, China
| | - Jian Luo
- Respiratory Medicine Unit and Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Zongan Liang
- Department of Respiratory and Critical Care Medicine, West China School of Medicine and West China Hospital, Sichuan University, China.
| | - Jie Li
- Department of Cardiopulmonary Sciences, Division of Respiratory Care, Rush University, Chicago, IL, 60612, USA.
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