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Lee S, Choi JW, Chung IS, Kim TJ, Sim WS, Park S, Ahn HJ. Comparison of high-flow nasal cannula and conventional nasal cannula during deep sedation for endoscopic submucosal dissection: a randomized controlled trial. J Anesth 2024:10.1007/s00540-024-03352-2. [PMID: 38824469 DOI: 10.1007/s00540-024-03352-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 05/19/2024] [Indexed: 06/03/2024]
Abstract
PURPOSE Adequate oxygenation and airway management during deep sedation can be challenging. We investigated the effect of high-flow nasal cannula (group HF) and conventional nasal cannula (group CO) during sedation for endoscopic submucosal dissection (ESD). METHODS Patients undergoing ESD with deep sedation were enrolled. The primary outcome was difference in lowest oxygen saturation (SpO2) between the groups. Incidence of hypoxia (SpO2 < 90%), patients with SpO2 < 95%, hypercapnia, and airway interventions; operator satisfaction; and adverse events were recorded. RESULTS Thirty-two patients in each group completed the study. The mean of minimum SpO2 values was significantly higher in group HF than in group CO (96.8% ± 4.2% vs. 93.3% ± 5.3%, p = 0.005). The incidence of hypoxia was comparable between the groups (4 [12.5%] vs. 6 [18.8%], p = 0.491); however, patients with SpO2 < 95% were significantly less in group HF (5 [15.6%] vs. 18 [56.3%], p = 0.003). Incidence of hypercapnia was higher in group HF than in group CO (14 [46.7%] vs. 5 [16.7%], p = 0.013). Airway rescue interventions were significantly less common in group HF. Satisfaction of operators and post-procedural complications were comparable between the two groups. In multivariable analysis, group CO and higher body mass index were risk factors for airway managements (odds ratio [95% confidence interval]: 6.204 [1.784-21.575], p = 0.004; 1.337 [1.043-1.715], p = 0.022, respectively). CONCLUSIONS Compared to conventional nasal cannula, high-flow nasal cannula maintained higher minimum SpO2 value during deep sedation with propofol-remifentanil for ESD. TRIAL REGISTRATION Clinical Trial Registry of the Republic of Korea (KCT0006618, https://cris.nih.go.kr ; registered September 29, 2021; principal investigator: Ji Won Choi).
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Affiliation(s)
- Seungwon Lee
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Korea
| | - Ji Won Choi
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Korea.
| | - In Sun Chung
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Korea
| | - Tae Jun Kim
- Division of Gastroenterology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Woo Seog Sim
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Korea
| | - Seojin Park
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Korea
| | - Hyun Joo Ahn
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Korea
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Poirier M, Walton RAL. The successful use of a subcutaneous catheter in the management of severe subcutaneous emphysema in a dog with laryngeal crush injury and tracheostomy tube placement. J Vet Emerg Crit Care (San Antonio) 2023; 33:710-714. [PMID: 37793056 DOI: 10.1111/vec.13322] [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: 12/09/2021] [Revised: 06/26/2022] [Accepted: 06/30/2022] [Indexed: 10/06/2023]
Abstract
OBJECTIVE To describe the placement of a subcutaneous catheter in a dog for the management of severe subcutaneous emphysema secondary to severe laryngeal crushing injury and temporary tracheostomy tube placement. CASE SUMMARY A 6-year-old male neutered Kelpie suffered a severe laryngeal crushing injury following a dog attack. Case management included the placement of a temporary tracheostomy tube due to severe respiratory compromise and inspiratory dyspnea associated with the crush injury. During hospitalization, the patient developed severe subcutaneous emphysema, pneumomediastinum, and a pneumothorax as a complication of the laryngeal crushing injury and temporary tracheostomy. A subcutaneous catheter was placed to manage the recurrent subcutaneous emphysema while the tracheostomy stoma healed. Five months posttrauma, the dog returned to normal with mild stridor during excitement and while panting. NEW OR UNIQUE INFORMATION PROVIDED This is the first report in veterinary medicine describing the use of a subcutaneous catheter for the management of subcutaneous emphysema secondary to laryngeal crush injury and temporary tracheostomy tube placement.
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Affiliation(s)
- Maude Poirier
- Department of Small Animal Emergency and Critical Care, College of Veterinary Medicine, Iowa State University, Ames, Iowa, USA
| | - Rebecca A L Walton
- Department of Small Animal Emergency and Critical Care, College of Veterinary Medicine, Iowa State University, Ames, Iowa, USA
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Lee S, Choi JW, Chung IS, Kim DK, Sim WS, Kim TJ. Comparison of high-flow nasal cannula and conventional nasal cannula during sedation for endoscopic submucosal dissection: a retrospective study. Therap Adv Gastroenterol 2023; 16:17562848231189957. [PMID: 37655054 PMCID: PMC10467296 DOI: 10.1177/17562848231189957] [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: 12/18/2022] [Accepted: 05/27/2023] [Indexed: 09/02/2023] Open
Abstract
Background The high-flow nasal cannula (HFNC) is a relatively recent method that provides high-flow, heated, humidified gas delivery. Objectives We compared HFNC (group HF) and conventional nasal cannula (NC) (group CO) during deep sedation with propofol and remifentanil for endoscopic submucosal dissection (ESD). Design Single-center, retrospective observational cohort study. Methods In this study, a total of 159 cases were analyzed (group CO, 71 and group HF, 88). We collected the data from electronic medical records from September 2020 to June 2021. The lowest oxygen saturation (SpO2), incidence of hypoxia (SpO2 < 90%), rescue interventions, and adverse events between the two groups were investigated. Results There were significant differences between the two groups in lowest SpO2 and incidence of hypoxia [group CO versus group HF; 90.3 ± 9.7% versus 95.7 ± 9.0%, 25 (35.2%) versus 10 (11.4%); p < 0.001, p < 0.001; respectively]. Among the rescue interventions, the number of jaw thrust, patient stimulation, O2 flow increase, and nasal airway insertion were significantly higher in the CO group than in the HF group. However, postprocedural chest X-ray showed higher rates of abnormal findings (atelectasis, aspiration, and pneumoperitoneum) in group HF than in group CO [group CO: 8 (11.3%) versus group HF: 26 (29.5%), p = 0.005]. In multivariable analysis, besides group CO, difficult type of lesion was the risk factor for hypoxia. Conclusions Compared to the conventional NC, HFNC provided adequate oxygenation and a stable procedure without significant adverse events during sedation for ESD. However, caution is needed to avoid complications associated with deep sedation and difficult type of lesions.
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Affiliation(s)
- Seungwon Lee
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ji Won Choi
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Republic of Korea
| | - In Sun Chung
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Duk Kyung Kim
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Woo Seog Sim
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Tae Jun Kim
- Division of Gastroenterology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Ganessane E, Devendiran A, Ramesh S, Uthayakumar A, Chandrasekar V, Sadasivam AS, Nathan B, Ayyan M. Pneumomediastinum in COVID-19 disease: Clinical review with emphasis on emergency management. J Am Coll Emerg Physicians Open 2023; 4:e12935. [PMID: 37056716 PMCID: PMC10086517 DOI: 10.1002/emp2.12935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 02/17/2023] [Accepted: 02/27/2023] [Indexed: 04/15/2023] Open
Abstract
Pneumomediastinum can be primary (spontaneous) or secondary to iatrogenic, traumatic, and non-traumatic causes. The incidence of spontaneous and secondary pneumomediastinum is higher in patients with coronavirus disease 2019 (COVID-19) compared to the general population. So, pneumomediastinum should be considered in the differential diagnosis of any patient with COVID-19 presenting with chest pain and breathlessness. A high level of suspicion is required to diagnose this condition promptly. Unlike in other disease conditions, pneumomediastinum in COVID-19 has a complicated course with higher mortality in intubated patients. No guidelines exist for managing pneumomediastinum patients with COVID-19. Therefore, emergency physicians should be aware of the various treatment modalities besides conservative management for pneumomediastinum and life-saving interventions for tension pneumomediastinum.
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Affiliation(s)
| | | | - Swetha Ramesh
- Department of Emergency MedicineJIPMERPuducherryIndia
| | | | | | | | | | - Manu Ayyan
- Department of Emergency MedicineJIPMERPuducherryIndia
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Whitney J, Keir I. Clinical review of high-flow nasal oxygen therapy in human and veterinary patients. Front Vet Sci 2023; 10:1070881. [PMID: 36950541 PMCID: PMC10027015 DOI: 10.3389/fvets.2023.1070881] [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: 10/15/2022] [Accepted: 02/02/2023] [Indexed: 03/08/2023] Open
Abstract
Oxygen therapy is the first-line treatment for hypoxemic acute respiratory failure. In veterinary medicine this has traditionally been provided via mask, low-flow nasal oxygen cannulas, oxygen cages and invasive positive pressure ventilation. Traditional non-invasive modalities are limited by the maximum flow rate and fraction of inspired oxygen (FiO2) that can be delivered, variability in oxygen delivery and patient compliance. The invasive techniques are able to provide higher FiO2 in a more predictable manner but are limited by sedation/anesthesia requirements, potential complications and cost. High-flow nasal oxygen therapy (HFNOT) represents an alternative to conventional oxygen therapy. This modality delivers heated and humidified medical gas at adjustable flow rates, up to 60 L/min, and FiO2, up to 100%, via nasal cannulas. It has been proposed that HFNOT improves pulmonary mechanics and reduces respiratory fatigue via reduction of anatomical dead space, provision of low-level positive end-expiratory pressure (PEEP), provision of constant FiO2 at rates corresponding to patient requirements and through improved patient tolerance. Investigations into the use of HFNOT in veterinary patients have increased in frequency since its clinical use was first reported in dogs with acute respiratory failure in 2016. Current indications in dogs include acute respiratory failure associated with pulmonary parenchymal disease, upper airway obstruction and carbon monoxide intoxication. The use of HFNOT has also been advocated in certain conditions in cats and foals. HFNOT is also being used with increasing frequency in the treatment of a widening range of conditions in humans. Although there remains conflict regarding its use and efficacy in some patient groups, overall these reports indicate that HFNOT decreases breathing frequency and work of breathing and reduces the need for escalation of respiratory support. In addition, they provide insight into potential future veterinary applications. Complications of HFNOT have been rarely reported in humans and animals. These are usually self-limiting and typically result in lower morbidity and mortality than those associated with invasive ventilation techniques.
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Krawec P, Marshall K, Odunayo A. A Review of High Flow Nasal Cannula Oxygen Therapy in Human and Veterinary Medicine. Top Companion Anim Med 2021; 46:100596. [PMID: 34757156 DOI: 10.1016/j.tcam.2021.100596] [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: 09/01/2020] [Revised: 10/20/2021] [Accepted: 10/21/2021] [Indexed: 10/19/2022]
Abstract
Respiratory distress is a common ailment in small animal medicine. Oxygen supplementation is a mainstay of initial therapy. High Flow Nasal Cannula Oxygen Therapy (HFNCOT) has become increasingly popular as a treatment modality in human medicine, and more recently in canine patients. These devices deliver high flow rates of heated and humidified oxygen at an adjustable fraction of inspired oxygen (FiO2). This article reviews current literature in human patients on HFNCOT as well as studies that have evaluated its use in veterinary patients. A discussion of the respiratory physiology that is associated with respiratory distress, in addition to an overview of currently available oxygen supplementation modalities is provided. The physiologic benefits of HFNCOT are explained, as are technical aspects associated with its use. Recommendations on initial settings, maintenance therapy, and weaning are also described.
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Affiliation(s)
- Philip Krawec
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville.
| | - Kristen Marshall
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville
| | - Adesola Odunayo
- Department of Small Animal Clinical Sciences, University of Florida, Gainesville, Florida
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Heijboer F, Oswald L, Cretier S, Braunstahl GJ. Pneumomediastinum in a patient with COVID-19 due to diffuse alveolar damage. BMJ Case Rep 2021; 14:14/5/e242527. [PMID: 33975848 PMCID: PMC8117474 DOI: 10.1136/bcr-2021-242527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
A 74-year-old man with COVID-19 was admitted and experienced progressive dyspnoea while receiving supplemental oxygen via high-flow nasal cannula (HFNC). A CT of the thorax showed a pneumomediastinum. The HFNC was temporally interrupted, since it was uncertain whether the positive end-expiratory pressure of the HFNC could be the cause of the pneumomediastinum. After restart of the HFNC, there was no increase of symptoms. We suggest that the pneumomediastinum was the result of COVID-19-related alveolar damage, and not due to the use of HFNC. This observation is relevant since HFNC is often used in the treatment of severe COVID-19 pneumonia.
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Affiliation(s)
- Frank Heijboer
- Pulmonology, Franciscus Gasthuis en Vlietland, Rotterdam, The Netherlands
| | - Laurien Oswald
- Pulmonology, Franciscus Gasthuis en Vlietland, Rotterdam, The Netherlands
| | - Sander Cretier
- Radiology, Franciscus Gasthuis en Vlietland, Rotterdam, The Netherlands
| | - Gert-Jan Braunstahl
- Pulmonology, Franciscus Gasthuis en Vlietland, Rotterdam, The Netherlands .,Pulmonology, Erasmus Medical Center, Rotterdam, The Netherlands
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Cancelliere A, Procopio G, Mazzitelli M, Lio E, Petullà M, Serapide F, Pelle MC, Davoli C, Trecarichi EM, Torti C. A case report of pneumomediastinum in a COVID-19 patient treated with high-flow nasal cannula and review of the literature: Is this a "spontaneous" complication? Clin Case Rep 2021; 9:e04007. [PMID: 34084480 PMCID: PMC8142302 DOI: 10.1002/ccr3.4007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 01/21/2021] [Accepted: 02/09/2021] [Indexed: 12/16/2022] Open
Abstract
Oxygen support with high-flow nasal cannula (HFNC) is gentler than mechanical ventilation and may provide significant benefits, but more studies are needed to investigate the efficacy and safety of different respiratory supports in patients with COVID-19 pneumonia.
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Affiliation(s)
- Anna Cancelliere
- Infectious and Tropical Disease UnitDepartment of Medical and Surgical Sciences“Magna Graecia” University of CatanzaroCatanzaroItaly
| | - Giada Procopio
- Infectious and Tropical Disease UnitDepartment of Medical and Surgical Sciences“Magna Graecia” University of CatanzaroCatanzaroItaly
| | - Maria Mazzitelli
- Infectious and Tropical Disease UnitDepartment of Medical and Surgical Sciences“Magna Graecia” University of CatanzaroCatanzaroItaly
| | - Elena Lio
- Infectious and Tropical Disease UnitDepartment of Medical and Surgical Sciences“Magna Graecia” University of CatanzaroCatanzaroItaly
| | - Maria Petullà
- Radiology UnitDepartment of Medical and Surgical Sciences“Magna Graecia” University of CatanzaroCatanzaroItaly
| | - Francesca Serapide
- Infectious and Tropical Disease UnitDepartment of Medical and Surgical Sciences“Magna Graecia” University of CatanzaroCatanzaroItaly
| | - Maria Chiara Pelle
- Infectious and Tropical Disease UnitDepartment of Medical and Surgical Sciences“Magna Graecia” University of CatanzaroCatanzaroItaly
| | - Chiara Davoli
- Infectious and Tropical Disease UnitDepartment of Medical and Surgical Sciences“Magna Graecia” University of CatanzaroCatanzaroItaly
| | - Enrico Maria Trecarichi
- Infectious and Tropical Disease UnitDepartment of Medical and Surgical Sciences“Magna Graecia” University of CatanzaroCatanzaroItaly
| | - Carlo Torti
- Infectious and Tropical Disease UnitDepartment of Medical and Surgical Sciences“Magna Graecia” University of CatanzaroCatanzaroItaly
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Valencia Salazar JC, Zamarriego RJ, Bejarano Castro M, Arzayuz Patiño L. Drenaje percutáneo con catéter del neumotórax en pacientes con COVID–19. REVISTA COLOMBIANA DE CIRUGÍA 2020. [DOI: 10.30944/20117582.772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introducción: La transmisión del SARS-CoV-2 principalmente se da por gotas y contacto cercano con las personas infectadas, pero los aerosoles parecen ser también una fuente de infección. El neumotórax espontáneo o secundario puede presentarse en pacientes con COVID-19, ayudado por patologías de base como la enfermedad pulmonar obstructiva crónica. Es necesario garantizar procedimientos seguros para los pacientes y buscar todas las medidas posibles para la protección del personal de la salud, por eso el drenaje de neumotórax con catéter pleural en lugar de sonda de toracostomía puede ser una de ellas.
El objetivo de este estudio es presentar a los cirujanos una alternativa a la toracostomía tradicional, mediante la utilización de catéteres de menor diámetro, para la resolución de la ocupación pleural.
Aspectos Técnicos: Se presenta el protocolo para inserción segura de un catéter pleural para el drenaje de neumotórax, mediante un sistema completamente cerrado, y se dan recomendaciones sobre el uso de filtros virales y solución viricida en el sistema de drenaje pleural conectado al catéter.
Conclusión: El estado de pandemia por COVID-19 y el riesgo que representa para los profesionales de la salud la exposición a fuentes de transmisión durante procedimientos generadores de aerosoles, hace que se deban extremar las medidas para evitar el contagio.
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Abstract
INTRODUCTION Since the end of 2019, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has affected more than 1,000,000 population in the world. Subcutaneous emphysema and pneumothorax are uncommon complications of SARS-CoV-2 pneumonia. Herein, we describe a fatal case of SARS-CoV-2 pneumonia with subcutaneous emphysema and pneumothorax. PATIENT CONCERNS Subcutaneous emphysema was found in neck, bilateral chest walls, abdomen wall, groin area, and scrotum of a 67-year-old man. Extensive air-space opacities, subcutaneous emphysema and a small amount of pneumothorax were found in his chest X-ray scan. Echocardiography showed left ventricular enlargement with ejection fraction 20%. DIAGNOSIS This resident of Wuhan with laboratory-confirmed SARS-CoV-2 infection had chronic pulmonary and cardiac diseases. Liver dysfunction, myocardial injury, and coagulation disorder were suggested by laboratory findings. Pneumonia, subcutaneous emphysema, and pneumothorax were confirmed with chest X-ray. Heart failure was revealed by echocardiography. INTERVENTIONS He was transferred to intensive care unit, where invasive ventilation was used for him during the whole hospitalization. Prone position ventilation, vasoconstrictor, antibacteria, and antiviral therapy were given. OUTCOMES He died on the twelfth day after admission. CONCLUSIONS Subcutaneous emphysema and pneumothorax may occur in patients with SARS-CoV-2 pneumonia and chronic pulmonary disease. Chronic cardiac disease might be aggravated by SARS-CoV-2 infection, and develop heart failure.
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