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Alrzoq RA, Alateeq OM, Almslam MS, Alanzi FA, Alhuthil RT. Cardiopulmonary outcomes following high flow nasal cannula in pediatric population: A systematic review. Heart Lung 2023; 61:46-50. [PMID: 37148814 DOI: 10.1016/j.hrtlng.2023.04.009] [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: 01/10/2023] [Revised: 04/11/2023] [Accepted: 04/21/2023] [Indexed: 05/08/2023]
Abstract
BACKGROUND The high-flow nasal cannula (HFNC) has received much attention in various clinical settings and has been approved recently for application in pediatric care. OBJECTIVES To determine whether HFNC use improves cardiopulmonary outcomes in pediatric patients with the cardiac disease more effectively than alternative oxygen therapies. METHODS Systematic review was performed using PubMed, Scopus, and Web of Science databases. Randomized controlled trials comparing HFNC with alternative oxygen therapies and observational studies that solely reported on the use of HFNC in the pediatric population were included between 2012 and 2022. RESULTS Nine studies with approximately 656 patients were reported in this review. HFNC significantly increased systemic oxygen saturation across all literature investigating this parameter. Other notable outcomes in HFNC patients included normalizing heart rate, partial blood pressure, and PaO2/FiO2 ratio. However, some studies reported a complication rate concurrent with traditional oxygen therapies, and a suggested HFNC failure rate of 50% was observed. CONCLUSIONS Compared with traditional oxygen therapies, HFNC can reduce anatomical dead space and normalize systemic oxygen saturation, PaO2/FiO2 ratio, heart rate, and partial blood pressure. We advocate using HFNC therapy in children with cardiac diseases as the currently available evidence supports HFNC use over other oxygenation treatments in the pediatric population.
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Affiliation(s)
- Rakan A Alrzoq
- Department of Pediatrics, King Faisal Specialist Hospital and Research Centre, Al Takhassousi & 12713, Riyadh 11211, Saudi Arabia.
| | - Osama M Alateeq
- Department of Pediatrics, King Salman Hospital, Riyadh 56773 Saudi Arabia
| | - Maha S Almslam
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.
| | - Fawaz A Alanzi
- Department of Pediatrics, King Faisal Specialist Hospital and Research Centre, Al Takhassousi & 12713, Riyadh 11211, Saudi Arabia.
| | - Raghad T Alhuthil
- Department of Pediatrics, King Faisal Specialist Hospital and Research Centre, Al Takhassousi & 12713, Riyadh 11211, Saudi Arabia
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Scheuermann S, Tan A, Govender P, Mckie M, Pack J, Martinez G, Falter F, George S, A Klein A. High-flow nasal oxygen vs. standard oxygen therapy for patients undergoing transcatheter aortic valve replacement with conscious sedation: a randomised controlled trial. Perioper Med (Lond) 2023; 12:11. [PMID: 37060038 PMCID: PMC10103409 DOI: 10.1186/s13741-023-00300-8] [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: 10/17/2021] [Accepted: 03/30/2023] [Indexed: 04/16/2023] Open
Abstract
BACKGROUND Minimally invasive surgery is becoming more common and transfemoral transcatheter aortic valve replacement is offered to older patients with multiple comorbidities. Sternotomy is not required but patients must lie flat and still for up to 2-3 h. This procedure is increasingly being performed under conscious sedation with supplementary oxygen, but hypoxia and agitation are commonly observed. METHODS In this randomised controlled trial, we hypothesised that high-flow nasal oxygen would provide superior oxygenation as compared with our standard practice, 2 l min-1 oxygen by dry nasal specs. This was administered using the Optiflow THRIVE Nasal High Flow delivery system (Fisher and Paykel, Auckland, New Zealand) at a flow rate of 50 l min-1 and FiO2 0.3. The primary endpoint was the change in arterial partial pressure of oxygen (pO2) during the procedure. Secondary outcomes included the incidence of oxygen desaturation, airway interventions, the number of times the patient reached for the oxygen delivery device, incidence of cerebral desaturation, peri-operative oxygen therapy duration, hospital length of stay and patient satisfaction scores. RESULTS A total of 72 patients were recruited. There was no difference in change in pO2 from baseline using high-flow compared with standard oxygen therapy: median [IQR] increase from 12.10 (10.05-15.22 [7.2-29.8]) to 13.69 (10.85-18.38 [8.5-32.3]) kPa vs. decrease from 15.45 (12.17-19.33 [9.2-22.8]) to 14.20 (11.80-19.40 [9.7-35.1]) kPa, respectively. The percentage change in pO2 after 30 min was also not significantly different between the two groups (p = 0.171). There was a lower incidence of oxygen desaturation in the high-flow group (p = 0.027). Patients in the high-flow group assigned a significantly higher comfort score to their treatment (p ≤ 0.001). CONCLUSION This study has demonstrated that high flow, compared with standard oxygen therapy, does not improve arterial oxygenation over the course of the procedure. There are suggestions that it may improve the secondary outcomes studied. TRIAL REGISTRATION International Standard Randomised Controlled Trial Number (ISRCTN) 13,804,861. Registered on 15 April 2019. https://doi.org/10.1186/ISRCTN13804861.
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Affiliation(s)
- S Scheuermann
- Department of Anaesthesia and Intensive Care, Royal Papworth Hospital, Cambridge, UK
| | - A Tan
- Department of Anaesthesia and Intensive Care, Royal Papworth Hospital, Cambridge, UK.
| | - P Govender
- Department of Anaesthesia and Intensive Care, Royal Papworth Hospital, Cambridge, UK
| | - M Mckie
- MRC Biostatistics Unit, University of Cambridge, Cambridge, UK
| | - J Pack
- Department of Anaesthesia and Intensive Care, Royal Papworth Hospital, Cambridge, UK
| | - G Martinez
- Department of Anaesthesia and Intensive Care, Royal Papworth Hospital, Cambridge, UK
| | - F Falter
- Department of Anaesthesia and Intensive Care, Royal Papworth Hospital, Cambridge, UK
| | - S George
- Department of Anaesthesia and Intensive Care, Royal Papworth Hospital, Cambridge, UK
| | - A A Klein
- Department of Anaesthesia and Intensive Care, Royal Papworth Hospital, Cambridge, UK
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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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LIU X, WU R, LAI L, LIN J. Clinical application of High-flow nasal cannula oxygen therapy in acute heart failure. FOOD SCIENCE AND TECHNOLOGY 2022. [DOI: 10.1590/fst.40020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Xiong LIU
- The first affiliated hospital of Xiamen university, China; Fujian Medical University, China
| | - Rong WU
- The first affiliated hospital of Xiamen university, China; Fujian Medical University, China
| | - Liren LAI
- The first affiliated hospital of Xiamen university, China; Fujian Medical University, China
| | - Jiyan LIN
- The first affiliated hospital of Xiamen university, China; Fujian Medical University, China
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Chen X, Li Y, Shao TR, Yang LL, Li SJ, Wang XJ, Li A, Wu YY, Liu XF, Liu CM, Liu YH, Zeng F, Cen Y. Some characteristics of clinical sequelae of COVID-19 survivors from Wuhan, China: A multi-center longitudinal study. Influenza Other Respir Viruses 2021; 16:395-401. [PMID: 34796652 PMCID: PMC8652839 DOI: 10.1111/irv.12943] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 11/07/2021] [Indexed: 01/10/2023] Open
Abstract
Background The pandemic of COVID‐19 has a persistent impact on global health, yet its sequelae need to be addressed at a wide scale around the globe. This study aims to investigate the characteristics, prevalence, and risk factors for mid‐term (>6 months) clinical sequelae in a cohort of COVID‐19 survivors. Methods Totally 715 COVID‐19 survivors discharged before April 1, 2020, from three medical centers in Wuhan, China, were included. The longitudinal study was conducted by telephone interviews based on a questionnaire including the clinical sequelae of general, respiratory, and cardiovascular systems. Demographics and some characteristics of clinical sequelae of the survivors were recorded and analyzed. Multivariate logistic regression analysis was applied to explore the risk factors for the sequelae. Results The median time interval from discharge to telephone interview was 225.0 days. The COVID‐19 survivors' median ages were 69 years, and 51.3% were male. Among them, 29.9% had at least one clinical sequela. There were 19.2%, 22.7%, and 5.0% of the survivors reporting fatigue, respiratory symptoms, and cardiovascular symptoms, respectively. Comorbidities, disease severity, the application of mechanical ventilation and high‐flow oxygen therapy, and the history of re‐admission were associated with the presence of clinical sequelae. Conclusions Our study provides further evidence for the prevalence and characteristics of clinical sequelae of COVID‐19 survivors, suggesting long‐term monitoring and management is needed for their full recovery.
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Affiliation(s)
- Xian Chen
- Department of Anesthesiology, Daping Hospital, Army Medical University, Chongqing, China
| | - Ying Li
- Department of Ophthalmology, Daping Hospital, Army Medical University, Chongqing, China
| | - Tong-Ren Shao
- Department of Medical Education, Daping Hospital, Army Medical University, Chongqing, China
| | - Ling-Li Yang
- Department of Orthopedics, Daping Hospital, Army Medical University, Chongqing, China
| | - Si-Jing Li
- Department of Orthopedics, Daping Hospital, Army Medical University, Chongqing, China
| | - Xiu-Juan Wang
- Department of Anesthesiology, Daping Hospital, Army Medical University, Chongqing, China
| | - Ao Li
- Department of Anesthesiology, Daping Hospital, Army Medical University, Chongqing, China
| | - Yin-Yu Wu
- Department of Anesthesiology, Daping Hospital, Army Medical University, Chongqing, China
| | - Xue-Fei Liu
- Department of Ophthalmology, Daping Hospital, Army Medical University, Chongqing, China
| | - Chun-Mei Liu
- Department of Ophthalmology, Daping Hospital, Army Medical University, Chongqing, China
| | - Yu-Hui Liu
- Department of Neurology and Center for Clinical Neuroscience, Daping Hospital, Army Medical University, Chongqing, China
| | - Fan Zeng
- Department of Neurology and Center for Clinical Neuroscience, Daping Hospital, Army Medical University, Chongqing, China
| | - Yuan Cen
- Department of Orthopedics, Daping Hospital, Army Medical University, Chongqing, China
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Puah SH, Li A, Cove ME, Phua J, Ng V, Kansal A, Tan QL, Sahagun JT, Taculod J, Tan AYH, Mukhopadhyay A, Tay CK, Ramanathan K, Chia YW, Sewa DW, Chew M, Lew SJW, Goh S, Dhanvijay S, Tan JJE, See KC. High-flow nasal cannula therapy: A multicentred survey of the practices among physicians and respiratory therapists in Singapore. Aust Crit Care 2021; 35:520-526. [PMID: 34518063 DOI: 10.1016/j.aucc.2021.08.001] [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: 02/13/2021] [Revised: 07/28/2021] [Accepted: 08/03/2021] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Use of high-flow nasal cannula (HFNC) has become a regular intervention in the intensive care units especially in patients coming in with hypoxaemic respiratory failure. Clinical practices may differ from published literature. OBJECTIVES The objective of this study was to determine the clinical practices of physicians and respiratory therapists (RTs) on the use of HFNC. METHODS A retrospective observational study looking at medical records on HFNC usage from January 2015 to September 2017 was performed and was followed by a series of questions related to HFNC practices. The survey involved physicians and RTs in intensive care units from multiple centres in Singapore from January to April 2018. Indications and thresholds for HFNC usage with titration and weaning practices were compared with the retrospective observational study data. RESULTS One hundred twenty-three recipients (69.9%) responded to the survey and reported postextubation (87.8%), pneumonia in nonimmunocompromised (65.9%), and pneumonia in immunocompromised (61.8%) patients as the top three indications for HFNC. Of all, 39.8% of respondents wanted to use HFNC for palliative intent. Similar practices were observed in the retrospective study with the large cohort of 63% patients (483 of the total 768 patients) where HFNC was used for acute hypoxaemic respiratory failure and 274 (35.7%) patients to facilitate extubation. The survey suggested that respondents would initiate HFNC at a lower fraction of inspired oxygen (FiO2), higher partial pressure of oxygen to FiO2 ratio, and higher oxygen saturation to FiO2 ratio for nonpneumonia patients than patients with pneumonia. RTs were less likely to start HFNC for patients suffering from pneumonia and interstitial lung disease than physicians. RTs also preferred adjustment of FiO2 to improve oxygen saturations and noninvasive ventilation for rescue. CONCLUSIONS Among the different intensive care units surveyed, the indications and thresholds for the initiation of HFNC differed in the clinical practices of physicians and RTs.
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Affiliation(s)
- Ser Hon Puah
- Department of Respiratory and Critical Care Medicine, Tan Tock Seng Hospital, Singapore.
| | - Andrew Li
- Division of Respiratory and Critical Care Medicine, Department of Medicine, National University Hospital, National University Health System, Singapore
| | - Matthew Edward Cove
- Division of Respiratory and Critical Care Medicine, Department of Medicine, National University Hospital, National University Health System, Singapore
| | - Jason Phua
- Division of Respiratory and Critical Care Medicine, Department of Medicine, National University Hospital, National University Health System, Singapore; Fast and Chronic Programmes, Alexandra Hospital, National University Health System, Singapore
| | - Vicky Ng
- Department of Anaesthesiology, Intensive Care and Pain Medicine, Tan Tock Seng Hospital, Singapore
| | - Amit Kansal
- Department of Intensive Care Medicine, Ng Teng Fong General Hospital, National University Health System, Singapore
| | - Qiao Li Tan
- Department of Respiratory Medicine and Critical Care Medicine, Singapore General Hospital, Singapore
| | - Juliet Tolentino Sahagun
- Division of Critical Care, National University Hospital, National University Health System, Singapore
| | - Juvel Taculod
- Division of Critical Care, National University Hospital, National University Health System, Singapore
| | - Addy Yong-Hu Tan
- Department of Anaesthesia, National University Hospital, National University Health System, Singapore
| | - Amartya Mukhopadhyay
- Division of Respiratory and Critical Care Medicine, Department of Medicine, National University Hospital, National University Health System, Singapore
| | - Chee Kiang Tay
- Department of Respiratory Medicine and Critical Care Medicine, Singapore General Hospital, Singapore
| | - Kollengode Ramanathan
- Department of Cardiac Thoracic and Vascular Surgery, National University Heart Centre, National University Hospital, Singapore
| | - Yew Woon Chia
- Department of Cardiology, Tan Tock Seng Hospital, Singapore
| | - Duu Wen Sewa
- Department of Respiratory Medicine and Critical Care Medicine, Singapore General Hospital, Singapore
| | - Meiying Chew
- Division of Respiratory and Critical Care Medicine, Department of Medicine, National University Hospital, National University Health System, Singapore
| | - Sennen J W Lew
- Department of Respiratory and Critical Care Medicine, Tan Tock Seng Hospital, Singapore
| | - Shirley Goh
- Department of Anaesthesiology, Intensive Care and Pain Medicine, Tan Tock Seng Hospital, Singapore
| | - Shekhar Dhanvijay
- Department of Intensive Care Medicine, Ng Teng Fong General Hospital, National University Health System, Singapore
| | - Jonathan Jit-Ern Tan
- Department of Anaesthesiology, Intensive Care and Pain Medicine, Tan Tock Seng Hospital, Singapore
| | - Kay Choong See
- Division of Respiratory and Critical Care Medicine, Department of Medicine, National University Hospital, National University Health System, Singapore
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Yu Y, Yao RQ, Zhang YF, Wang SY, Xi W, Wang JN, Huang XY, Yao YM, Wang ZN. Is oxygen therapy beneficial for normoxemic patients with acute heart failure? A propensity score matched study. Mil Med Res 2021; 8:38. [PMID: 34238369 PMCID: PMC8268364 DOI: 10.1186/s40779-021-00330-7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 06/01/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The clinical efficiency of routine oxygen therapy is uncertain in patients with acute heart failure (AHF) who do not have hypoxemia. The aim of this study was to investigate the association between oxygen therapy and clinical outcomes in normoxemic patients hospitalized with AHF using real-world data. METHODS Normoxemic patients diagnosed with AHF on ICU admission from the electronic ICU (eICU) Collaborative Research Database were included in the current study, in which the study population was divided into the oxygen therapy group and the ambient-air group. Propensity score matching (PSM) was applied to create a balanced covariate distribution between patients receiving supplemental oxygen and those exposed to ambient air. Linear regression and logistic regression models were performed to assess the associations between oxygen therapy and length of stay (LOS), and all-cause in-hospital as well as ICU mortality rates, respectively. A series of sensitivity and subgroup analyses were conducted to further validate the robustness of our findings. RESULTS A total of 2922 normoxemic patients with AHF were finally included in the analysis. Overall, 42.1% (1230/2922) patients were exposed to oxygen therapy, and 57.9% (1692/2922) patients did not receive oxygen therapy (defined as the ambient-air group). After PSM analysis, 1122 pairs of patients were matched: each patient receiving oxygen therapy was matched with a patient without receiving supplemental oxygen. The multivariable logistic model showed that there was no significant interaction between the ambient air and oxygen group for all-cause in-hospital mortality [odds ratio (OR) 1.30; 95% confidence interval (CI) 0.92-1.82; P = 0.138] or ICU mortality (OR 1.39; 95% CI 0.83-2.32; P = 0.206) in the post-PSM cohorts. In addition, linear regression analysis revealed that oxygen therapy was associated with prolonged ICU LOS (OR 1.11; 95% CI 1.06-1.15; P < 0.001) and hospital LOS (OR 1.06; 95% CI 1.01-1.10; P = 0.009) after PSM. Furthermore, the absence of an effect of supplemental oxygen on mortality was consistent in all subgroups. CONCLUSION Routine use of supplemental oxygen in AHF patients without hypoxemia was not found to reduce all-cause in-hospital mortality or ICU mortality.
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Affiliation(s)
- Yue Yu
- Department of Cardiothoracic Surgery, Changzheng Hospital, Naval Medical University, 415 Fengyang Road, Huangpu District, Shanghai, 200003, China
| | - Ren-Qi Yao
- Trauma Research Center, Fourth Medical Center and Medical Innovation Research Department of the Chinese PLA General Hospital, 51 Fucheng Road, Haidian District, Beijing, 100048, China.,Department of Burn Surgery, Changhai Hospital, Naval Medical University, Shanghai, 200433, China
| | - Yu-Feng Zhang
- Department of Cardiothoracic Surgery, Changzheng Hospital, Naval Medical University, 415 Fengyang Road, Huangpu District, Shanghai, 200003, China
| | - Su-Yu Wang
- Department of Cardiothoracic Surgery, Changzheng Hospital, Naval Medical University, 415 Fengyang Road, Huangpu District, Shanghai, 200003, China
| | - Wang Xi
- Department of Cardiothoracic Surgery, Changzheng Hospital, Naval Medical University, 415 Fengyang Road, Huangpu District, Shanghai, 200003, China
| | - Jun-Nan Wang
- Department of Cardiothoracic Surgery, Changzheng Hospital, Naval Medical University, 415 Fengyang Road, Huangpu District, Shanghai, 200003, China.,Medical Research Center of War Injuries and Trauma, Changzheng Hospital, Naval Medical University, Shanghai, 200003, China
| | - Xiao-Yi Huang
- Department of Pathology, Changhai Hospital, Naval Medical University, Shanghai, 200433, China
| | - Yong-Ming Yao
- Trauma Research Center, Fourth Medical Center and Medical Innovation Research Department of the Chinese PLA General Hospital, 51 Fucheng Road, Haidian District, Beijing, 100048, China.
| | - Zhi-Nong Wang
- Department of Cardiothoracic Surgery, Changzheng Hospital, Naval Medical University, 415 Fengyang Road, Huangpu District, Shanghai, 200003, China.
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Spiesshoefer J, Bannwitz B, Mohr M, Herkenrath S, Randerath W, Sciarrone P, Thiedemann C, Schneider H, Braun AT, Emdin M, Passino C, Dreher M, Boentert M, Giannoni A. Effects of nasal high flow on sympathovagal balance, sleep, and sleep-related breathing in patients with precapillary pulmonary hypertension. Sleep Breath 2021; 25:705-717. [PMID: 32827122 PMCID: PMC8195975 DOI: 10.1007/s11325-020-02159-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 07/09/2020] [Accepted: 08/01/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND In precapillary pulmonary hypertension (PH), nasal high flow therapy (NHF) may favorably alter sympathovagal balance (SVB) and sleep-related breathing through washout of anatomical dead space and alleviation of obstructive sleep apnea (OSA) due to generation of positive airway pressure. OBJECTIVES To investigate the effects of NHF on SVB, sleep, and OSA in patients with PH, and compare them with those of positive airway pressure therapy (PAP). METHODS Twelve patients with PH (Nice class I or IV) and confirmed OSA underwent full polysomnography, and noninvasive monitoring of SVB parameters (spectral analysis of heart rate, diastolic blood pressure variability). Study nights were randomly split into four 2-h segments with no treatment, PAP, NHF 20 L/min, or NHF 50 L/min. In-depth SVB analysis was conducted on 10-min epochs during daytime and stable N2 sleep at nighttime. RESULTS At daytime and compared with no treatment, NHF20 and NHF50 were associated with a flow-dependent increase in peripheral oxygen saturation but a shift in SVB towards increased sympathetic drive. At nighttime, NHF20 was associated with increased parasympathetic drive and improvements in sleep efficiency, but did not alter OSA severity. NHF50 was poorly tolerated. PAP therapy improved OSA but had heterogenous effects on SVB and neutral effects on sleep outcomes. Hemodynamic effects were neutral for all interventions. CONCLUSIONS In sleeping PH patients with OSA NHF20 but not NHF50 leads to decreased sympathetic drive likely due to washout of anatomical dead space. NHF was not effective in lowering the apnea-hypopnoea index and NHF50 was poorly tolerated.
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Affiliation(s)
- Jens Spiesshoefer
- Department of Neurology with Institute for Translational Neurology, University of Muenster, Muenster, Germany.
- Institute of Life Sciences, Scuola Superiore Sant'Anna, Piazza Martiri della Libertà, 33, 56127, Pisa, PI, Italy.
| | - Britta Bannwitz
- Department of Neurology with Institute for Translational Neurology, University of Muenster, Muenster, Germany
| | - Michael Mohr
- Department of Medicine A, Hematology, Oncology and Pulmonary Medicine, University Hospital Muenster, Muenster, Germany
| | - Simon Herkenrath
- Bethanien Hospital gGmbH Solingen, Solingen, Germany and Institute for Pneumology at the University of Cologne, Solingen, Germany
| | - Winfried Randerath
- Bethanien Hospital gGmbH Solingen, Solingen, Germany and Institute for Pneumology at the University of Cologne, Solingen, Germany
| | - Paolo Sciarrone
- Cardiology and Cardiovascular Medicine Division, Fondazione Toscana Gabriele Monasterio, National Research Council, CNR-Regione Toscana, Pisa, Italy
| | - Christian Thiedemann
- Department of Neurology with Institute for Translational Neurology, University of Muenster, Muenster, Germany
| | - Hartmut Schneider
- Sleep Disorders Center, Bayview Hospital, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Andrew T Braun
- Division of Allergy, Pulmonary and Critical Care, Department of Medicine, University of Wisconsin, Madison, WI, USA
| | - Michele Emdin
- Institute of Life Sciences, Scuola Superiore Sant'Anna, Piazza Martiri della Libertà, 33, 56127, Pisa, PI, Italy
- Cardiology and Cardiovascular Medicine Division, Fondazione Toscana Gabriele Monasterio, National Research Council, CNR-Regione Toscana, Pisa, Italy
| | - Claudio Passino
- Institute of Life Sciences, Scuola Superiore Sant'Anna, Piazza Martiri della Libertà, 33, 56127, Pisa, PI, Italy
- Cardiology and Cardiovascular Medicine Division, Fondazione Toscana Gabriele Monasterio, National Research Council, CNR-Regione Toscana, Pisa, Italy
| | - Michael Dreher
- Department of Pneumology and Intensive Care Medicine, University Hospital RWTH, Aachen, Germany
| | - Matthias Boentert
- Department of Neurology with Institute for Translational Neurology, University of Muenster, Muenster, Germany
- Department of Medicine, UKM Marienhospital, Steinfurt, Germany
| | - Alberto Giannoni
- Institute of Life Sciences, Scuola Superiore Sant'Anna, Piazza Martiri della Libertà, 33, 56127, Pisa, PI, Italy
- Cardiology and Cardiovascular Medicine Division, Fondazione Toscana Gabriele Monasterio, National Research Council, CNR-Regione Toscana, Pisa, Italy
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Nishikimi M, Nishida K, Shindo Y, Shoaib M, Kasugai D, Yasuda Y, Higashi M, Numaguchi A, Yamamoto T, Matsui S, Matsuda N. Failure of non-invasive respiratory support after 6 hours from initiation is associated with ICU mortality. PLoS One 2021; 16:e0251030. [PMID: 33930089 PMCID: PMC8087003 DOI: 10.1371/journal.pone.0251030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 04/19/2021] [Indexed: 12/28/2022] Open
Abstract
A previous study has shown that late failure (> 48 hours) of high-flow nasal cannula (HFNC) was associated with intensive care unit (ICU) mortality. The aim of this study was to investigate whether failure of non-invasive respiratory support, including HFNC and non-invasive positive pressure ventilation (NPPV), was also associated with the risk of mortality even if it occurs in the earlier phase. We retrospectively analyzed 59 intubated patients for acute respiratory failure due to lung diseases between April 2014 and June 2018. We divided the patients into 2 groups according to the time from starting non-invasive ventilatory support until their intubation: ≤ 6 hours failure and > 6 hours failure group. We evaluated the differences in the ICU mortality between these two groups. The multivariate logistic regression analysis showed the highest mortality in the > 6 hours failure group as compared to the ≤ 6 hours failure group, with a statistically significant difference (p < 0.01). It was also associated with a statistically significant increased 30-day mortality and decreased ventilator weaning rate. The ICU mortality in patients with acute respiratory failure caused by lung diseases was increased if the time until failure of HFNC and NPPV was more than 6 hours.
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Affiliation(s)
- Mitsuaki Nishikimi
- Department of Emergency and Critical Care Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Department of Emergency Medicine, Northwell Health, NY, NY, United States of America
- Laboratory for Critical Care Physiology at the Feinstein Institutes for Medical Research, Northwell Health, NY, NY, United States of America
- * E-mail:
| | - Kazuki Nishida
- Department of Biostatistics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yuichiro Shindo
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Muhammad Shoaib
- Laboratory for Critical Care Physiology at the Feinstein Institutes for Medical Research, Northwell Health, NY, NY, United States of America
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States of America
| | - Daisuke Kasugai
- Department of Emergency and Critical Care Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yuma Yasuda
- Department of Emergency and Critical Care Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Michiko Higashi
- Department of Emergency and Critical Care Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Atsushi Numaguchi
- Department of Emergency and Critical Care Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takanori Yamamoto
- Department of Emergency and Critical Care Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shigeyuki Matsui
- Department of Biostatistics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Naoyuki Matsuda
- Department of Emergency and Critical Care Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
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10
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Yi P, Li Q, Yang Z, Cao L, Hu X, Gu H. High-flow nasal cannula improves clinical efficacy of airway management in patients undergoing awake craniotomy. BMC Anesthesiol 2020; 20:156. [PMID: 32593287 PMCID: PMC7320587 DOI: 10.1186/s12871-020-01073-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 06/15/2020] [Indexed: 01/10/2023] Open
Abstract
Background Awake craniotomy requires specific sedation procedure in an awake patient who should be able to cooperate during the intraoperative neurological assessment. Currently, limited number of literatures on the application of high-flow nasal cannula (HFNC) in the anesthetic management for awake craniotomy has been reported. Hence, we carried out a prospective study to assess the safety and efficacy of humidified high-flow nasal cannula (HFNC) airway management in the patients undergoing awake craniotomy. Methods Sixty-five patients who underwent awake craniotomy were randomly assigned to use HFNC with oxygen flow rate at 40 L/min or 60 L/min, or nasopharynx airway (NPA) device in the anesthetic management. Data regarding airway management, intraoperative blood gas analysis, intracranial pressure, gastric antral volume, and adverse events were collected and analyzed. Results Patients using HFNC with oxygen flow rate at 40 or 60 L/min presented less airway obstruction and injuries. Patients with HFNC 60 L/min maintained longer awake time than the patients with NPA. While the intraoperative PaO2 and SPO2 were not significantly different between the HFNC and NPA groups, HFNC patients achieved higher PaO2/FiO2 than patients with NPA. There were no differences in Brain Relaxation Score and gastric antral volume among the three groups as well as before and after operation in any of the three groups. Conclusion HFNC was safe and effective for the patients during awake craniotomy. Trial registration Chinese Clinical Trial Registry, CHiCTR1800016621. Date of Registration: 12 June 2018.
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Affiliation(s)
- Ping Yi
- Department of Anesthesiology, Huashan Hospital, Fudan University, No.12 Wulumuqi Zhong Road, Shanghai, 200040, China
| | - Qiong Li
- Department of Anesthesiology, Shanghai Jiahui International Hospital, Shanghai, 200000, China
| | - Zhoujing Yang
- Department of Anesthesiology, Huashan Hospital, Fudan University, No.12 Wulumuqi Zhong Road, Shanghai, 200040, China
| | - Li Cao
- Department of Anesthesiology, Huashan Hospital, Fudan University, No.12 Wulumuqi Zhong Road, Shanghai, 200040, China
| | - Xiaobing Hu
- Department of Anesthesiology, Huashan Hospital, Fudan University, No.12 Wulumuqi Zhong Road, Shanghai, 200040, China
| | - Huahua Gu
- Department of Anesthesiology, Huashan Hospital, Fudan University, No.12 Wulumuqi Zhong Road, Shanghai, 200040, China.
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11
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Ko DR, Beom J, Lee HS, You JS, Chung HS, Chung SP. Benefits of High-Flow Nasal Cannula Therapy for Acute Pulmonary Edema in Patients with Heart Failure in the Emergency Department: A Prospective Multi-Center Randomized Controlled Trial. J Clin Med 2020; 9:jcm9061937. [PMID: 32575829 PMCID: PMC7355695 DOI: 10.3390/jcm9061937] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 06/10/2020] [Accepted: 06/17/2020] [Indexed: 11/16/2022] Open
Abstract
Heart failure patients with pulmonary edema presenting to the emergency department (ED) require an effective approach to deliver sufficient oxygen and reduce the rate of intubation and mechanical ventilation in the ED; conventional oxygen therapy has proven ineffective in delivering enough oxygen to the tissues. We aimed to identify whether high-flow nasal cannula (HFNC) therapy over time improved the respiratory rate (RR), lactate clearance, and certain arterial blood gas (ABG) parameters, in comparison with conventional oxygen therapy, in patients with cardiogenic pulmonary edema. This prospective, multi-institutional, and interventional study (clinical trial, reference KCT0004578) conducted between 2016 and 2019 included adult patients diagnosed with heart failure within the previous year and pulmonary edema confirmed at admission. Patients were randomly assigned to the conventional or HFNC group and treated with the goal of maintaining oxygen saturation (SpO2) ≥ 93. We obtained RR, SpO2, lactate levels, and ABG parameters at baseline and 30 and 60 min after randomization. All parameters showed greater improvement with HFNC therapy than with conventional therapy. Significant changes in ABG parameters were achieved within 30 min. HFNC therapy could therefore be considered as initial oxygen therapy. Physicians may consider advanced ventilation if there is no significant improvement in ABG parameters within 30 min of HFNC therapy.
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Affiliation(s)
- Dong Ryul Ko
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul 06273, Korea; (D.R.K.); (J.B.); (S.P.C.)
- Department of Emergency Medicine, Graduate School of Medicine, Kangwon National University, Chuncheon 24289, Korea
| | - Jinho Beom
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul 06273, Korea; (D.R.K.); (J.B.); (S.P.C.)
| | - Hye Sun Lee
- Department of Research Affairs, Biostatistics Collaboration Unit, College of Medicine, Yonsei University, Seoul 06273, Korea;
| | - Je Sung You
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul 06273, Korea; (D.R.K.); (J.B.); (S.P.C.)
- Correspondence: (J.S.Y.); (H.S.C.); Tel.: +82-2-2019-3030 (J.S.Y.); +82-2-2228-2460 (H.S.C.); Fax: +82-2-2019-4820 (J.S.Y.); +82-2-2227-7908 (H.S.C.)
| | - Hyun Soo Chung
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul 06273, Korea; (D.R.K.); (J.B.); (S.P.C.)
- Correspondence: (J.S.Y.); (H.S.C.); Tel.: +82-2-2019-3030 (J.S.Y.); +82-2-2228-2460 (H.S.C.); Fax: +82-2-2019-4820 (J.S.Y.); +82-2-2227-7908 (H.S.C.)
| | - Sung Phil Chung
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul 06273, Korea; (D.R.K.); (J.B.); (S.P.C.)
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12
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Kang MG, Kim K, Ju S, Park HW, Lee SJ, Koh JS, Hwang SJ, Hwang JY, Bae JS, Ahn JH, Jang JY, Park Y, Jeong YH, Kwak CH, Park JR. Erratum to clinical efficacy of high-flow oxygen therapy through nasal cannula in patients with acute heart failure. J Thorac Dis 2019; 11:E65. [PMID: 31019806 DOI: 10.21037/jtd.2019.03.59] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
[This corrects the article DOI: 10.21037/jtd.2019.01.51.].
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Affiliation(s)
- Min Gyu Kang
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Gyeongsang National University, Gyeongsang National University Hospital, Jinju, Korea
| | - Kyehwan Kim
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Gyeongsang National University, Gyeongsang National University Hospital, Jinju, Korea
| | - Sunmi Ju
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Gyeongsang National University, Gyeongsang National University Hospital, Jinju, Korea
| | - Hyun Woong Park
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Gyeongsang National University, Gyeongsang National University Hospital, Jinju, Korea
| | - Seung Jun Lee
- Division of Pulmonology and Critical Care, Department of Internal Medicine, College of Medicine, Gyeongsang National University, Gyeongsang National University Hospital, Jinju, Korea
| | - Jin-Sin Koh
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Gyeongsang National University, Gyeongsang National University Hospital, Jinju, Korea
| | - Seok-Jae Hwang
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Gyeongsang National University, Gyeongsang National University Hospital, Jinju, Korea
| | - Jin-Yong Hwang
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Gyeongsang National University, Gyeongsang National University Hospital, Jinju, Korea
| | - Jae Seok Bae
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Cardiovascular Center, Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Jong-Hwa Ahn
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Cardiovascular Center, Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Jeong Yoon Jang
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Cardiovascular Center, Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Yongwhi Park
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Cardiovascular Center, Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Young-Hoon Jeong
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Cardiovascular Center, Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Choong Hwan Kwak
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Cardiovascular Center, Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Jeong Rang Park
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Gyeongsang National University, Gyeongsang National University Hospital, Jinju, Korea
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