Home High-Flow Therapy in Patients with Chronic Respiratory Diseases: Physiological Rationale and Clinical Results

A novel therapy for intractable chronic cough

Two cases of intractable chronic cough improved significantly with humidified high flow therapy (HHFT). A 59-year-old woman with Primary Sjogren's disease and interstitial lung disease, was trialled on a Fisher and Paykel myAIRVO™ system. She reported sustained benefits of uninterrupted sleep and increased socialization with tapering use of HHFT. A 67-year-old woman with idiopathic pulmonary fibrosis also benefited from the use of myAIRVO™. She had relentless cough with minimal movement, and nocturnal cough causing fragmented sleep. Her cough subsided considerably with continuous HHFT, but recurred without. Both patients reported significant reductions in the cough visual analogue scale. The mechanisms by which HHFT improve intractable cough may include reducing airway dryness, inhibition of neutrophil inflammation and mucus obstruction, and splinting of the airways. HHFT significantly improved cough and health-related quality of life in two patients with interstitial lung disease. Further research is warranted to explore the role of domiciliary HHFT.

ERS International Congress 2023: highlights from the Respiratory Intensive Care Assembly

Early career members of Assembly 2 (Respiratory Intensive Care) attended the 2023 European Respiratory Society International Congress in Milan, Italy. The conference covered acute and chronic respiratory failure. Sessions of interest to our assembly members and to those interested in respiratory critical care are summarised in this article and include the latest updates in respiratory intensive care, in particular acute respiratory distress syndrome and mechanical ventilation.

Effect of high flow nasal oxygen on inspiratory effort of patients with acute hypoxic respiratory failure and do not intubate orders

High flow nasal oxygen (HFNO) is recommended as a first-line respiratory support during acute hypoxic respiratory failure (AHRF) and represents a proportionate treatment option for patients with do not intubate (DNI) orders. The aim of the study is to assess the effect of HFNO on inspiratory effort as assessed by esophageal manometry in a population of DNI patients suffering from AHRF. Patients with AHRF and DNI orders admitted to Respiratory intermediate Care Unit between January 1st, 2018 and May 31st, 2023 to receive HFNO and subjected to esophageal manometry were enrolled. Esophageal pressure swing (ΔPes), clinical variables before and after 2 h of HFNO and clinical outcome (including HFNO failure) were collected and compared as appropriate. The change in physiological and clinical parameters according to the intensity of baseline breathing effort was assessed and the correlation between baseline ΔPes values and the relative change in breathing effort and clinical variables after 2 h of HFNO was explored. Eighty-two consecutive patients were enrolled according to sample size calculation. Two hours after HFNO start, patients presented significant improvement in ΔPes (12 VS 16 cmH2O, p < 0.0001), respiratory rate (RR) (22 VS 28 bpm, p < 0.0001), PaO2/FiO2 (133 VS 126 mmHg, p < 0.0001), Heart rate, Acidosis, Consciousness, Oxygenation and respiratory rate (HACOR) score, (4 VS 6, p < 0.0001), Respiratory rate Oxygenation (ROX) index (8.5 VS 6.1, p < 0.0001) and BORG (1 VS 4, p < 000.1). Patients with baseline ΔPes below 20 cmH2O where those who improved all the explored variables, while patients with baseline ΔPes above 30 cmH2O did not report significant changes in physiological or clinical features. A significant correlation was found between baseline ΔPes values and after 2 h of HFNO (R2 = 0.9, p < 0.0001). ΔPes change 2 h after HFNO significantly correlated with change in BORG (p < 0.0001), ROX index (p < 0.0001), HACOR score (p < 0.001) and RR (p < 0.001). In DNI patients with AHRF, HFNO was effective in reducing breathing effort and improving respiratory and clinical variables only for those patients with not excessive inspiratory effort.

Non-Invasive Respiratory Support: How to Get It Right in Clinical Medicine

It is with great pleasure and enthusiasm that I introduce this Special Issue of the Journal of Clinical Medicine, entitled "Non-invasive Respiratory Support: How to Get It Right in Clinical Medicine" [...].