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Al Nufaiei ZF, Al Zhranei RM. High-Flow Nasal Cannula Oxygen Therapy versus Non-Invasive Ventilation in patients at very high risk for extubating failure: A systematic review of randomized controlled trials. PLoS One 2024; 19:e0299693. [PMID: 38568930 PMCID: PMC10990192 DOI: 10.1371/journal.pone.0299693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 02/15/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND Mechanical ventilation is commonly used for managing respiratory failure in chronic obstructive pulmonary disease (COPD) patients, but weaning patients off ventilator support can be challenging and associated with complications. While many patients respond well to Non-invasive ventilation (NIV), a significant proportion may not respond as favourably. We aimed to assess whether high-flow nasal cannula (HFNC) is equally effective as NIV in reducing extubation failure among previously intubated COPD patients. METHODS This systematic review was carried out in line with PRISMA guidelines We searched PubMed, Scopus, Web of Science, and Cochrane library from inception until February 15, 2023. Randomized Clinical Trials (RCTs) of adults at high risk for extubating failure were included. We examined the use of HFNC as the intervention and NIV as the comparator. Our outcome of interest included, reintubation rate, length of hospital or intensive care unit (ICU) stay, adverse events, and time to reintubation. The Cochrane risk-of-bias tool was used for randomized trials to assess risk of bias. RESULTS We identified 348 citations, 11 of which were included, representing 2,666 patients. The trials indicate that HFNC is comparable to NIV in preventing reintubation after extubating in COPD patients. In comparison to NIV, HFNC also produced improved tolerance, comfort, and less complications such as airway care interventions. NIV with active humification may be more effective that HFNC in avoiding reintubation in patients who are at extremely high risk for extubating failure. CONCLUSION The inconclusive nature of emerging evidence highlights the need for additional studies to establish the efficacy and suitability of HFNC as an alternative to NIV for previously intubated COPD patients. Clinicians should consider the available options and individualize their approach based on patient characteristics. Future research should focus on addressing these gaps in knowledge to guide clinical decision-making and optimize outcomes for this patient population.
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Affiliation(s)
- Ziyad F. Al Nufaiei
- College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
- Ministry of the National Guard—Health Affairs, Jeddah, Saudi Arabia
| | - Raid M. Al Zhranei
- College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
- Ministry of the National Guard—Health Affairs, Jeddah, Saudi Arabia
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Pelaia C, Armentaro G, Lupia C, Maiorano A, Montenegro N, Miceli S, Condoleo V, Cassano V, Bruni A, Garofalo E, Crimi C, Vatrella A, Pelaia G, Longhini F, Sciacqua A. Effects of High-Flow Nasal Cannula on Right Heart Dysfunction in Patients with Acute-on-Chronic Respiratory Failure and Pulmonary Hypertension. J Clin Med 2023; 12:5472. [PMID: 37685538 PMCID: PMC10488050 DOI: 10.3390/jcm12175472] [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: 08/03/2023] [Revised: 08/20/2023] [Accepted: 08/23/2023] [Indexed: 09/10/2023] Open
Abstract
High-flow nasal cannula (HFNC) has several benefits in patients affected by different forms of acute respiratory failure, based on its own mechanisms. We postulated that HFNC may have some advantages over conventional oxygen therapy (COT) on the heart function in patients with acute-on-chronic respiratory failure with concomitant pulmonary hypertension (PH). We therefore designed this retrospective observational study to assess if HFNC improves the right and left ventricle functions and morphologies, arterial blood gases (ABGs), and patients' dyspnea, compared to COT. We enrolled 17 hospitalized patients receiving HFNC, matched with 17 patients receiving COT. Echocardiographic evaluation was performed at the time of admission (baseline) and 10 days after (T10). HFNC showed significant improvements in right ventricular morphology and function, and a reduction in sPAP. However, there were no significant changes in the left heart measurements with HFNC application. Conversely, COT did not lead to any modifications in echocardiographic measurements. In both groups, oxygenation significantly improved from baseline to T10 (in the HFNC group, from 155 ± 47 to 204 ± 61 mmHg while in the COT group, from 157 ± 27 to 207 ± 27 mmHg; p < 0.0001 for both comparisons). In conclusion, these data suggest an improvement of oxygenation with both treatments; however, only HFNC was able to improve the right ventricular morphology and function after 10 days from the beginning of treatment in a small cohort of patients with acute-on-chronic respiratory failure with PH.
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Affiliation(s)
- Corrado Pelaia
- Department of Health Sciences, University “Magna Græcia” of Catanzaro, 88100 Catanzaro, Italy; (C.P.); (C.L.); (A.M.); (N.M.); (G.P.)
| | - Giuseppe Armentaro
- Department of Medical and Surgical Sciences, University “Magna Græcia” of Catanzaro, 88100 Catanzaro, Italy; (G.A.); (S.M.); (V.C.); (V.C.); (A.B.); (E.G.); (A.S.)
| | - Chiara Lupia
- Department of Health Sciences, University “Magna Græcia” of Catanzaro, 88100 Catanzaro, Italy; (C.P.); (C.L.); (A.M.); (N.M.); (G.P.)
| | - Antonio Maiorano
- Department of Health Sciences, University “Magna Græcia” of Catanzaro, 88100 Catanzaro, Italy; (C.P.); (C.L.); (A.M.); (N.M.); (G.P.)
| | - Nicola Montenegro
- Department of Health Sciences, University “Magna Græcia” of Catanzaro, 88100 Catanzaro, Italy; (C.P.); (C.L.); (A.M.); (N.M.); (G.P.)
| | - Sofia Miceli
- Department of Medical and Surgical Sciences, University “Magna Græcia” of Catanzaro, 88100 Catanzaro, Italy; (G.A.); (S.M.); (V.C.); (V.C.); (A.B.); (E.G.); (A.S.)
| | - Valentino Condoleo
- Department of Medical and Surgical Sciences, University “Magna Græcia” of Catanzaro, 88100 Catanzaro, Italy; (G.A.); (S.M.); (V.C.); (V.C.); (A.B.); (E.G.); (A.S.)
| | - Velia Cassano
- Department of Medical and Surgical Sciences, University “Magna Græcia” of Catanzaro, 88100 Catanzaro, Italy; (G.A.); (S.M.); (V.C.); (V.C.); (A.B.); (E.G.); (A.S.)
| | - Andrea Bruni
- Department of Medical and Surgical Sciences, University “Magna Græcia” of Catanzaro, 88100 Catanzaro, Italy; (G.A.); (S.M.); (V.C.); (V.C.); (A.B.); (E.G.); (A.S.)
| | - Eugenio Garofalo
- Department of Medical and Surgical Sciences, University “Magna Græcia” of Catanzaro, 88100 Catanzaro, Italy; (G.A.); (S.M.); (V.C.); (V.C.); (A.B.); (E.G.); (A.S.)
| | - Claudia Crimi
- Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy;
| | - Alessandro Vatrella
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Salerno, Italy;
| | - Girolamo Pelaia
- Department of Health Sciences, University “Magna Græcia” of Catanzaro, 88100 Catanzaro, Italy; (C.P.); (C.L.); (A.M.); (N.M.); (G.P.)
| | - Federico Longhini
- Department of Medical and Surgical Sciences, University “Magna Græcia” of Catanzaro, 88100 Catanzaro, Italy; (G.A.); (S.M.); (V.C.); (V.C.); (A.B.); (E.G.); (A.S.)
| | - Angela Sciacqua
- Department of Medical and Surgical Sciences, University “Magna Græcia” of Catanzaro, 88100 Catanzaro, Italy; (G.A.); (S.M.); (V.C.); (V.C.); (A.B.); (E.G.); (A.S.)
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Hong AW, Toppen W, Lee J, Wilhalme H, Saggar R, Barjaktarevic IZ. Outcomes and Prognostic Factors of Pulmonary Hypertension Patients Undergoing Emergent Endotracheal Intubation. J Intensive Care Med 2023; 38:280-289. [PMID: 35934945 PMCID: PMC9806479 DOI: 10.1177/08850666221118839] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Background: Emergent endotracheal intubations (ETI) in pulmonary hypertension (PH) patients are associated with increased mortality. Post-intubation interventions that could increase survivability in this population have not been explored. We evaluate early clinical characteristics and complications following emergent endotracheal intubation and seek predictors of adverse outcomes during this post-intubation period. Methods: Retrospective cohort analysis of adult patients with groups 1 and 3 PH who underwent emergent intubation between 2005-2021 in medical and liver transplant ICUs at a tertiary medical center. PH patients were compared to non-PH patients, matched by Charlson Comorbidity Index. Primary outcomes were 24-h post-intubation and inpatient mortalities. Various 24-h post-intubation secondary outcomes were compared between PH and control cohorts. Results: We identified 48 PH and 110 non-PH patients. Pulmonary hypertension was not associated with increased 24-h mortality (OR 1.32, 95%CI 0.35-4.94, P = .18), but was associated with inpatient mortality (OR 4.03, 95%CI 1.29-12.5, P = .016) after intubation. Within 24 h post-intubation, PH patients experienced more frequent acute kidney injury (43.5% vs. 19.8%, P = .006) and required higher norepinephrine dosing equivalents (6.90 [0.13-10.6] mcg/kg/min, vs. 0.20 [0.10-2.03] mcg/kg/min, P = .037). Additionally, the median P/F ratio (PaO2/FiO2) was lower in PH patients (96.3 [58.9-201] vs. 233 [146-346] in non-PH, P = .001). Finally, a post-intubation increase in PaCO2 was associated with mortality in the PH cohort (post-intubation change in PaCO2 +5.14 ± 16.1 in non-survivors vs. -18.7 ± 28.0 in survivors, P = .007). Conclusions: Pulmonary hypertension was associated with worse outcomes after emergent endotracheal intubation than similar patients without PH. More importantly, our data suggest that the first 24 hours following intubation in the PH group represent a particularly vulnerable period that may determine long-term outcomes. Early post-intubation interventions may be key to improving survival in this population.
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Affiliation(s)
- Andrew W. Hong
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA,Igor Barjaktarevic, Department of Pulmonary
and Critical Care, UCLA Medical Center, 10833 Le Conte Ave, Los Angeles, CA,
USA.
| | - William Toppen
- Department of Medicine, University of California, Los
Angeles, CA, USA
| | - Joyce Lee
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Holly Wilhalme
- Division of General Internal Medicine and Health Services Research, David Geffen School of
Medicine, Los Angeles, CA, USA
| | - Rajan Saggar
- Department of Pulmonary and Critical Care, UCLA Medical Center, Los
Angeles, CA, USA
| | - Igor Z. Barjaktarevic
- Department of Pulmonary and Critical Care, UCLA Medical Center, Los
Angeles, CA, USA
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Ri HS, Jeon Y. Monitored anesthesia care for craniotomy in a patient with Eisenmenger syndrome: A case report. World J Clin Cases 2022; 10:9859-9864. [PMID: 36186179 PMCID: PMC9516911 DOI: 10.12998/wjcc.v10.i27.9859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 06/14/2022] [Accepted: 08/21/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Eisenmenger syndrome (ES) is an uncorrected congenital cardiac defect with a left-to-right shunt, leading to pulmonary arterial hypertension. Patients with ES are susceptible to hemodynamic alterations during noncardiac surgery with general anesthesia, which increases perioperative morbidity and mortality. Monitored anesthesia care (MAC) is often used during minor procedures in patients with cardiac disease. However, few reports on MAC in patients with ES exist.
CASE SUMMARY A 49-year-old man was admitted for a severe headache lasting 30 d. He had been diagnosed with a large perimembranous ventricular septal defect (VSD) with bidirectional shunt flow and pulmonary arterial hypertension 10 years ago. A round mass in the right frontal lobe was revealed by Magnetic resonance imaging. Stereotactic aspiration using a neuronavigation system was performed under MAC. The patient was stayed in the hospital for 5 d, and discharged without complications.
CONCLUSION MAC may be effective for craniotomy in patients with ES.
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Affiliation(s)
- Hyun-Su Ri
- Department of Anesthesiology and Pain Medicine, School of Medicine, Kyungpook National University, Daegu 41944, South Korea
| | - Younghoon Jeon
- Department of Anesthesiology and Pain Medicine, School of Medicine, Kyungpook National University, Daegu 41944, South Korea
- Department of Anesthesiology and Pain Medicine, School of Dentistry, Kyungpook National University, Daegu 41944, South Korea
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The Right Ventricle-You May Forget it, but It Will Not Forget You. J Clin Med 2020; 9:jcm9020432. [PMID: 32033368 PMCID: PMC7074056 DOI: 10.3390/jcm9020432] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 01/23/2020] [Accepted: 01/27/2020] [Indexed: 01/21/2023] Open
Abstract
Right ventricular (RV) dysfunction and failure are common and often overlooked causes of perioperative deterioration and adverse outcomes. Due to its unique pathophysiologic underpinnings, RV failure often does not respond to typical therapeutic measures such as volume resuscitation and often worsens when therapy is escalated and mechanical ventilation is begun, with a danger of irreversible cardiovascular collapse and death. The single most important factor in improving outcomes in the context of RV failure is anticipating and recognizing it. Once established, a vicious circle of systemic hypotension, and RV ischemia and dilation is set in motion, rapidly spiraling down into a state of shock culminating in multi-organ failure and ultimately death. Therapy of RV failure must focus on rapidly reestablishing RV coronary perfusion, lowering pulmonary vascular resistance and optimizing volemia. In parallel, underlying reversible causes should be sought and if possible treated. In all stages of diagnostics and therapy, echocardiography plays a central role. In severe cases of RV dysfunction there remains a role for the use of the pulmonary artery catheter. When these mostly simple measures are undertaken in a timely fashion, the spiral of death of RV failure can often be broken or even prevented altogether.
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