Reply to: Epistaxis as a complication of high-flow nasal cannula therapy in adults

Veiga, Viviane Cordeiro; Silva, Lígia Maria Coscrato Junqueira; Sady, Erica Regina Ribeiro; Maia, Israel Silva; Cavalcanti, Alexandre Biasi

doi:10.5935/0103-507x.20220047resp-en

Cited by 5 publications

(5 citation statements)

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“…The use of smaller nasal cannulae was not included in this investigation as the occlusion of the nares would be reduced and, therefore, it is unlikely to lead to increased airway pressure. Furthermore, a recent study suggested that small-bore nasal cannulae generate a jetting effect and can result in undue shear stress on the mucosa, leading to epistaxis in 7 of 70 patients ( 39 ). It should be noted that NHF rates in this study did not exceed 40 L/min.…”

Section: Discussionmentioning

confidence: 99%

Asymmetrical nasal high flow ventilation improves clearance of CO₂ from the anatomical dead space and increases positive airway pressure

Tatkov

Rees

Gulley

et al. 2023

Journal of Applied Physiology

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Positive airway pressure that dynamically changes with breathing, and clearance of anatomical dead space are the key mechanisms of noninvasive respiratory support with nasal high flow (NHF). Pressure mainly depends on flow rate and nare occlusion. The hypothesis is that an increase in asymmetrical occlusion of the nares leads to an improvement in dead-space clearance resulting in a reduction in re-breathing. Clearance was investigated with volumetric capnography in an adult upper-airway model, which was ventilated by a lung simulator with entrained carbon dioxide (CO2) at respiratory rates (RR) of 15-45min-1, and at 18min-1 with COPD breathing patterns. Clearance was assessed at NHF of 20-60L/min with a symmetrical interface (SI) and an asymmetrical interface (AI). CO2 kinetics visualized by infrared spectroscopy and mathematical modeling were used to study the mechanisms of clearance. At a higher RR(35 min-1) and NHF of 60L/min clearance in the upper airway was significantly higher with the AI when compared to the SI(29.64±9.96%,p < 0.001), as opposed to at a lower RR (15min-1) (1.40±6.25%,p > 0.05), (mean±SD). With COPD breathing, clearance by NHF was reduced, but significantly improved with the AI by 45.93% relative to the SI at NHF 20L/min (p < 0.0001). The maximum pressure achieved with the AI was 6.6cmH2O and NHF 60L/min at the end of expiration. Pressure differences between nasal cavities led to the reverse flow observed in the optical model. Asymmetrical NHF increases dead-space clearance by reverse flow through the choanae and accelerates purging of expired gas via the less occluded nare.

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Section: Discussionmentioning

confidence: 99%

Asymmetrical nasal high flow ventilation improves clearance of CO₂ from the anatomical dead space and increases positive airway pressure

Tatkov

Rees

Gulley

et al. 2023

Journal of Applied Physiology

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“…Gastrointestinal bleeding is most frequently a consequence of gastric and duodenal ulcers [ 24 ], while epistaxis is more likely caused by the administration of high-flow oxygen. A study conducted on patients receiving oxygen through a high-flow nasal cannula (HFNC) discovered an incidence of 10% for epistaxis [ 25 ]. Hemoptysis is most likely secondary to a pulmonary embolism.…”

Section: Discussionmentioning

confidence: 99%

Complications During Hospitalization in Patients With SARS-CoV-2 Pneumonia in a Romanian Pulmonary Center

Cristea¹,

Zaharia²,

Leu³

et al. 2023

Cureus

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The coronavirus disease (COVID-19) was declared a pandemic by the World Health Organization (WHO) on March 11, 2020. Facing a new and unknown virus, the entire medical community made considerable efforts to find a specific treatment, develop guidelines, and even create a vaccine. Besides all the measures taken, a wide range of complications associated with the disease increased the mortality and morbidity rates, adding more difficulty to the management of the patients. Study designWe performed a retrospective study, including the patients with SARS-CoV-2 pneumonia who were admitted to our hospital between March 2020 and August 2021. We analyzed complications that developed during the hospitalization, such as respiratory failure or acute injury to other organs (the heart, pancreas, kidneys, and liver), and whether they were treatment-and hospitalization-related. ResultsOne thousand eight hundred and forty-four cases were evaluated, and we analyzed the complications that developed during the hospitalization. Out of this, 1392 (75.48%) cases developed at least one complication during hospitalization, most frequently respiratory failure (71.14%), hyperglycemia (43.54%), renal injury (42.67%), or cardiovascular events (7.10%). ConclusionSARS-CoV-2 infection in hospitalized patients with pneumonia can cause injuries to any organ, making the management of those patients even more difficult.

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“…We have read with great interest this original article by Veiga et al titled “Epistaxis as a complication of high-flow nasal cannula therapy in adults”. ( 1 ) Although epistaxis is an infrequent complication, it is very interesting as epistaxis has important clinical repercussions. The authors consider that the high flow rate in use (65L/minute) and smaller prong configuration that increases the velocity of the gas represent a jetting effect.…”

Section: To the Editormentioning

confidence: 99%

To: Epistaxis as a complication of high-flow nasal cannula therapy in adults

Nair¹,

Esquinas²

2022

RBTI

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Reply to: Epistaxis as a complication of high-flow nasal cannula therapy in adults

Cited by 5 publications

References 1 publication

Asymmetrical nasal high flow ventilation improves clearance of CO₂ from the anatomical dead space and increases positive airway pressure

Asymmetrical nasal high flow ventilation improves clearance of CO₂ from the anatomical dead space and increases positive airway pressure

Complications During Hospitalization in Patients With SARS-CoV-2 Pneumonia in a Romanian Pulmonary Center

To: Epistaxis as a complication of high-flow nasal cannula therapy in adults

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Reply to: Epistaxis as a complication of high-flow nasal cannula therapy in adults

Cited by 5 publications

References 1 publication

Asymmetrical nasal high flow ventilation improves clearance of CO2 from the anatomical dead space and increases positive airway pressure

Asymmetrical nasal high flow ventilation improves clearance of CO2 from the anatomical dead space and increases positive airway pressure

Complications During Hospitalization in Patients With SARS-CoV-2 Pneumonia in a Romanian Pulmonary Center

To: Epistaxis as a complication of high-flow nasal cannula therapy in adults

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Asymmetrical nasal high flow ventilation improves clearance of CO₂ from the anatomical dead space and increases positive airway pressure

Asymmetrical nasal high flow ventilation improves clearance of CO₂ from the anatomical dead space and increases positive airway pressure