Early high-flow nasal cannula oxygen therapy in adults with acute hypoxemic respiratory failure in the ED: A before-after study

Mace, J.; Marjanovic, Nicolas; Faranpour, F.; Mimoz, Olivier; Frerebeau, Marc; Violeau, M.; Bourry, Pierre-Alexis; Guenezan, Jérémy; Thille, Arnaud W.; Frat, Jean‐Pierre

doi:10.1016/j.ajem.2019.03.004

Cited by 24 publications

(10 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…HFNC has shown remarkable results as primary respiratory support in de novo ARF [ 63 ], improving oxygenation and decreasing escalation of care and intubation rate when compared to standard oxygen therapy [ 63 – 65 ]. The benefit may result from the decrease of the anatomic dead space, reducing the ventilatory demand and work of breathing (WOB) [ 66 ].…”

Section: Rationale Of Non-invasive Support In Arf Due To Sars-cov2: Hmentioning

confidence: 99%

A physiological approach to understand the role of respiratory effort in the progression of lung injury in SARS-CoV-2 infection

et al. 2020

View full text Add to dashboard Cite

Deterioration of lung function during the first week of COVID-19 has been observed when patients remain with insufficient respiratory support. Patient self-inflicted lung injury (P-SILI) is theorized as the responsible, but there is not robust experimental and clinical data to support it. Given the limited understanding of P-SILI, we describe the physiological basis of P-SILI and we show experimental data to comprehend the role of regional strain and heterogeneity in lung injury due to increased work of breathing. In addition, we discuss the current approach to respiratory support for COVID-19 under this point of view.

show abstract

Section: Rationale Of Non-invasive Support In Arf Due To Sars-cov2: Hmentioning

confidence: 99%

A physiological approach to understand the role of respiratory effort in the progression of lung injury in SARS-CoV-2 infection

et al. 2020

View full text Add to dashboard Cite

show abstract

“…However, it has scarcely been explored in the treatment of select hypercapnic respiratory failure or in the context of early emergency department management. [25][26][27][28] In the emergency department setting, HFNC has been reported to be noninferior to NIV in preventing endotracheal intubation in unselected emergency department subjects with acute respiratory failure, as well as in the subgroup of subjects with acute decompensated heart failure. 29,30 HFNC has also been reported to lower 60-min breathing frequency compared to standard oxygen therapy in a randomized controlled trial of 128 subjects with mild acute CPE in the emergency department.…”

Section: Introductionmentioning

confidence: 99%

High-Flow Nasal Cannula in Early Emergency Department Management of Acute Hypercapnic Respiratory Failure Due to Cardiogenic Pulmonary Edema

et al. 2020

Self Cite

View full text Add to dashboard Cite

BACKGROUND: Noninvasive ventilation (NIV) is the recommended ventilatory support for acute cardiogenic pulmonary edema (CPE) associated with acute respiratory failure or hypercapnia. High-flow nasal cannula (HFNC) has emerged as an alternative to NIV in acute hypoxemic respiratory failure. We aimed to assess the efficacy of HFNC on early changes in P aCO 2 and respiratory parameters in patients in the emergency department with acute hypercapnic CPE and to compare it to NIV. METHODS: We conducted a prospective observational study in consecutive emergency department patients with acute hypercapnic CPE. Subjects received either HFNC or NIV, according to the attending emergency physician's expertise in HFNC. The primary outcome was change in P aCO 2 after treatment for 1 h. Secondary outcomes were change in pH, breathing frequency, signs of work of breathing, and comparisons to NIV. RESULTS: Twenty-seven subjects with a discharge diagnosis of hypercapnic CPE were analyzed. Subjects had a median age of 87 y (interquartile range [IQR] 78-93); 37% were male. Twelve (44%) received HFNC, and 15 (56%) received NIV. Median of changes in P aCO 2 from baseline to after 1 h of treatment were 7 mm Hg (IQR 4-11, P 5 .002) for HFNC and 3 mm Hg (IQR 1-8, P 5 .02) for NIV, with no between-group difference. pH, breathing frequency and signs of work of breathing also improved after both HFNC and NIV. CONCLUSIONS: This preliminary study suggests that HFNC treatment for 1 h improves P aCO 2 and respiratory parameters in subjects with hypercapnic acute CPE in a manner that is comparable to NIV. Further studies are needed to assess HFNC as a possible alternative to NIV in early management of acute hypercapnic respiratory failure of cardiogenic origin. (ClinicalTrials.gov registration NCT03883555.

show abstract

“…A recent observational before-after study conducted in two EDs showed that patients under HFNT experienced more improved oxygenation and were much more likely to recover from respiratory failure within one hour after initiation of treatment than those under standard oxygen. However, there were no differences in intubation rates (17% in both groups) 51 . The advantages of HFNT over standard oxygen delivered through facemask may be explained by its multiple physiologic effects including less inspiratory effort, improved lung volume, aeration and compliance, better oxygenation 52,53 , and satisfactory comfort with preserved humidification 54 .…”

Section: Barcelona Respiratory Networkmentioning

confidence: 73%

“…These potential benefits of HFNT have also been observed when used early in the management of patients with de novo ARF 51 . A recent observational before-after study conducted in two EDs showed that patients under HFNT experienced more improved oxygenation and were much more likely to recover from respiratory failure within one hour after initiation of treatment than those under standard oxygen.…”

Section: Barcelona Respiratory Networkmentioning

confidence: 91%

Non-invasive Ventilation and High Flow Nasal Therapy in Acute Respiratory Failure: 2019 Novelties

Ferrer¹

2021

BRN

View full text Add to dashboard Cite

There is strong evidence suggesting use of non-invasive ventilation in patients with severe exacerbation of chronic obstructive pulmonary disease, while use of high-flow nasal therapy in this indication is promising. However, current data suggest that non-invasive ventilation provides limited benefit in de novo acute respiratory failure, and specifically in immunocompromised patients. In this indication, high-flow nasal therapy is increasingly used, but new studies are needed to confirm its superiority over standard oxygen or non-invasive ventilation. In patients undergoing planned extubation, high-flow nasal therapy is effective in preventing re-intubation in patients at lower risk for this complication, while the combination of both non-invasive ventilation and high-flow nasal therapy appears the best strategy for those at higher risk for post-extubation respiratory failure. Finally, providing supplemental oxygen and ventilation from the start of pre-oxygenation until laryngoscopy could be the most effective approach to preventing life-threatening hypoxaemia for patients undergoing endotracheal intubation.

show abstract

Early high-flow nasal cannula oxygen therapy in adults with acute hypoxemic respiratory failure in the ED: A before-after study

Cited by 24 publications

References 35 publications

A physiological approach to understand the role of respiratory effort in the progression of lung injury in SARS-CoV-2 infection

A physiological approach to understand the role of respiratory effort in the progression of lung injury in SARS-CoV-2 infection

High-Flow Nasal Cannula in Early Emergency Department Management of Acute Hypercapnic Respiratory Failure Due to Cardiogenic Pulmonary Edema

Non-invasive Ventilation and High Flow Nasal Therapy in Acute Respiratory Failure: 2019 Novelties

Contact Info

Product

Resources

About