Effect of High-Flow Nasal Cannula and Body Position on End-Expiratory Lung Volume: A Cohort Study Using Electrical Impedance Tomography

Riera, Jordi; Pérez, Purificación; Martínez, Jordi; Roca, Oriol; Masclans, Joan Ramón; Rello, Jordi

doi:10.4187/respcare.02086

Cited by 170 publications

(123 citation statements)

References 41 publications

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“…This mechanism resembles the application of positive end-expiratory pressure (PEEP), and it results in recruitment of the atelectatic areas and thus increase of end-expiratory lung volume (EELV) by ∼25% [5]. This effect is more pronounced in subjects with higher body mass index (BMI), regardless of body position [5,10]. Furthermore, lung compliance increases and the patient breathes more slowly, with almost 10% higher tidal volumes [5].…”

Section: Mechanisms Of Actionmentioning

confidence: 99%

“…In addition, these high flow rates create a positive airway pressure which linearly correlates with the administered flow rate [3][4][5][6][7][8]. For every 10 L·min −1 increase in gas flow, the mean airway pressure increases by ∼0.69 cmH 2 O in the mouth-closed position and by 0.35 cmH 2 O in the mouth-open position [8]. Analysis of the pressure generated during different parts of the respiratory cycle demonstrated that higher pressures are obtained during expiration than inspiration, which are flow dependent [9].…”

Section: Mechanisms Of Actionmentioning

confidence: 99%

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Nasal high flow therapy: a novel treatment rather than a more expensive oxygen device

2017

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Nasal high flow is a promising novel oxygen delivery device, whose mechanisms of action offer some beneficial effects over conventional oxygen systems. The administration of a high flow of heated and humidified gas mixture promotes higher and more stable inspiratory oxygen fraction values, decreases anatomical dead space and generates a positive airway pressure that can reduce the work of breathing and enhance patient comfort and tolerance. Nasal high flow has been used as a prophylactic tool or as a treatment device mostly in patients with acute hypoxaemic respiratory failure, with the majority of studies showing positive results. Recently, its clinical indications have been expanded to post-extubated patients in intensive care or following surgery, for pre-and peri-oxygenation during intubation, during bronchoscopy, in immunocompromised patients and in patients with "do not intubate" status. In the present review, we differentiate studies that suggest an advantage (benefit) from other studies that do not suggest an advantage (no benefit) compared to conventional oxygen devices or noninvasive ventilation, and propose an algorithm in cases of nasal high flow application in patients with acute hypoxaemic respiratory failure of almost any cause.

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Section: Mechanisms Of Actionmentioning

confidence: 99%

Section: Mechanisms Of Actionmentioning

confidence: 99%

Nasal high flow therapy: a novel treatment rather than a more expensive oxygen device

2017

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“…In an investigation that they conducted with 10 healthy adults, Groves and Tobin (8) found that the average airway pressure was 7.1 cmH 2 O at a flow rate of 50 L/min. Riera et al (17) measured the global and regional end-expiratory lung impedance index (ΔEELI) in supine and prone positions with electrical impedance tomography in 20 healthy adults. EELI increased in both positions.…”

Section: B Peep Effect and Alveolar Recruitmentmentioning

confidence: 99%

High Flow Nasal Oxygen Therapy: From Physiology to Clinic

Yıldırım¹,

Öcal²,

Ersoy³

et al. 2017

Eurasian J Pulmonol

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INTRODUCTIONOxygen support therapy should be given to the patients with acute hypoxic respiratory insufficiency in order to provide oxygenation of the tissues until the underlying pathology improves. The inspiratory flow rate requirement of patients with respiratory insufficiency varies between 30 and 120 L/min. Low flow and high flow conventional oxygen support systems produce a maximum flow rate of 15 L/min, and FiO 2 changes depending on the patient's peak inspiratory flow rate, respiratory pattern, the mask that is used, or the characteristics of the cannula. The inability to provide adequate airflow leads to discomfort in tachypneic patients. With high-flow nasal oxygen (HFNO) cannulas, warmed and humidified air matching the body temperature can be regulated at flow rates of 5-60 L/min, and oxygen delivery varies between 21% and 100%. When HFNO, first used in infants, was reported to increase the risk of infection, its long-term use was stopped. This problem was later eliminated with the use of sterile water, and its use has become a current issue in critical adult patients as well. Studies show that HFNO treatment improves physiological parameters when compared to conventional oxygen systems. Although there are studies indicating successful applications in different patient groups, there are also studies indicating that it does not create any difference in clinical parameters, but patient comfort is better in HFNO when compared with standard oxygen therapy and noninvasive mechanical ventilation (NIMV) (1-6). In this compilation, the physiological effect mechanisms of HFNO treatment and its use in various clinical situations are discussed in the light of current studies. The Impact Mechanisms of High Flow Nasal Oxygen TherapyThe HFNO device consists of an air/oxygen mixer, an active heater, a humidifier, a unidirectional inspiratory circuit hose, and a soft nasal cannula that is slightly larger than the standard nasal cannula. AbstractHigh-flow nasal oxygen (HFNO) therapy has several physiological advantages over traditional oxygen therapy devices, including decreased nasopharyngeal resistance, washing out of the nasopharyngeal dead space, generation of positive pressure in the pharynx, increasing alveolar recruitment in the lungs, humidification of the airways, increased fraction of inspired oxygen and improved mucociliary clearance. Recently, the use of HFNO in treating adult critical illness patients has significantly increased, and it is now being used in many patients with a range of different disease conditions. However, there are no established guidelines to direct the safe and effective use of HFNO for critical patients. This review summarizes the positive physiological effects, mechanisms of action, and the clinical applications of HFNO with available published literatures.

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“…Riera et al 37 used electrical impedance tomography to investigate the effects of high-flow nasal cannula and body position on global and regional endexpiratory lung impedance variation in healthy subjects. High-flow nasal cannula increased global end-expiratory lung impedance variation regardless of body position, suggesting an increase in functional residual capacity.…”

Section: Respiratory Mechanics Lung Volume and Lung Densities Distrmentioning

confidence: 99%

Respiratory Care Year in Review 2013: Airway Management, Noninvasive Monitoring, and Invasive Mechanical Ventilation

et al. 2014

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Effect of High-Flow Nasal Cannula and Body Position on End-Expiratory Lung Volume: A Cohort Study Using Electrical Impedance Tomography

Cited by 170 publications

References 41 publications

Nasal high flow therapy: a novel treatment rather than a more expensive oxygen device

Nasal high flow therapy: a novel treatment rather than a more expensive oxygen device

High Flow Nasal Oxygen Therapy: From Physiology to Clinic

Respiratory Care Year in Review 2013: Airway Management, Noninvasive Monitoring, and Invasive Mechanical Ventilation

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