High‐flow nasal cannula oxygen therapy in acute hypoxemic respiratory failure in 22 dogs requiring oxygen support escalation

Abstract

ObjectiveTo determine the effect of high‐flow nasal cannula (HFNC) oxygen therapy on cardiorespiratory variables and outcome in dogs with acute hypoxemic respiratory failure.DesignProspective, sequential clinical trial.SettingUniversity veterinary teaching hospital.AnimalsTwenty‐two client‐owned dogs that failed to respond to traditional oxygen support.InterventionsInitiation of HFNC therapy after traditional oxygen supplementation failed to increase Spo2 > 96% and Pao2 > 75 mm Hg or improve respiratory rate/effort.Measurements and Main ResultsPhysiological variables, blood gas analyses, and dyspnea/sedation/tolerance scores were collected prior to HFNC initiation (on traditional oxygen support [time 0 or T0]), and subsequently during HFNC oxygen administration at time 30 minutes, 60 minutes, and 7 ± 1 hours. Relative to T0, use of HFNC resulted in a decreased respiratory rate at 1 hour (P = 0.022) and 7 hours (P = 0.012), a decrease in dyspnea score at all times (P < 0.01), and an increase in Spo2 at all times (P < 0.01). There was no difference in arterial/venous Pco2 relative to T0, although Paco2 was correlated with flow rate. Based on respiratory assessment, 60% of dogs responded to HFNC use by 30 minutes, and 45% ultimately responded to HFNC use and survived. No clinical air‐leak syndromes were observed.ConclusionsHFNC use improved oxygenation and work of breathing relative to traditional oxygen therapies, without impairing ventilation. HFNC use appears to be a beneficial oxygen support modality to bridge the gap between standard oxygen supplementation and mechanical ventilation.

Nasal high flow oxygen therapy in hospitalised neonatal foals

“…In humans, the main reported complications include gastric distension and rarely “air‐leak syndrome” with the development of pneumothorax and pulmonary interstitial emphysema 15,16 . In healthy dogs, aerophagia was noted on abdominal radiographs although abdominal distension was not noted clinically 9 . One foal in this series was noted to develop mild abdominal distension.…”

“…15,16 In healthy dogs, aerophagia was noted on abdominal radiographs although abdominal distension was not noted clinically. 9 One foal in this series was noted to develop mild abdominal distension. This foal had significant multi-systemic disease and other factors may have contributed to its development.…”

“…High‐flow oxygen therapy is widely used in human neonatal care as it is technically easy to provide and often better tolerated than CPAP 7 . The use of HFOT has been described in dogs with encouraging results 8‐11 …”

“…7 The use of HFOT has been described in dogs with encouraging results. [8][9][10][11] The use of HFOT has never been described in neonatal foals. This mode of NIV delivers heated and humidified gas (air/oxygen mixture) at a high flow rate via nasal canulae.…”

Successful treatment of carbon monoxide toxicity with high flow nasal oxygen compared to mechanical ventilation

“…18 MV requires heavy sedation, specialized equipment requiring additional training for use, and is both costly and labour intensive. 15,19 Additionally, MV can be associated with complications such as ventilatorassociated pneumonia, ventilator-induced lung injury, pneumothorax, and tracheal tube occlusion. 15,17,18 For these reasons, a less invasive method to provide intense oxygen therapy would be preferable over MV.…”