High-Flow Nasal Cannula Therapy in Do-Not-Intubate Patients With Hypoxemic Respiratory Distress

Peters, Steve G.; Holets, Steven R

doi:10.4187/respcare.01887

Cited by 161 publications

(115 citation statements)

References 20 publications

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“…This result was consistent with 19 during invasive procedures such as bronchoscopy, 20 and do-not-intubate patients. 21 As in this study the subjects showed relatively low levels of dyspnea (dyspnea score of Ͻ 3 points), low breathing frequency (Ͻ 25 breaths/min), and low heart rate (Ͻ 100 beats/min), one could argue that similar results may have been achieved with only the conventional oxygen therapy. However, it can be reasonably speculated that greater benefits may be obtained with HFNC in patients showing greater degrees of post-extubation respiratory distress.…”

Section: Discussionmentioning

confidence: 80%

High-Flow Nasal Cannula Versus Conventional Oxygen Therapy After Endotracheal Extubation: A Randomized Crossover Physiologic Study

2013

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OBJECTIVE: Compare the short-term benefit of high-flow nasal cannula (HFNC) with nonrebreathing mask in terms of change in dyspnea, physiologic variables, and patient comfort in subjects after endotracheal extubation. METHODS: A randomized crossover study was conducted in a 10-bed respiratory care unit in a university hospital. Seventeen mechanically ventilated subjects were randomized after extubation to either Protocol A (applied HFNC for 30 min, followed by non-rebreathing mask for another 30 min) or Protocol B (applied non-rebreathing mask for 30 min, followed by HFNC for another 30 min). The level of dyspnea, breathing frequency, heart rate, blood pressure, oxygen saturation, and patient comfort were recorded. The results were expressed as mean ؎ SD, frequency, or percentage. Categorical variables were compared by chi-square test or Fisher exact test, and continuous variables were compared by dependent or paired t test. Statistical significance was defined as P < .05. RESULTS: Seventeen subjects were divided into 2 groups: 9 subjects in Protocol A and 8 subjects in Protocol B. The baseline characteristics and physiologic parameters before extubation were not significantly different in each protocol. At the end of study, HFNC indicated less dyspnea (P ‫؍‬ .04) and lower breathing frequency (P ‫؍‬ .009) and heart rate (P ‫؍‬ .006) compared with non-rebreathing mask. Most of the subjects (88.2%) preferred HFNC to non-rebreathing mask. CONCLUSIONS: HFNC can improve dyspnea and physiologic parameters, including breathing frequency and heart rate, in extubated subjects compared with conventional oxygen therapy. This device may have a potential role for use after endotracheal extubation.

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Section: Discussionmentioning

confidence: 80%

High-Flow Nasal Cannula Versus Conventional Oxygen Therapy After Endotracheal Extubation: A Randomized Crossover Physiologic Study

2013

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“…For subjects with acute respiratory failure, multiple comorbidities, and do-not-intubate orders, HFNC may be a useful means of palliation. Peters and colleagues 18 reported that HFNC provided adequate oxygenation for 82% of subjects with do-not-intubate orders without requiring escalation to NIV. To our knowledge, the use of HFNC has not been studied in a palliative population, and further examination is warranted to determine its therapeutic utility.…”

Section: Discussionmentioning

confidence: 99%

High-Flow Nasal Cannula in a Mixed Adult ICU

et al. 2015

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“…Two randomized trials comparing standard oxygen therapy and HFOS have shown a better patient comfort but no significant difference in gas exchange in post-extubation patients [7,8]. Two retrospective analysis of HFOS in Do-Not-Intubate patients with cancer and respiratory distress have shown that nearly 85% of patients 38 Karakurt et treated with HFOS improved or remained stable but 18% of patients still needed escalation of therapy to NIMV [9,10].…”

Section: High Flow Oxygen Systemmentioning

confidence: 99%

Improvements in intensive care units

Karakurt¹,

Yalçin²,

Arıkan³

2016

MMJ

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We have had some important improvements in the intensive care units (ICU) like high flow oxygen system (HFOS), therapeutic hypothermia, extra corporeal membrane oxygenation (ECMO), extra corporeal carbon dioxide removal (ECCOR), echocardiography (ECHO) and ultrasonography (US).HFOS gives oxygen to the patients at rates of flow higher (up to 60 L/min) than that delivered traditionally in LFOS (up to 16L/ min). It is obtained 1 cmH2O PEEP for every 10L/min of flow delivered by HFOS. HFOS serves as an important alternative to noninvasive mechanical ventilation especially in the management of the patients with hypoxemic respiratory failure.Post-resuscitation care consists of optimization of oxygenation and ventilation, avoiding hypotension, treating immediate precipitants of cardiac arrest such as acute coronary ischemia and initiating therapeutic (induced) hypothermia. Therapeutic hypothermia decreases cerebral metabolic rate, blood volume, and intracranial pressure, prevents reperfusion injury. So hypotermia protects cerebral functions.ECMO, the type of cardiopulmonary support, has become an essential tool in critical care patients with severe respiratory and cardiac failure, refractory to conventional therapy methods.Critical care ultrasonography (CCUS) and echocardiography have utility for intensivist-performed, immediate diagnoses of life threatening diseases, with no need to transport patients to radiology or cardiology departments or wait for radiologist or cardiologist on a consultative basis. CCUS and echocardiography should be an essential part of training of every ICU physician.

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High-Flow Nasal Cannula Therapy in Do-Not-Intubate Patients With Hypoxemic Respiratory Distress

Abstract: HFNC can provide adequate oxygenation for many patients with hypoxemic respiratory failure and may be an alternative to NIV for DNI patients.

Cited by 161 publications

References 20 publications

High-Flow Nasal Cannula Versus Conventional Oxygen Therapy After Endotracheal Extubation: A Randomized Crossover Physiologic Study

High-Flow Nasal Cannula Versus Conventional Oxygen Therapy After Endotracheal Extubation: A Randomized Crossover Physiologic Study

High-Flow Nasal Cannula in a Mixed Adult ICU

Improvements in intensive care units

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