High-flow nasal cannulae for respiratory support in adult intensive care patients

Lewis, Sharon R; Baker, Philip; Parker, Roses; Smith, Andrew F

doi:10.1002/14651858.cd010172.pub3

Cited by 39 publications

(33 citation statements)

References 100 publications

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“…During high-flow nasal cannula (HFNC) therapy, oxygenation is improved by delivering supplemental oxygen at a flow that exceeds the patient’s peak inspiratory flow [ 1 , 2 ]. Numerous randomized controlled trials and meta-analyses have shown that HFNC improves oxygenation and reduces the need for intubation in hypoxemic patients compared with conventional oxygen therapy [ 3 – 8 ]. Additionally, a recent clinical practice guideline provides a strong recommendation for use of HFNC in patients with acute hypoxemic respiratory failure (AHRF) [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Optimizing high-flow nasal cannula flow settings in adult hypoxemic patients based on peak inspiratory flow during tidal breathing

Scott

Fink

et al. 2021

Ann. Intensive Care

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Background Optimal flow settings during high-flow nasal cannula (HFNC) therapy are unknown. We investigated the optimal flow settings during HFNC therapy based on breathing pattern and tidal inspiratory flows in patients with acute hypoxemic respiratory failure (AHRF). Methods We conducted a prospective clinical study in adult hypoxemic patients treated by HFNC with a fraction of inspired oxygen (FIO2) ≥ 0.4. Patient’s peak tidal inspiratory flow (PTIF) was measured and HFNC flows were set to match individual PTIF and then increased by 10 L/min every 5–10 min up to 60 L/min. FIO2 was titrated to maintain pulse oximetry (SpO2) of 90–97%. SpO2/FIO2, respiratory rate (RR), ROX index [(SpO2/FIO2)/RR], and patient comfort were recorded after 5–10 min on each setting. We also conducted an in vitro study to explore the relationship between the HFNC flows and the tracheal FIO2, peak inspiratory and expiratory pressures. Results Forty-nine patients aged 58.0 (SD 14.1) years were enrolled. At enrollment, HFNC flow was set at 45 (38, 50) L/min, with an FIO2 at 0.62 (0.16) to obtain an SpO2/FIO2 of 160 (40). Mean PTIF was 34 (9) L/min. An increase in HFNC flows up to two times of the individual patient’s PTIF, incrementally improved oxygenation but the ROX index plateaued with HFNC flows of 1.34–1.67 times the individual PTIF. In the in vitro study, when the HFNC flow was set higher than PTIF, tracheal peak inspiratory and expiratory pressures increased as HFNC flow increased but the FIO2 did not change. Conclusion Mean PTIF values in most patients with AHRF were between 30 and 40 L/min. We observed improvement in oxygenation with HFNC flows set above patient PTIF. Thus, a pragmatic approach to set optimal flows in patients with AHRF would be to initiate HFNC flow at 40 L/min and titrate the flow based on improvement in ROX index and patient tolerance. Trial registration: ClinicalTrials.gov (NCT03738345). Registered on November 13th, 2018. https://clinicaltrials.gov/ct2/show/NCT03738345?term=NCT03738345&draw=2&rank=1

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Section: Introductionmentioning

confidence: 99%

Optimizing high-flow nasal cannula flow settings in adult hypoxemic patients based on peak inspiratory flow during tidal breathing

Scott

Fink

et al. 2021

Ann. Intensive Care

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“…1 Use of HFNC reduces the need for intubation among hypoxemic patients. [1][2][3][4] In-line placement of a nebulizer with HFNC has been employed to deliver aerosolized medications, 5 such as inhaled epoprostenol for patients with pulmonary hypertension or refractory hypoxemia, 6,7 or inhaled albuterol for patients with asthma 8 or chronic obstructive diseases. 9,10 HFNC has been shown to be advantageous for nebulized therapy, compared to conventional aerosol delivery methods including nebulizers with facemask/mouthpiece, pressurized metered-dose inhalers (pMDIs), or dry powder inhalers (DPIs).…”

Section: Introductionmentioning

confidence: 99%

Mitigating Fugitive Aerosols During Aerosol Delivery via High-Flow Nasal Cannula Devices

Alolaiwat

Harnois

et al. 2021

Respir Care

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Background: Aerosol delivery via high-flow nasal cannula (HFNC) has attracted clinical interests in recent years. However, both HFNC and nebulization are categorized as aerosol generating procedures (AGPs). In-vitro studies raised concerns that AGPs had high transmission risk. Very few in-vivo studies examined fugitive aerosols with HFNC and nebulization via HFNC, and effective methods to mitigate aerosol dispersion are unknown.Method: Two HFNC devices (Airvo2 and Vapotherm) with or without a vibrating mesh nebulizer (VMN) were compared; HFNC alone, surgical mask over HFNC interface, and HFNC with face tent scavenger were used in a random order for nine healthy volunteers. Fugitive aerosol concentrations at sizes of 0.3-10 μm were continuously measured by particle sizers placed at one and three feet from participants. On a different day, six of the nine participants received six additional nebulizer treatments via VMN or small volume nebulizer (SVN) with mouthpiece with/without an expiratory filter or facemask. In-vitro simulation was employed to quantify inhaled dose with VMN via Airvo2 and Vapotherm.Results: Compared to baseline, neither HFNC device generated higher aerosol concentrations.Compared to HFNC alone, VMN via Airvo2 generated higher 0.3-1.0 μm particles (all p<.05) but VMN via Vapotherm did not. Concentrations of 1.0-3.0 μm particles with VMN via Airvo2 were similar with VMN and a mouthpiece/facemask but lower than SVN with a mouthpiece/facemask (all p<.05). Placing a surgical mask over HFNC during nebulization reduced 0.5-1.0 μm particles (all p<.05) to levels similar to the use of a nebulizer with mouthpiece and expiratory filter. In-vitro the inhaled dose with VMN via Airvo2 was 6 times higher than VMN via Vapotherm.

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“…Before ICU admission, the median ROX H0-H8 value under non-invasive procedures was 6.26 [5.04-8.18]. After ICU admission, the median (IQR) duration of invasive mechanical ventilation was 12 (7-21) days, with a median (IQR) ICU length of stay of 13.5 (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23) days, a median (IQR) IMCU length of stay of 4 (2-7) days, and a median (IQR) total hospital stay of 27 days. ICU mortality was 40% (32/82).…”

Section: Resultsmentioning

confidence: 99%

Early Measurement of ROX Index in Intermediary Care Unit Is Associated with Mortality in Intubated COVID-19 Patients: A Retrospective Study

Leszek

Wozniak

Giudicelli-Bailly

et al. 2022

JCM

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COVID-19 patients often present with rapidly progressing acute hypoxemic respiratory failure, requiring orotracheal intubation with different prognostic issues. However, ICU specialists lack predictive tools to stratify these patients. We conducted a single-center cross-sectional retrospective study to evaluate if the ROX index, measured under non-invasive oxygenation support, can predict ICU mortality in a COVID-19 intubated patient cohort. This study took place in the division of intensive care at the Geneva University Hospitals (Geneva, Switzerland). We included all consecutive adult patients treated by non-invasive oxygenation support and requiring intubation for acute respiratory failure due to COVID-19 between 9 September 2020 and 30 March 2021, corresponding to the second local surge of COVID-19 cases. Baseline demographic data, comorbidities, median ROX between H0 and H8, and clinical outcomes were collected. Overall, 82 patients were intubated after failing a non-invasive oxygenation procedure. Women represented 25.6% of the whole cohort. Median age and median BMI were 70 (60–75) years and 28 (25–33), respectively. Before intubation, the median ROX between H0 and H8 was 6.3 (5.0–8.2). In a multivariate analysis, the median ROX H0–H8 was associated with ICU mortality as a protective factor with an odds ratio (95% CI) = 0.77 (0.60–0.99); p < 0.05. In intubated COVID-19 patients treated initially by non-invasive oxygenation support for acute respiratory failure, the median ROX H0–H8 could be an interesting predictive factor associated with ICU mortality.

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High-flow nasal cannulae for respiratory support in adult intensive care patients

Abstract: High-flow nasal cannulae for respiratory support in adult intensive care patients.

Cited by 39 publications

References 100 publications

Optimizing high-flow nasal cannula flow settings in adult hypoxemic patients based on peak inspiratory flow during tidal breathing

Optimizing high-flow nasal cannula flow settings in adult hypoxemic patients based on peak inspiratory flow during tidal breathing

Mitigating Fugitive Aerosols During Aerosol Delivery via High-Flow Nasal Cannula Devices

Early Measurement of ROX Index in Intermediary Care Unit Is Associated with Mortality in Intubated COVID-19 Patients: A Retrospective Study

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