High-Flow Nasal Oxygen Therapy for Postextubation Acute Hypoxemic Respiratory Failure—Reply

Stéphan, François

doi:10.1001/jama.2015.11438

Cited by 7 publications

(6 citation statements)

References 4 publications

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“…High-flow nasal cannula oxygen therapy is the administration of a warmed and humidified air/oxygen mixture at a flow rate between 20 and 60 L/min [1] through nasal cannulae (HFNC). HFNC is increasingly used in several clinical contexts, particularly in de novo hypoxemic respiratory failure [2–5]; post-extubation [6, 7] and in post-cardiothoracic surgery [8]. Compared with conventional oxygen therapy (conventional O 2 ), HFNC produces several physiological effects [9], which include: a better matching between the delivered gas flow mixture and patient’s spontaneous inspiratory flow; a positive end-expiratory pressure (PEEP) effect (generally between 2 and 8 cm H 2 O [10, 11]) and a “CO 2 wash out” effect from the upper airways [12, 13].…”

Section: Introductionmentioning

confidence: 99%

High-flow oxygen therapy in tracheostomized patients at high risk of weaning failure

Stripoli

Spadaro

Mussi

et al. 2019

Ann. Intensive Care

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PurposeHigh-flow oxygen therapy delivered through nasal cannulae improves oxygenation and decreases work of breathing in critically ill patients. Little is known of the physiological effects of high-flow oxygen therapy applied to the tracheostomy cannula (T-HF). In this study, we compared the effects of T-HF or conventional low-flow oxygen therapy (conventional O2) on neuro-ventilatory drive, work of breathing, respiratory rate (RR) and gas exchange, in a mixed population of tracheostomized patients at high risk of weaning failure.MethodsThis was a single-center, unblinded, cross-over study on fourteen patients. After disconnection from the ventilator, each patient received two 1-h periods of T-HF (T-HF1 and T-HF2) alternated with 1 h of conventional O2. The inspiratory oxygen fraction was titrated to achieve an arterial O2 saturation target of 94–98% (88–92% in COPD patients). We recorded neuro-ventilatory drive (electrical diaphragmatic activity, EAdi), work of breathing (inspiratory muscular pressure–time product per breath and per minute, PTPmusc/b and PTPmusc/min, respectively) respiratory rate and arterial blood gases.ResultsThe EAdipeak remained unchanged (mean ± SD) in the T-HF1, conventional O2 and T-HF2 study periods (8.8 ± 4.3 μV vs 8.9 ± 4.8 μV vs 9.0 ± 4.1 μV, respectively, p = 0.99). Similarly, PTPmusc/b and PTPmusc/min, RR and gas exchange remained unchanged.ConclusionsIn tracheostomized patients at high risk of weaning failure from mechanical ventilation, T-HF did not improve neuro-ventilatory drive, work of breathing, respiratory rate and gas exchange compared with conventional O2 after disconnection from the ventilator. The present findings might suggest that physiological effects of high-flow therapy through tracheostomy substantially differ from nasal high flow.

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Section: Introductionmentioning

confidence: 99%

High-flow oxygen therapy in tracheostomized patients at high risk of weaning failure

Stripoli

Spadaro

Mussi

et al. 2019

Ann. Intensive Care

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“…To our knowledge, no study has been done to compare the use of HFNC and standard O 2 therapy to treat postoperative patients with hypoxemic respiratory failure. As reported in the aforementioned section, one of the 3 subgroups in the RCT by Ste ´phan et al 67…”

Section: Curative Use Of Niv or Cpap Versus Standard O 2 Therapy Vers...mentioning

confidence: 88%

“…Ste ´phan et al 67 conducted a unique RCT to compare HFNC with NIV for subjects after cardiothoracic surgery, who were divided into 3 groups: 1) subjects who passed a spontaneous breathing trial (SBT) and had one of 3 high-risk factors (BMI > 30 kg/m 2 , left-ventricular ejection fraction of <40%, or failure of previous extubation); 2) subjects who passed an SBT but developed hypoxemic respiratory failure after extubation; 3) subjects in whom an SBT failed but were still extubated. Randomization was stratified based on the 3 groups.…”

Section: Prophylactic Use Of Hfnc Versus Standard O 2 Therapy Versus ...mentioning

confidence: 99%

“…Interestingly, even though the outcomes between the 2 overall groups were not significantly different, the subgroup analysis on the prophylactic use of HFNC versus NIV for the subjects with high-risk factors showed lower rates of treatment failure in the HFNC group (5.7% vs 12.6%; P ¼.04). 67 This result might be explained by the better compliance and longer use of HFNC than NIV due to patient comfort and convenience with the 2 devices. This is the only RCT that compared the prophylactic use of HFNC with NIV for subjects after surgery.…”

Section: Prophylactic Use Of Hfnc Versus Standard O 2 Therapy Versus ...mentioning

confidence: 99%

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Management of Postoperative Hypoxemia

et al. 2021

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“…However, one multicentre, randomized non‐inferiority study of 830 patients after cardiothoracic surgery compared HFOT with NIV for prevention or resolution of ARF . Around 60% of patients presented with ARF, and HFOT was not inferior to NIV in terms of reintubation for mechanical ventilation or switch to the other treatment, 27.8% and 27.4% for NIV and HFOT, respectively …”

Section: Post‐extubation Respiratory Failurementioning

confidence: 99%

Non‐invasive ventilation or high‐flow oxygen therapy: When to choose one over the other?

2018

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It has been found that high-flow oxygen therapy (HFOT) can reduce mortality of patients admitted to intensive care unit (ICU) for de novo acute respiratory failure (ARF) as compared to non-invasive ventilation (NIV). HFOT might therefore be considered as a firstline strategy of oxygenation in these patients. The beneficial effects of HFOT may be explained by its good tolerance and by physiological characteristics including delivery of high FiO 2 , positive end expiratory pressure (PEEP) effect and continuous dead space washout contributing to decreased work of breathing. In contrast, NIV should be used cautiously in patients with de novo ARF due to high tidal volumes promoted by pressure support and that may potentially worsen pre-existing lung injury. Although recent studies have reported no benefit and even deleterious effects of NIV in immunocompromised patients with ARF, the experts have recommended its use as a first-line strategy. In patients with acute-on-chronic respiratory failure and respiratory acidosis, it has been clearly shown that NIV is the best strategy of oxygenation. However, HFOT seems able to reverse respiratory acidosis and further studies are needed to evaluate whether HFOT could represent an alternative to standard oxygen. Although NIV is recommended to treat ARF in postoperative patients or to prevent post-extubation respiratory failure in ICU, recent large-scale randomized studies suggest that HFOT could be equivalent to NIV. While recent recommendations have been established from studies comparing NIV with standard oxygen, new studies are needed to compare NIV versus HFOT in order to better define the appropriate indications for both treatments.

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High-Flow Nasal Oxygen Therapy for Postextubation Acute Hypoxemic Respiratory Failure—Reply

Cited by 7 publications

References 4 publications

High-flow oxygen therapy in tracheostomized patients at high risk of weaning failure

High-flow oxygen therapy in tracheostomized patients at high risk of weaning failure

Management of Postoperative Hypoxemia

Non‐invasive ventilation or high‐flow oxygen therapy: When to choose one over the other?

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