Impact of flow and temperature on patient comfort during respiratory support by high-flow nasal cannula

Nasal high flow (NHF) has gained popularity among intensivists to manage patients with acute respiratory failure. An important literature has accompanied this evolution. In this review, an international panel of experts assessed potential benefits of NHF in different areas of acute respiratory failure management. Analyses of the physiological effects of NHF indicate flow-dependent improvement in various respiratory function parameters. These beneficial effects allow some patients with severe acute hypoxemic respiratory failure to avoid intubation and improve their outcome. They require close monitoring to not delay intubation. Such a delay may worsen outcome. The ROX index may help clinicians decide when to intubate. In immunocompromised patients, NHF reduces the need for intubation but does not impact mortality. Beneficial physiological effects of NHF have also been reported in patients with chronic respiratory failure, suggesting a possible indication in acute hypercapnic respiratory failure. When intubation is required, NHF can be used to pre-oxygenate patients either alone or in combination with non-invasive ventilation (NIV). Similarly, NHF reduces reintubation alone in low-risk patients and in combination with NIV in high-risk patients. NHF may be used in the emergency department in patients who would not be offered intubation and can be better tolerated than NIV.

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“…Importantly, higher flows are well tolerated by hypoxemic patients, whose comfort was not adversely affected by higher gas flows [6].…”

Section: Physiological Effects Of Nhfmentioning

confidence: 99%

“…5 Medical ICU Saint Louis Hospital, APHP, Paris, France. 6 Critical Care Research Group, The Prince Charles Hospital, Chermside, Australia. 7 University of Queensland, Brisbane, QLD, Australia.…”

Section: Critical Care Department Vall D'hebron University Hospitalmentioning

confidence: 99%

Use of nasal high flow oxygen during acute respiratory failure

et al. 2020

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“…The flow of 40 L/min may exceed the patient's tolerance. In fact, the flow of 30-60 L/min reportedly caused discomfort, especially in the population with less severe acute hypoxemic respiratory failure [24]. In our study, most of the patients had normal lung function, which may be related to the discomfort despite the severity of SDB.…”

Section: Discussionmentioning

confidence: 50%

Effect of High-Flow Nasal Cannula on Sleep-disordered Breathing and Sleep Quality in Patients With Acute Stroke

Nakanishi

Suzuki

Ishihara

et al. 2020

Cureus

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Introduction Sleep-disordered breathing (SDB) is common after stroke. Although the standard treatment of SDB is continuous positive airway pressure (CPAP) ventilation, the patient's intolerance and discomfort result in low adherence rates. Alternatively, high-flow nasal cannula (HFNC) may be useful as it reduces upper airway collapse with low level of positive pressure and well tolerability. The aim of this study was to investigate whether HFNC therapy reduces SDB and improves sleep quality with higher compliance rate. Methods We included acute stroke patients with SDB for the assessment of apnea-hypopnea index (AHI) >5/h using WatchPAT 200 (Itamar Medical Ltd, Caesarea, Israel). Patients who met inclusion criteria received HFNC therapy (40 L/min) with monitoring by WatchPAT. AHI, oxygen desaturation index (ODI), sleep efficiency, and rapid eye movement (REM) sleep were compared in patients with and without HFNC therapy. We also evaluated the patient's comfort of HFNC therapy (discomfort or not). Results Among 17 patients assessed for AHI, 12 received HFNC therapy. HFNC therapy was not adhered in two patients due to intolerance. Eight patients remained for final analysis. There were no differences in SDB and sleep quality with and without HFNC therapy as follows: HFNC therapy vs control; AHI 24.9 ± 20.1 vs 21.3 ± 15.0/h (p = 0.63), ODI 16.2 ± 16.5 vs 12.9 ± 12.3/h (p = 0.54), sleep efficiency 80.4 ± 12.9 vs 87.1 ± 6.2 (p = 0.28), percentage of REM sleep 19.4% ± 9.6% vs 27.6% ± 8.9% (p = 0.07). Two patients (17%) complained of discomfort among eight patients. Conclusion HFNC therapy did not improve SDB and sleep quality. Nonadherence and discomfort were observed in HFNC therapy. We need a large trial to confirm this result.

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“…Over half of the patients considered the device to be moderately to very uncomfortable. The use of a high flow of 60 L/min and the perception self‐reported by patients that the inspired air was too hot (despite the fact that it was set at 31°C which corresponds to the minimal possible temperature of the device) might have contributed to the perception of discomfort …”

Section: Discussionmentioning

confidence: 99%

Nasal high flow does not improve exercise tolerance in COPD patients recovering from acute exacerbation: A randomized crossover study

et al. 2019

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Background and objective: We hypothesized that by reducing respiratory work and improving gas exchange, nasal high flow (NHF) would improve exercise tolerance in patients with chronic obstructive pulmonary disease (COPD) following respiratory exacerbation. Methods: This was a monocentric, randomized, controlled crossover study. Patients with severe to very severe COPD carried out two high-intensity constant work-rate exercise tests (CWRET) with and without NHF on two consecutive days. The primary outcome was the mean difference in endurance time between both conditions. The secondary aims included vastus lateralis oxygenation (StO 2 ), dyspnoea, leg discomfort, maximal inspiratory pressure (MIP), transcutaneous CO 2 pressure (PtcCO 2 ), respiratory rate (RR), heart rate (HR) and pulsed O 2 saturation (SpO 2 ), as well as the patients' opinions of the device. Results: A total of 19 patients were included (mean forced expiratory volume in 1 s = 28.7 AE 10.8%, age = 62.1 AE 9.1 years). No significant differences in endurance time during the CWRET were found between the two test conditions (−66.58 (95% CI: −155.9 to 22.7) s, P = 0.12). StO 2 , PtCO 2 and HR were reduced at the end of the exercise with NHF (−2.1% (95% CI: −4.3 to −0.0); −1.3 mm Hg (95% CI: −2.5 to −0.2); −2.7 bpm (95% CI: −5.0 to −0.5), respectively, P ≤ 0.05). No significant differences were found for any of the other secondary outcomes. Half of the patients evaluated the device as being moderately to very uncomfortable.Conclusion: NHF during exercise did not increase endurance time in patients with COPD following exacerbation.Clinical trial registration: NCT03058081 at clinicaltrials. gov Key words: chronic obstructive pulmonary disease, exercise, muscle oxygenation, nasal high flow, pulmonary rehabilitation.

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Impact of flow and temperature on patient comfort during respiratory support by high-flow nasal cannula

Cited by 102 publications

References 36 publications

Use of nasal high flow oxygen during acute respiratory failure

Use of nasal high flow oxygen during acute respiratory failure

Effect of High-Flow Nasal Cannula on Sleep-disordered Breathing and Sleep Quality in Patients With Acute Stroke

Nasal high flow does not improve exercise tolerance in COPD patients recovering from acute exacerbation: A randomized crossover study

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