Nasal high flow therapy: a novel treatment rather than a more expensive oxygen device

Ischaki, Eleni; Pantazopoulos, Ioannis; Zakynthinos, Spyros

doi:10.1183/16000617.0028-2017

Cited by 62 publications

(58 citation statements)

References 101 publications

(170 reference statements)

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“…High‐flow nasal oxygenation entails administration of warmed and humidified oxygen‐enriched air at flow rates between 40 l.min −1 and 60 l.min −1 to patients who are breathing spontaneously via a special purpose nasal cannula . High‐flow nasal oxygenation is effective in the intensive care setting for treating hypoxaemia , reducing reintubation rates and has been shown to reduce 90‐day mortality in this patient group .…”

Section: Introductionmentioning

confidence: 99%

A physiological study to determine the mechanism of carbon dioxide clearance during apnoea when using transnasal humidified rapid insufflation ventilatory exchange (THRIVE)

et al. 2019

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Summary Clinical observations suggest that compared with standard apnoeic oxygenation, transnasal humidified rapid‐insufflation ventilatory exchange using high‐flow nasal oxygenation reduces the rate of carbon dioxide accumulation in patients who are anaesthetised and apnoeic. This suggests that active gas exchange takes place, but the mechanisms by which it may occur have not been described. We used three laboratory airway models to investigate mechanisms of carbon dioxide clearance in apnoeic patients. We determined flow patterns using particle image velocimetry in a two‐dimensional model using particle‐seeded fluorescent solution; visualised gas clearance in a three‐dimensional printed trachea model in air; and measured intra‐tracheal turbulence levels and carbon dioxide clearance rates using a three‐dimensional printed model in air mounted on a lung simulator. Cardiogenic oscillations were simulated in all experiments. The visualisation experiments indicated that gaseous mixing was occurring in the trachea. With no cardiogenic oscillations applied, mean (SD) carbon dioxide clearance increased from 0.29 (0.04) ml.min−1 to 1.34 (0.14) ml.min−1 as the transnasal humidified rapid‐insufflation ventilatory exchange flow rate was increased from 20 l.min−1 to 70 l.min−1 (p = 0.0001). With a cardiogenic oscillation of 20 ml.beat−1 applied, carbon dioxide clearance increased from 11.9 (0.50) ml.min−1 to 17.4 (1.2) ml.min−1 as the transnasal humidified rapid‐insufflation ventilatory exchange flow rate was increased from 20 l.min−1 to 70 l.min−1 (p = 0.0014). These findings suggest that enhanced carbon dioxide clearance observed under apnoeic conditions with transnasal humidified rapid‐insufflation ventilatory exchange, as compared with classical apnoeic oxygenation, may be explained by an interaction between entrained and highly turbulent supraglottic flow vortices created by high‐flow nasal oxygen and cardiogenic oscillations.

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Section: Introductionmentioning

confidence: 99%

A physiological study to determine the mechanism of carbon dioxide clearance during apnoea when using transnasal humidified rapid insufflation ventilatory exchange (THRIVE)

et al. 2019

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“…The intervals of these decrements will be based on the patient's above mentioned clinical and physiological parameters. When the patient is stable for 1–2 h with minimal or no supplemental oxygen while S pO 2 remains >88–92% and flow rate <15 L·min −1 , NHF will be stopped and a Venturi mask or nasal prongs will be provided, if supplementary oxygen is still needed [ 9 , 19 , 23 ].…”

Section: Methodsmentioning

confidence: 99%

“…The simplistic nature of the device has favourable effects on patients’ cooperation and tolerance of the treatment. The beneficial effects of NHF arise from several mechanisms, which include the high and stable inspiratory oxygen fraction, decrease in anatomical dead space, and positive airway pressure generation [ 9 ]. Despite the fact that the role of NHF in the management of hypoxaemic respiratory failure is well established [ 8 , 10 ], there are no explicit data for its application in COPD patients.…”

Section: Introductionmentioning

confidence: 99%

Nasal high-flow oxygen versus noninvasive ventilation in acute exacerbation of COPD: protocol for a randomised noninferiority clinical trial

Papalampidou

Bibaki²,

Boutlas

et al. 2020

ERJ Open Res

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BackgroundNoninvasive ventilation (NIV) is considered as the first-line treatment for acute exacerbation of COPD (AECOPD) complicated by respiratory acidosis. Recent studies demonstrate a role of nasal high-flow oxygen (NHF) in AECOPD as an alternative treatment in patients intolerant to NIV or with contraindications to it.AimThe study aimed to evaluate whether NHF respiratory support is noninferior compared to NIV in respect to treatment failure, defined as need for intubation or change to alternative treatment group, in patients with AECOPD and mild-to-moderate acute or acute-on-chronic hypercapnic respiratory failure.MethodsWe designed a multicentre, prospective, randomised trial on patients with AECOPD, who have pH<7.35 but >7.25 and PaCO2 >45 mmHg, in whom NIV is indicated as a first-line treatment. According to power analysis, 498 participants will be required for establishing noninferiority of NHF compared to NIV. Patients will be randomly assigned to receive NIV or NHF. Treatment will be adjusted to maintain SpO2 between 88%–92% for both groups. Arterial blood gases, respiratory variables, comfort, dyspnoea score and any pulmonary or extrapulmonary complications will be assessed at baseline, before treatment initiation, and at 1, 2, 4, 6, 12, 24, 48 h, then once daily from day 3 to patient discharge, intubation or death.ConclusionGiven the increasing number of studies demonstrating the physiological effects of NHF in COPD patients, we hypothesise that NHF respiratory support will be noninferior to NIV in patients with AECOPD and mild-to-moderate acute or acute on chronic hypercapnic respiratory failure.

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“…High flow nasal oxygen (HFNO) is a novel respiratory support that integrates humidified air with high flow rate of up to 60 L/min. Current evidence demonstrates additional benefits from HFNO that include, consistent fractional inspired oxygen (FiO2) delivery, dead space washout, reduced work of breath, comfort and tolerability, ability to communicate, mucous clearance and NIV-like effects which make it a more tolerable method for patients (14,15). In the last 20 years, HFNO was presented as a therapy for neonatal care with a facemask interface (16,17).…”

Section: Systematic Review Registrationmentioning

confidence: 99%

High Flow Nasal Oxygen for Acute Type 2 Respiratory Failure: A Systematic Review and Meta-Analysis Protocol

Alnajada¹,

Blackwood²,

Almobrad³

et al. 2020

Preprint

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BackgroundAcute Type 2 respiratory failure (AT2RF) is defined by hypercapnia (>6kPa) and these patients require ventilatory support in a significant proportion of cases. Non-invasive ventilation (NIV) is effective in preventing escalation to invasive mechanical ventilation (IMV) but has a high failure rate. High flow nasal oxygen (HFNO) is a novel device that integrates humidified air with oxygen at flow rates of up to 60 L/min. Various additional benefits including carbon-di-oxide (CO2) clearance have been attributed to HFNO. This systematic review aims to determine whether the use of HFNO for patients with AT2RF 1) improves arterial CO2 (PaCO2), 2) improves other clinical and patient-centred outcomes and 3) assess any potential harms.MethodSearches for relevant studies will be conducted in MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials, with no language restrictions. In addition, we will search Google Scholar and the references of all articles for any pertinent studies not found in our initial search. With the assistance of a professional librarian, we will develop a systematic search strategy using appropriate keywords and MeSH terms. We will identify trials that examined the efficacy of HFNO in adult AT2RF patients. We will include randomised trials and observational studies that compared two or more modalities of oxygen delivery that includes high flow nasal oxygen as one of the modes with the comparator being low flow oxygen and/or non-invasive ventilation. The primary outcome is change in PaCO2 level while other clinical and patient centred outcomes will be collected. Two reviewers will independently assess studies for eligibility, data extraction and quality appraisal. We will conduct a meta-analysis and/or a narrative summary as appropriate.DiscussionHFNO is utilised extensively in clinical practice with widening indications of use. The effects of HFNO includes CO2 clearance and PEEP benefits that may be beneficial to patients with AT2RF. While current publications indicate a beneficial role, no systematic review has attempted to summarise the evidence for this indication. The results of the proposed systematic review will summarise the current evidence to guide practice, guideline development and the design of future trials.Systematic review registrationPROSPERO CRD42019148748. (https://www.crd.york.ac.uk/prospero/)

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Nasal high flow therapy: a novel treatment rather than a more expensive oxygen device

Cited by 62 publications

References 101 publications

A physiological study to determine the mechanism of carbon dioxide clearance during apnoea when using transnasal humidified rapid insufflation ventilatory exchange (THRIVE)

A physiological study to determine the mechanism of carbon dioxide clearance during apnoea when using transnasal humidified rapid insufflation ventilatory exchange (THRIVE)

Nasal high-flow oxygen versus noninvasive ventilation in acute exacerbation of COPD: protocol for a randomised noninferiority clinical trial

High Flow Nasal Oxygen for Acute Type 2 Respiratory Failure: A Systematic Review and Meta-Analysis Protocol

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