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

Frat, Jean‐Pierre; Coudroy, Rémi; Thille, Arnaud W.

doi:10.1111/resp.13435

Cited by 21 publications

(20 citation statements)

References 86 publications

(133 reference statements)

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“…HFNC is a more comfortable means of respiratory support and is associated with more relief of dyspnea compared to conventional oxygen therapy, 16,40 and HFNC is frequently used in patients with hypoxemic respiratory failure with S pO 2 Ͻ 90 despite being treated with conventional oxygen therapy during postextubation respiratory failure and during intubation. 11 In contrast to the trial by Frat et al, 5 other trials found no difference between HFNC and conventional oxygen therapy in subjects with hypoxemic respiratory failure. 12,16,17,40,41 However, HFNC showed superiority over conventional oxygen therapy in subjects with postextubation respiratory failure in terms of a reduction of intubation rates.…”

Section: Discussionmentioning

confidence: 86%

“…9,10 Recently, high-flow nasal cannula (HFNC) therapy has been used more frequently in the treatment of acute hypoxemic respiratory failure. 11 In a large RCT, Frat et al 5 reported that HFNC was associated with a reduction in 90-d mortality when compared to NIV and conventional oxygen therapy in subjects with acute hypoxemic respiratory failure. However, further subsequent trials and metaanalyses showed no difference between HFNC and conventional oxygen therapy [12][13][14][15][16][17] or NIV.…”

Section: Introductionmentioning

confidence: 99%

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Initial Noninvasive Oxygenation Strategies in Subjects With De Novo Acute Hypoxemic Respiratory Failure

Zayed¹,

Barbarawi²,

Kheiri³

et al. 2019

Respir Care

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BACKGROUND: De novo hypoxemic respiratory failure is defined as significant hypoxemia in the absence of chronic lung disease such as COPD, and excluding respiratory failure occurring in the immediate postoperative or postextubation period. We aimed to evaluate the efficacy of various oxygenation strategies including noninvasive ventilation (NIV), high-flow nasal cannula (HFNC), and conventional oxygen therapy in patients with de novo hypoxemic respiratory failure. METHODS: We performed electronic database searches of PubMed, Cochrane Library, and Embase from inception to December 2018 to include randomized controlled trials that compared various oxygenation strategies in cases of de novo hypoxemic respiratory failure occurring in adult subjects without a preexisting chronic lung disease and excluding respiratory failure in the immediate postoperative or postextubation periods. We performed a Bayesian network meta-analysis to calculate odds ratio (OR) and Bayesian 95% credible intervals (CrI). RESULTS: 16 studies were included, involving 2,180 subjects with a mean age of 61 ؎ 17 y (66% were male; 46% of the included subjects were treated with conventional oxygen, 27.8% were treated with NIV, and 25.8% were treated with HFNC). Compared to conventional oxygen, NIV was associated with reduced intubation rates (OR 0.42, 95% CrI 0.26-0.62) but no significant reduction in short-term (OR 0.73, 95% CrI 0.47-1.02) or long-term mortality (OR 0.60, 95% CrI 0.29-1.06). There was no significant difference between NIV and HFNC or between HFNC and conventional oxygen regarding all outcomes. In a sensitivity analysis, the results remained consistent after exclusion of studies that included subjects with respiratory failure secondary to cardiogenic pulmonary edema. CONCLUSION: Among subjects with hypoxemic respiratory failure, NIV was associated with a significant reduction in intubation rates but not short-or long-term mortality when compared to conventional oxygen therapy. There was no significant difference between NIV and HFNC or between HFNC and conventional oxygen regarding all outcomes.

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Section: Discussionmentioning

confidence: 86%

Section: Introductionmentioning

confidence: 99%

Initial Noninvasive Oxygenation Strategies in Subjects With De Novo Acute Hypoxemic Respiratory Failure

Zayed¹,

Barbarawi²,

Kheiri³

et al. 2019

Respir Care

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“…Therefore, the optimal treatment regimen for the management of moderate and severe bronchiolitis (SB) remains unclear. In recent years, heated humidiﬁed high‐ﬂow nasal cannula (HHHFNC) therapy has been introduced as a novel alternative method for the management of acute respiratory distress due to bronchiolitis …”

Section: Introductionmentioning

confidence: 99%

Comparison of heated humidiﬁed high‐flow nasal cannula flow rates (1‐L·kg·min⁻¹ vs 2‐L·kg·min⁻¹) in the management of acute bronchiolitis

Yurtseven

Turan

Erseven

et al. 2019

Pediatric Pulmonology

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Objective We aimed to compare the heated humidiﬁed high‐ﬂow nasal cannula (HHHFNC) flow rate of 1‐L·kg·min−1 (1 L) with 2‐L·kg·min −1 (2 L) in patients with severe bronchiolitis presenting to the pediatric emergency department. Study design We performed a study in which all patients were allocated to receive these two flow rates. The primary outcome was admitted as treatment failure, which was defined as a clinical escalation in respiratory status. Secondary outcomes covered a decrease of respiratory rate (RR), heart rate (HR), the clinical respiratory score (CRS), rise of peripheral capillary oxygen saturation (SpO2), and rates of weaning, intubation, and intensive care unit (ICU) admission. Results One hundred and sixty‐eight cases (88 received the 1‐L flow rate and 80, the 2‐L flow rate) were included in the analyses. Treatment failure was 11.4% (10 of 88) in the 1‐L group, and 10% (8 of 80) in the 2‐L group (P = .775). Significant variation in the intubation rate or the ICU admission rate was not determined. At the 2nd hour, the rate of weaning (53.4% vs 35%; P = .017), the falling down of the CRS (−2.1 vs −1.5; P < .001), RR (−15.2 vs −11.8; P < .001), and HR (− 24.8 vs − 21.2; P < .001), and the increase of SpO 2 (4.8 vs 3.6; P < .001) were significantly more evident in the 1‐L group. Conclusion HHHFNC with the 1‐L·kg·min−1 flow rate, which provides a more frequent earlier effect, reached therapy success as high as the 2‐L·kg·min −1 flow rate in patients with severe acute bronchiolitis.

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“…In recent years, high-flow nasal cannula (HFNC), a non-invasive ventilation (NIV) modality, has become the preferred initial treatment method for children with respiratory distress. 5 The use of HFNC was previously limited to in neonatal intensive care units and pediatric intensive care units (PICU). 6 Given its proven safety and efficacy, it is currently used with increasing frequency in PEDs and general pediatric wards.…”

Section: Introductionmentioning

confidence: 99%

Safety and Efficacy of High-flow Nasal Cannula Therapy in the Pediatric Emergency Department

Yurtseven¹,

Saz²,

Hennes³

2019

cayd

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The objective of this review was to provide a summary of the current literature on heated humidified high-flow nasal cannula therapy (HFNC), discuss the mechanism of action, describe how HFNC is used, indications for use, and safety and efficacy in the pediatric emergency department (PED). A computer-based literature search through January 2019 was conducted using MEDLINE (PubMed) and Google Scholar. We included all original studies on HFNC use in pediatric patients in the PED. Our search identified fourteen studies that met the search criteria and all were reviewed by the authors. The majority of patients (1867, 67%) included in these studies were children with acute bronchiolitis. While, most of the studies concluded that HFNC was more effective than standard oxygen therapy in reducing respiratory rate, heart rate, endotracheal intubation rate and pediatric intensive care unit (PICU) admission, the limited data suggest that HFNC had similar effect to continuous positive airway pressure in patients with acute bronchiolitis. There is no general practice about the initiation and weaning of HFNC yet. Although a small number of adverse effects have been reported, HFNC therapy was usually safe. HFNC is a useful treatment modality for children with acute bronchiolitis. In the acute setting, it was shown to decrease respiratory rate, heart rate, RS, need for endotracheal intubation, and PICU admission. However, there is limited data on the initiation process, flow rate, and standardized protocol for weaning patients off HFNC. Further studies are needed to address these issues. AbstractÖz

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

Cited by 21 publications

References 86 publications

Initial Noninvasive Oxygenation Strategies in Subjects With De Novo Acute Hypoxemic Respiratory Failure

Initial Noninvasive Oxygenation Strategies in Subjects With De Novo Acute Hypoxemic Respiratory Failure

Comparison of heated humidiﬁed high‐flow nasal cannula flow rates (1‐L·kg·min⁻¹ vs 2‐L·kg·min⁻¹) in the management of acute bronchiolitis

Safety and Efficacy of High-flow Nasal Cannula Therapy in the Pediatric Emergency Department

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

Cited by 21 publications

References 86 publications

Initial Noninvasive Oxygenation Strategies in Subjects With De Novo Acute Hypoxemic Respiratory Failure

Initial Noninvasive Oxygenation Strategies in Subjects With De Novo Acute Hypoxemic Respiratory Failure

Comparison of heated humidiﬁed high‐flow nasal cannula flow rates (1‐L·kg·min−1 vs 2‐L·kg·min−1) in the management of acute bronchiolitis

Safety and Efficacy of High-flow Nasal Cannula Therapy in the Pediatric Emergency Department

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Comparison of heated humidiﬁed high‐flow nasal cannula flow rates (1‐L·kg·min⁻¹ vs 2‐L·kg·min⁻¹) in the management of acute bronchiolitis