Optimum support by high-flow nasal cannula in acute hypoxemic respiratory failure: effects of increasing flow rates

Mauri, Tommaso; Alban, L.; Turrini, Cecilia; Cambiaghi, Barbara; Carlesso, Eleonora; Taccone, Paolo; Bottino, Nicola; Lissoni, Alfredo; Spadaro, Savino; Volta, Carlo Alberto; Gattinoni, Luciano; Pesenti, Antonio

doi:10.1007/s00134-017-4890-1

Cited by 195 publications

(190 citation statements)

References 30 publications

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“…The level of flow rate, however, was dictated by patient’s preference. In addition, a recent study showed that most of the effect on inspiratory workload and CO 2 clearance is already obtained at the lowest flow rate [45]. In addition, it remains unclear whether the relationship between flow rate and physiological response holds true in chronically hypercapnic patients.…”

Section: Discussionmentioning

confidence: 99%

High-flow nasal oxygen versus noninvasive ventilation in adult patients with cystic fibrosis: a randomized crossover physiological study

Sklar

Dres

Rittayamai

et al. 2018

Ann. Intensive Care

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BackgroundNoninvasive ventilation (NIV) is the first-line treatment of adult patients with exacerbations of cystic fibrosis (CF). High-flow nasal oxygen therapy (HFNT) might benefit patients with hypoxemia and can reduce physiological dead space. We hypothesized that HFNT and NIV would similarly reduce work of breathing and improving breathing pattern in CF patients. Our objective was to compare the effects of HFNT versus NIV in terms of work of breathing, assessed noninvasively by the thickening fraction of the diaphragm (TFdi, measured with ultrasound), breathing pattern, transcutaneous CO2 (PtcCO2), hemodynamics, dyspnea and comfort.MethodsAdult CF patients who had been stabilized after requiring ventilatory support for a few days were enrolled and ventilated with HFNT and NIV for 30 min in crossover random order.ResultsFifteen patients were enrolled. Compared to baseline, HFNT, but not NIV, reduced respiratory rate (by 3 breaths/min, p = 0.01) and minute ventilation (by 2 L/min, p = 0.01). Patients also took slightly larger tidal volumes with HFNT compared to NIV (p = 0.02). TFdi per breath was similar under the two techniques and did not change from baseline. MAP increased from baseline with NIV and compared to HFNT (p ≤ 0.01). Comfort was poorer with the application of both HFNT and NIV than baseline. No differences were found for heart rate, SpO2, PtcCO2 or dyspnea.ConclusionsIn adult CF patients stabilized after indication for ventilatory support, HFNT and NIV have similar effects on diaphragmatic work per breath, but high-flow therapy confers additional physiological benefits by decreasing respiratory rate and minute ventilation.Clinical trial registrationEthics Committee of St. Michael’s Hospital (REB #14-338) and clinicaltrial.gov (NCT02262871).Electronic supplementary materialThe online version of this article (10.1186/s13613-018-0432-4) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

High-flow nasal oxygen versus noninvasive ventilation in adult patients with cystic fibrosis: a randomized crossover physiological study

Sklar

Dres

Rittayamai

et al. 2018

Ann. Intensive Care

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“…Five studies evaluated the feasibility and safety of HFNO in immunocompromised patients with acute respiratory failure. In a retrospective single-centre study of 45 patients with haematological malignancies (half were bone marrow transplant recipients, 108 half had recently received systemic chemotherapy, and 42% were neutropenic), HFNO allowed recovery without intubation…”

Section: Oxygenation and Ventilation Strategiesmentioning

confidence: 99%

Acute respiratory failure in immunocompromised adults

Azoulay

Mokart

Kouatchet

et al. 2019

The Lancet Respiratory Medicine

108

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Acute respiratory failure occurs in up to half of patients with haematological malignancies and 15% of those with solid tumours or solid organ transplantation. Mortality remains high. Factors associated with mortality include a need for invasive mechanical ventilation, organ dysfunction, older age, frailty or poor performance status, delayed intensive care unit admission, and acute respiratory failure due to an invasive fungal infection or unknown cause. In addition to appropriate antibacterial therapy, initial clinical management aims to restore oxygenation and predict the most probable cause based on variables related to the underlying disease, acute respiratory failure characteristics, and radiographic findings. The cause of acute respiratory failure must then be confirmed using the most efficient, least invasive, and safest diagnostic tests. In patients with acute respiratory failure of undeter mined cause, a standardised diagnostic investi gation should be done immediately at admission before deciding whether to perform more invasive diagnostic procedures or to start empirical treatments. Collaborative and multidisciplinary clinical and research networks are crucial to improve our understanding of disease pathogenesis and causation and to develop less invasive diagnostic strategies and more targeted treatment options.www.thelancet.com/respiratory Vol

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“…Physiologic effects of high flow nasal cannula (HFNC) include CO 2 washout from the upper airways, reduction of the work of breathing (1)(2) and generation of positive end-expiratory pressure (PEEP) (3)(4). However, the PEEP level obtained by HFNC is relatively low (i.e., 2-5 cmH 2 O), very difficult to measure in clinical practice and predictably unstable (i.e., PEEP may vary with patient's mouth opening) (3)(4)(5)(6). The HELMET is an interface designed to deliver non-invasive positive pressure ventilation or continuous positive airway pressure (CPAP) in a more comfortable and effective way than facial masks (7)(8).…”

Section: Introductionmentioning

confidence: 99%

Nasal High Flow Delivered within the Helmet: A New Noninvasive Respiratory Support

Mauri

Spinelli

Mariani

et al. 2019

Am J Respir Crit Care Med

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ES drafted the work. All authors collaborated to interpretation of data, revising the work critically for important intellectual content and approved the version to be published. TM and AP agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.Sources of support. The present study was supported in part by institutional funding (Ricerca corrente 2018 -"Rimozione extracorporeal di anidride carbonica (CO 2 ) e modulazione della ventilazione spontanea in pazienti con insufficienza respiratoria acuta (sindrome da distress respiratorio, ARDS) e acuta su cronico (broncopneumopatia cronico ostruttiva, COPD)") of

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Optimum support by high-flow nasal cannula in acute hypoxemic respiratory failure: effects of increasing flow rates

Abstract: In this cohort of patients with AHRF, an increasing HFNC flow rate progressively decreased inspiratory effort and improved lung aeration, dynamic compliance and oxygenation. Most of the effect on inspiratory workload and CO clearance was already obtained at the lowest flow rate.

Cited by 195 publications

References 30 publications

High-flow nasal oxygen versus noninvasive ventilation in adult patients with cystic fibrosis: a randomized crossover physiological study

High-flow nasal oxygen versus noninvasive ventilation in adult patients with cystic fibrosis: a randomized crossover physiological study

Acute respiratory failure in immunocompromised adults

Nasal High Flow Delivered within the Helmet: A New Noninvasive Respiratory Support

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