Patients with New York Heart Association class III heart failure may benefit with high flow nasal cannula supportive therapy

Roca, Oriol; Pérez-Terán, Purificación; Masclans, Joan Ramón; Pérez, Lourdes Alicia Rodríguez; Galve, Enrique; Evangelista, Arturo; Rello, Jordi

doi:10.1016/j.jcrc.2013.02.007

Cited by 100 publications

(83 citation statements)

References 24 publications

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“…HFNC ϭ high-flow nasal oxygen cannula COT ϭ conventional oxygen therapy with acute respiratory failure. [25][26][27][28] In the present study, we found that HFNC significantly reduced breathing frequency during the study period, but there was no significant difference at the end of the study. This could be explained by the effect of specific treatments such as bronchodilator medications or diuretics, which had time to act and modified the pathophysiology of the subjects' presentation.…”

Section: Discussioncontrasting

confidence: 40%

Use of High-Flow Nasal Cannula for Acute Dyspnea and Hypoxemia in the Emergency Department

Rittayamai¹,

Tscheikuna²,

et al. 2015

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BACKGROUND: Acute dyspnea and hypoxemia are 2 of the most common problems in the emergency room. Oxygen therapy is an essential supportive treatment to correct these issues. In this study, we investigated the physiologic effects of high-flow nasal oxygen cannula (HFNC) compared with conventional oxygen therapy (COT) in subjects with acute dyspnea and hypoxemia in the emergency room. METHODS: A prospective randomized comparative study was conducted in the emergency department of a university hospital. Forty subjects were randomized to receive HFNC or COT for 1 h. The primary outcome was level of dyspnea, and secondary outcomes included change in breathing frequency, subject comfort, adverse events, and rate of hospitalization. RESULTS: Common causes of acute dyspnea and hypoxemia were congestive heart failure, asthma exacerbation, COPD exacerbation, and pneumonia. HFNC significantly improved dyspnea (2.0 ؎ 1.8 vs 3.8 ؎ 2.3, P ‫؍‬ .01) and subject comfort (1.6 ؎ 1.7 vs 3.7 ؎ 2.4, P ‫؍‬ .01) compared with COT. No statistically significant difference in breathing frequency was found between the 2 groups at the end of the study. HFNC was well tolerated, and no serious adverse events were found. The rate of hospitalization in the HFNC group was lower than in the COT group, but there was no statistically significant difference (50% vs 65%, P ‫؍‬ .34). CONCLUSIONS: HFNC improved dyspnea and comfort in subjects presenting with acute dyspnea and hypoxemia in the emergency department. HFNC may benefit patients requiring oxygen therapy in the emergency room.

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Section: Discussioncontrasting

confidence: 40%

Use of High-Flow Nasal Cannula for Acute Dyspnea and Hypoxemia in the Emergency Department

Rittayamai¹,

Tscheikuna²,

et al. 2015

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“…Examining the effect of HFNC on subjects with dyspnea and hypoxemia following NIV, Carratalá Perales et al 22 found that all of their 5 subjects showed clinical improvement and were successfully treated with HFNC. Roca et al 68 examined inferior vena cava collapse during inspiratory phase by echocardiography in subjects with New York Heart Association class III heart failure. HFNC decreased inspiratory collapse of the inferior vena cava, and it suggested that HFNC was supportive for subjects with severe heart failure.…”

Section: Acute Heart Failurementioning

confidence: 99%

High-Flow Nasal Cannula Oxygen Therapy in Adults: Physiological Benefits, Indication, Clinical Benefits, and Adverse Effects

2016

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High-flow nasal cannula (HFNC) oxygen therapy is carried out using an air/oxygen blender, active humidifier, single heated tube, and nasal cannula. Able to deliver adequately heated and humidified medical gas at flows up to 60 L/min, it is considered to have a number of physiological advantages compared with other standard oxygen therapies, including reduced anatomical dead space, PEEP, constant F IO 2 , and good humidification. Although few large randomized clinical trials have been performed, HFNC has been gaining attention as an alternative respiratory support for critically ill patients. Published data are mostly available for neonates. For critically ill adults, however, evidence is uneven because the reports cover various subjects with diverse underlying conditions, such as hypoxemic respiratory failure, exacerbation of COPD, postextubation, preintubation oxygenation, sleep apnea, acute heart failure, and conditions entailing do-not-intubate orders. Even so, across the diversity, many published reports suggest that HFNC decreases breathing frequency and work of breathing and reduces the need for respiratory support escalation. Some important issues remain to be resolved, such as definitive indications for HFNC and criteria for timing the starting and stopping of HFNC and for escalating treatment. Despite these issues, HFNC has emerged as an innovative and effective modality for early treatment of adults with respiratory failure with diverse underlying diseases.

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“…10,11 Indications for HFNC are not as well defined as for NIV, ranging from palliative situations 14,16,17 to pulmonary infections 18 or cardiac failure. 19 There is no precise view on this technique's exact place in the therapeutic arsenal of ARF, in particular regarding the most severe patients, those with ARDS. In addition, few studies have compared NIV and HFNC.…”

Section: See the Related Editorial On Page 307mentioning

confidence: 99%

Use of High-Flow Nasal Cannula Oxygen Therapy in Subjects With ARDS: A 1-Year Observational Study

et al. 2014

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BACKGROUND: Beneficial effects of high-flow nasal cannula (HFNC) oxygen on oxygenation and respiratory parameters have been reported in a small number of subjects with acute respiratory failure (ARF). We aimed to evaluate its effect in subjects with ARDS. METHODS: This was an observational single-center study. Prospectively obtained data were retrospectively analyzed. All patients admitted over 1 y to a university hospital medicosurgical ICU were included. Classification was according to the highest ventilatory support required. HFNC indications were reviewed, and demographics, clinical characteristics, and course of subjects with ARDS according to intubation need were compared. RESULTS: Of 607 subjects admitted, 560 required ventilatory or oxygen support, among whom 180 received noninvasive ventilatory support. HFNC was used in 87 subjects and as first-line treatment in 51 subjects (29% of first-line noninvasively treated subjects), 45 of which had ARDS (P aO 2 /F IO 2 of 137 mm Hg; 22 men, 57.9 y of age). Pneumonia accounted for 82% of ARDS causes. The intubation rate in these subjects was 40%. Higher Simplified Acute Physiology Score II (SAPS II; 46 vs 29, P ‫؍‬ .001), occurrence of additional organ failure (76% vs 26%, P ‫؍‬ .002), mainly hemodynamic (50% vs 7%, P ‫؍‬ .001) or neurological (22% vs 0, P ‫؍‬ .01), and trends toward lower P aO 2 /F IO 2 and higher breathing frequency after HFNC initiation were evidenced in subjects who failed HFNC. Higher SAPS II scores were associated with HFNC failure in multivariate analysis. CONCLUSIONS: In daily care, over one fourth of subjects requiring noninvasive ventilatory support were treated via HFNC, with a high success rate in subjects with severe ARDS. We conclude that HFNC may be considered as first-line therapy in ARF, including patients with ARDS.

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Patients with New York Heart Association class III heart failure may benefit with high flow nasal cannula supportive therapy

Cited by 100 publications

References 24 publications

Use of High-Flow Nasal Cannula for Acute Dyspnea and Hypoxemia in the Emergency Department

Use of High-Flow Nasal Cannula for Acute Dyspnea and Hypoxemia in the Emergency Department

High-Flow Nasal Cannula Oxygen Therapy in Adults: Physiological Benefits, Indication, Clinical Benefits, and Adverse Effects

Use of High-Flow Nasal Cannula Oxygen Therapy in Subjects With ARDS: A 1-Year Observational Study

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