Use of high flow nasal cannula for preoxygenation and apneic  oxygenation during intubation

Ricard, Jean‐Damien; Gaborieau, Baptiste; Bernier, Juliette; Breton, Camille Le; Messika, Jonathan

doi:10.21037/atm.2019.12.106

Cited by 10 publications

(6 citation statements)

References 18 publications

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“…Subsequently, other clinical trials expanded indications for NHF in adults to immunocompromised patients and to patients at risk for re-intubation after surgery or in the ICU [ 24 , 25 ]. However, for the present study, we reasoned that: (1) failure of NHF (i.e., intubation) is still higher than 30% and associated with high mortality rate, especially in the case of delayed timing [ 14 ]; (2) in neonates and infants, flow rates indexed per body weight are much higher than those used in the adult population (2–3 vs. 0.5–1 L/kg PBW/min) [ 26 ]; (3) Previous physiological studies showed that effects of NHF improve at higher flow rates [ 17 ]. Thus, we conceived an exploratory physiological study to assess whether use of NHF at flow rates comparable to the neonatal setting is associated with improved physiology.…”

Section: Resultsmentioning

confidence: 99%

“…Previous studies showed both the physiological and clinical benefits of noninvasive support by NHF in AHRF patients [ 9 , 10 ], to the point that NHF can already be considered as the recommended first-line noninvasive approach [ 11 – 13 ]. However, NHF fails to avoid intubation in around 30–40% of AHRF patients and research in this field should be aimed at finding more effective strategies able to decrease failure rate [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

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Nasal high flow higher than 60 L/min in patients with acute hypoxemic respiratory failure: a physiological study

et al. 2020

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Background Nasal high flow delivered at flow rates higher than 60 L/min in patients with acute hypoxemic respiratory failure might be associated with improved physiological effects. However, poor comfort might limit feasibility of its clinical use. Methods We performed a prospective randomized cross-over physiological study on 12 ICU patients with acute hypoxemic respiratory failure. Patients underwent three steps at the following gas flow: 0.5 L/kg PBW/min, 1 L/kg PBW/min, and 1.5 L/kg PBW/min in random order for 20 min. Temperature and FiO2 remained unchanged. Toward the end of each phase, we collected arterial blood gases, lung volumes, and regional distribution of ventilation assessed by electrical impedance tomography (EIT), and comfort. Results In five patients, the etiology was pulmonary; infective disease characterized seven patients; median PaO2/FiO2 at enrollment was 213 [IQR 136–232]. The range of flow rate during NHF 1.5 was 75–120 L/min. PaO2/FiO2 increased with flow, albeit non significantly (p = 0.064), PaCO2 and arterial pH remained stable (p = 0.108 and p = 0.105). Respiratory rate decreased at higher flow rates (p = 0.014). Inhomogeneity of ventilation decreased significantly at higher flows (p = 0.004) and lung volume at end-expiration significantly increased (p = 0.007), but mostly in the non-dependent regions. Comfort was significantly poorer during the step performed at the highest flow (p < 0.001). Conclusions NHF delivered at rates higher than 60 L/min in critically ill patients with acute hypoxemic respiratory failure is associated with reduced respiratory rate, increased lung homogeneity, and additional positive pressure effect, but also with worse comfort.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Nasal high flow higher than 60 L/min in patients with acute hypoxemic respiratory failure: a physiological study

et al. 2020

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“…A significant proportion of patients admitted to the ICU for AHRF will fail a noninvasive ventilatory strategy and, thus, require tracheal intubation [54]. In these patients, this procedure is at even greater risk of complications, mainly oxygen desaturation [55].…”

Section: Nhf and Preoxygenationmentioning

confidence: 99%

Use of nasal high flow oxygen during acute respiratory failure

et al. 2020

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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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“…[5] Currently, delivering oxygen through a high flow nasal cannula (HFNC) is being increasingly used in different clinical settings, and it is supposedly beneficial in preventing hypoxemia. [6][7][8] However, HFNC is a novel respiratory strategy treatment that delivers 50-60L/ min of warm, humidified air and many centers with limited resources do not have the appropriate equipment. [6][7][8][9][10] In centers with limited resources, oxygen delivery at 6L/min via nasal cannula or a facial mask is being used as a standard preoxygenation method.…”

Section: Medium-flow Oxygenation Through Facial Mask and Nasal Cannul...mentioning

confidence: 99%

“…[6][7][8] However, HFNC is a novel respiratory strategy treatment that delivers 50-60L/ min of warm, humidified air and many centers with limited resources do not have the appropriate equipment. [6][7][8][9][10] In centers with limited resources, oxygen delivery at 6L/min via nasal cannula or a facial mask is being used as a standard preoxygenation method. Moreover, the maximum available O2 (15L/min) from anesthesia machines is not so frequently used.…”

Section: Medium-flow Oxygenation Through Facial Mask and Nasal Cannul...mentioning

confidence: 99%

Medium-Flow Oxygenation Through Facial Mask and Nasal Cannula in a Limited Resource Setting

Gavrilovska-Brzanov

Shosholcheva

Карталов

et al. 2022

Prilozi

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Introduction: In centers with limited resources, a high flow nasal cannula is not available, thus we assess if preoxygenation with 15L flow of O2 available from anesthesia machines can prolong the safety period of induction of anesthesia before intubation and provide more time for securing the airway. Moreover, we compared the preoxygenation with standard 6L vs. 15L O2 through a facemask or a nasal cannula. Material and methods: Patients were allocated into four groups. Group I patients were preoxygenated with a nasal cannula on 6L of oxygen, patients in group II were preoxygenated with a nasal cannula on 15L of oxygen, patients in group III were preoxygenated with a facemask on 6L of oxygen, and patients in group IV were preoxygenated with a facemask on 15L of oxygen. The primary endpoint was time to desaturation and intubation. The secondary endpoints were PaO2, PaCO2, Sat% and ETCO2. Results: The groups with 15L preoxygenation had a statistically significant prolonged time to desaturation and intubation. Patients allocated to group II have a statistically significant greater PaO2 and lesser ETCO2 compered with group I. However, between patients in group III and IV there is a difference only in PaCO2, and although this effect is significant, both groups have values within the normal range. Conclusion: In centers with limited resources, preoxygenation with the maximum available oxygen flow from anesthesia machines (15L/min) are useful. This prolongs the safety period for securing the airway. We suggest the use of the maximum available amount of oxygen flow from anesthesia machines in clinical settings.

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Use of high flow nasal cannula for preoxygenation and apneic oxygenation during intubation

Cited by 10 publications

References 18 publications

Nasal high flow higher than 60 L/min in patients with acute hypoxemic respiratory failure: a physiological study

Nasal high flow higher than 60 L/min in patients with acute hypoxemic respiratory failure: a physiological study

Use of nasal high flow oxygen during acute respiratory failure

Medium-Flow Oxygenation Through Facial Mask and Nasal Cannula in a Limited Resource Setting

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