High-flow oxygen via tracheostomy improves oxygenation in patients weaning from mechanical ventilation: a randomised crossover study

Introduction: Application of oxygen at high flows via nasal cannula can be used in patients with hypoxemic respiratory failure and to prevent reintubation. It is well tolerated by the patients and has been associated with lower mortality. However, there is very little data on the use of oxygen at high flows connected to tracheal cannula (HFOTC). Case presentation: We present two patients in whom weaning from mechanical ventilation was difficult and we decided to use HFOTC for weaning. Weaning from mechanical ventilation with HFOTC was successful in both patients and they tolerated long term (4 and 2 days, respectively) ventilatory support with HFOTC without adverse effects. Conclusions: HFOTC might be used during weaning from mechanical ventilation, however, more data is needed to determine the optimal use of this treatment option.

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Use of High-Flow Nasal Cannula in Patients With Pneumonia and Hypoxemic Respiratory Failure at Altitudes Above 2600 m: What Is the Best Predictor of Success?

Journal of Intensive Care Medicine ◽

10.1177/08850666211057503 ◽

2021 ◽

pp. 088506662110575

Author(s):

Molano Franco Daniel ◽

Gómez Duque Mario ◽

Beltrán Edgar ◽

Villabon Mario ◽

Hurtado Alejandra ◽

...

Keyword(s):

Mechanical Ventilation ◽

Respiratory Failure ◽

Respiratory Rate ◽

High Flow ◽

Nasal Cannula ◽

High Flow Nasal Cannula ◽

Multicenter Cohort Study ◽

Hypoxemic Respiratory Failure ◽

Severity Scores ◽

High Flow Oxygen

Introduction: The use of high-flow nasal cannulas (HFNC) in patients with hypoxemic ventilatory failure reduces the need for mechanical ventilation and does not increase mortality when intubation is promptly applied. The aim of the study is to describe the behavior of HFNC in patients who live at high altitudes, and the performance of predictors of success/failure of this strategy. Methods: Prospective multicenter cohort study, with patients aged over 18 years recruited for 12 months in 2020 to 21. All had a diagnosis of hypoxemic respiratory failure secondary to pneumonia, were admitted to intensive care units, and were receiving initial management with a high-flow nasal cannula. The variables assessed included need for intubation, mortality in ICU, and the validation of SaO2, respiratory rate (RR) and ROX index (IROX) as predictors of HFNC success / failure. Results: One hundred and six patients were recruited, with a mean age of 59 years and a success rate of 74.5%. Patients with treatment failure were more likely to be obese (BMI 27.2 vs 25.5; OR: 1.03; 95% CI: .95-1.1) and had higher severity scores at admission (APACHE II 12 vs 20; OR 1.15; 95% CI: 1.06-1.24). Respiratory rates after 12 (AUC .81 CI: .70-.92) and 18 h (AUC .85 CI: .72-0.90) of HFNC use were the best predictors of failure, performing better than those that included oxygenation. ICU mortality was higher in the failure group (6% vs 29%; OR 8.8; 95% CI:1.75-44.7). Conclusions: High-flow oxygen cannula therapy in patients with hypoxemic respiratory failure living at altitudes above 2600 m is associated with low rates of therapy failure and a reduced need for mechanical ventilation in the ICU. The geographical conditions and secondary physiological changes influence the performance of the traditionally validated predictors of therapy success. Respiratory rate <30 proved to be the best indicator of early success of the device at 12 h of use.

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Comparative study of high flow nasal catheter device and noninvasive positive pressure ventilation for sequential treatment in sepsis patients after weaning from mechanical ventilation in intensive care unit

Annals of Palliative Medicine ◽

10.21037/apm-21-8 ◽

2021 ◽

Vol 10 (6) ◽

pp. 6270-6278

Author(s):

Lizhen Xuan ◽

Jiefei Ma ◽

Jiale Tao ◽

Ling Zhu ◽

Shilong Lin ◽

...

Keyword(s):

Intensive Care Unit ◽

Mechanical Ventilation ◽

Intensive Care ◽

Comparative Study ◽

Positive Pressure Ventilation ◽

Noninvasive Positive Pressure Ventilation ◽

High Flow ◽

Positive Pressure ◽

Weaning From Mechanical Ventilation ◽

Nasal Catheter

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Safety and clinical outcomes of remdesivir in hospitalised COVID-19 patients: a retrospective analysis of active surveillance database

BMC Infectious Diseases ◽

10.1186/s12879-021-07004-8 ◽

2022 ◽

Vol 22 (1) ◽

Author(s):

Vaishali Gupte ◽

Rashmi Hegde ◽

Sandesh Sawant ◽

Kabil Kalathingal ◽

Sonali Jadhav ◽

...

Keyword(s):

Mechanical Ventilation ◽

Retrospective Analysis ◽

Clinical Outcomes ◽

Oxygen Therapy ◽

High Flow ◽

Low Flow ◽

Invasive Ventilation ◽

Non Invasive ◽

Non Invasive Ventilation ◽

High Flow Oxygen

Abstract Background Real-world data on safety and clinical outcomes of remdesivir in COVID-19 management is scant. We present findings of data analysis conducted for assessing the safety and clinical outcomes of remdesivir treatment for COVID-19 in India. Methods This retrospective analysis used data from an active surveillance programme database of hospitalised patients with COVID-19 who were receiving remdesivir. Results Of the 2329 patients included, 67.40% were men. Diabetes (29.69%) and hypertension (20.33%) were the most common comorbidities. At remdesivir initiation, 2272 (97.55%) patients were receiving oxygen therapy. Remdesivir was administered for 5 days in 65.38% of patients. Antibiotics (64.90%) and steroids (47.90%) were the most common concomitant medications. Remdesivir was overall well tolerated, and total 119 adverse events were reported; most common were nausea and vomiting in 45.40% and increased liver enzymes in 14.28% patients. 84% of patients were cured/improved, 6.77% died and 9.16% showed no improvement in their clinical status at data collection. Subgroup analyses showed that the mortality rate was significantly lower in patients < 60 years old than in those > 60 years old. Amongst patients on oxygen therapy, the cure/improvement rate was significantly higher in those receiving standard low-flow oxygen than in those receiving mechanical ventilation, non-invasive ventilation, or high-flow oxygen. Factors that were associated with higher mortality were age > 60 years, cardiac disease, diabetes high flow oxygen, non-invasive ventilation and mechanical ventilation. Conclusion Our analysis showed that remdesivir is well tolerated and has an acceptable safety profile. The clinical outcome of cure/improvement was 84%, with a higher improvement in patients < 60 years old and on standard low-flow oxygen.

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A pediatric case managed with high-flow nasal cannula oxygen during weaning from mechanical ventilation

Journal of the Japanese Society of Intensive Care Medicine ◽

10.3918/jsicm.21.285 ◽

2014 ◽

Vol 21 (3) ◽

pp. 285-286

Author(s):

Shinya Miura ◽

Tatsuya Kawasaki ◽

Ikuya Ueta ◽

Takuma Kishimoto ◽

Yusuke Itou ◽

...

Keyword(s):

Mechanical Ventilation ◽

High Flow ◽

Nasal Cannula ◽

Weaning From Mechanical Ventilation ◽

High Flow Nasal Cannula ◽

Pediatric Case

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Effects of high-flow oxygen therapy on patients with hypoxemia after extubation and predictors of reintubation: a retrospective study based on the MIMIC-IV database

BMC Pulmonary Medicine ◽

10.1186/s12890-021-01526-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Taotao Liu ◽

Qinyu Zhao ◽

Bin Du

Keyword(s):

Mechanical Ventilation ◽

Treatment Group ◽

Medical Information ◽

Characteristic Curve ◽

Oxygenation Index ◽

High Flow ◽

Control Group ◽

Severe Hypoxemia ◽

High Flow Oxygen ◽

Weaning Failure

Abstract Background To investigate the indications for high-flow nasal cannula oxygen (HFNC) therapy in patients with hypoxemia during ventilator weaning and to explore the predictors of reintubation when treatment fails. Methods Adult patients with hypoxemia weaning from mechanical ventilation were identified from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. The patients were assigned to the treatment group or control group according to whether they were receiving HFNC or non-invasive ventilation (NIV) after extubation. The 28-day mortality and 28-day reintubation rates were compared between the two groups after Propensity score matching (PSM). The predictor for reintubation was formulated according to the risk factors with the XGBoost algorithm. The areas under the receiver operating characteristic curve (AUC) was calculated for reintubation prediction according to values at 4 h after extubation, which was compared with the ratio of SpO2/FiO2 to respiratory rate (ROX index). Results A total of 524,520 medical records were screened, and 801 patients with moderate or severe hypoxemia when undergoing mechanical ventilation weaning were included (100 < PaO2/FiO2 ≤ 300 mmHg), including 358 patients who received HFNC therapy after extubation in the treatment group. There were 315 patients with severe hypoxemia (100 < PaO2/FiO2 ≤ 200 mmHg) before extubation, and 190 patients remained in the treatment group with median oxygenation index 166[157,180] mmHg after PSM. There were no significant differences in the 28-day reintubation rate or 28-day mortality between the two groups with moderate or severe hypoxemia (all P > 0.05). Then HR/SpO2 was formulated as a predictor for 48-h reintubation according to the important features predicting weaning failure. According to values at 4 h after extubation, the AUC of HR/SpO2 was 0.657, which was larger than that of ROX index (0.583). When the HR/SpO2 reached 1.2 at 4 h after extubation, the specificity for 48-h reintubation prediction was 93%. Conclusions The treatment effect of HFNC therapy is not inferior to that of NIV, even on patients with oxygenation index from 160 to 180 mmHg when weaning from ventilator. HR/SpO2 is more early and accurate in predicting HFNC failure than ROX index.

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