High-flow nasal cannula therapy, factors affecting effective inspired oxygen fraction: an experimental adult bench model

Objective: Diabetes prevalence is a vital factor in COVID-19's clinical prognosis. This study aimed to investigate and compare the efficacy of High-flow Nasal Cannula (HFNC) with/without non-rebreather mask (NRM) on critical COVID-19 patients with/without diabetes. Materials and methods: For analysis and comparison, epidemiological, biochemical, and clinical data were collected from 240 HFNC±NRM treated severe and critical COVID-19 ICU patients (diabetic = 136; non-diabetic = 104) of five hospitals in Chattogram, Bangladesh. Results and Discussion: 59.1% patients with fever had diabetes (p=0.012). ICU stay was longer for diabetic patients (9.06±5.70) than non-diabetic ones (7.41±5.11) (p=0.020). Majority of hypertensive patients were diabetic (68.3%; p<0.001). Most of the diabetic patients (70.4%; p<0.005) had elevated creatinine levels. The partial pressure of oxygen after HFNC (only) was significantly (p=0.031) higher in non-diabetic patients (69.30±23.56) than diabetic ones (61.50±14.49). Diabetic (62.64±13.05) and non-diabetic patients (59.40±13.22) had similar partial pressure of oxygen from HFNC+NRM. Majority of the diabetic patients who required HFNC+NRM had elevated RBS (73.8%; p=0.001) and creatinine (75.7%; p=0.009). Factors affecting the HFNC only treated patients were fever and impaired glucose tolerance. Besides, increased plasma glucose level, age, and hypertension affected the HFNC + NRM treated diabetic patients. Conclusion: The results of this study imply that oxygen supply with HFNC+NRM may be beneficial for the elderly/hypertensive diabetic patients with COVID-19 associated AHRF; and that IGT and increased blood glucose levels could be determinants for COVID-19 severity. However, further experiments to substantiate these claims are required on a larger sample and among different clinical cohorts.

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Humidity and Inspired Oxygen Concentration During High-Flow Nasal Cannula Therapy in Neonatal and Infant Lung Models

Respiratory Care ◽

10.4187/respcare.05319 ◽

2017 ◽

Vol 62 (5) ◽

pp. 532-537 ◽

Cited By ~ 6

Author(s):

Yusuke Chikata ◽

Saki Ohnishi ◽

Masaji Nishimura

Keyword(s):

Oxygen Concentration ◽

High Flow ◽

Nasal Cannula ◽

High Flow Nasal Cannula ◽

Inspired Oxygen

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SpO2/FiO2 as a predictor of high flow nasal cannula outcomes in children with acute hypoxemic respiratory failure

Scientific Reports ◽

10.1038/s41598-021-92893-7 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Ga Eun Kim ◽

Sun Ha Choi ◽

Mireu Park ◽

Jae Hwa Jung ◽

Myeongjee Lee ◽

...

Keyword(s):

Respiratory Failure ◽

Predictive Factors ◽

High Flow ◽

Nasal Cannula ◽

High Flow Nasal Cannula ◽

Hypoxemic Respiratory Failure ◽

Acute Hypoxemic Respiratory Failure ◽

Fraction Of Inspired Oxygen ◽

Oxygen Ratio ◽

Inspired Oxygen

AbstractThe high-flow nasal cannula (HFNC) is a useful treatment modality for acute hypoxemic respiratory failure (AHRF) in children. We compared the ability of the oxygen saturation to fraction of inspired oxygen ratio (S/F) and arterial oxygen partial pressure to fraction of inspired oxygen ratio (P/F) to predict HFNC outcomes in children with AHRF. This study included children treated with HFNC due to AHRF from April 2013 to March 2019 at the Severance Children’s Hospital. HFNC failure was defined as the need for mechanical ventilation. Trends of S/F and P/F during HFNC were analyzed. To predict HFNC outcomes, a nomogram was constructed based on predictive factors. A total of 139 patients with arterial blood gas data were included in the S/F and P/F analyses. S/F < 230 at initiation showed high prediction accuracy for HFNC failure (area under the receiver operating characteristic curve: 0.751). Univariate analyses identified S/F < 230 at HFNC initiation and < 200 at 2 h (odds ratio [OR] 12.83, 95% CI 5.06–35.84), and hemato-oncologic disease (OR 3.79, 95% CI 1.12–12.78) as significant predictive factors of HFNC failure. The constructed nomogram had a highly predictive performance, with a concordance index of 0.765 and 0.831 for the exploratory and validation groups, respectively. S/F may be used as a predictor of HFNC outcomes. Our nomogram with S/F for HFNC failure within 2 h may prevent delayed intubation in children with AHRF.

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High-flow nasal cannula therapy for adult patients

Journal of International Medical Research ◽

10.1177/0300060516664621 ◽

2016 ◽

Vol 44 (6) ◽

pp. 1200-1211 ◽

Cited By ~ 8

Author(s):

Jian Zhang ◽

Ling Lin ◽

Konghan Pan ◽

Jiancang Zhou ◽

Xiaoyin Huang

Keyword(s):

Oxygen Therapy ◽

Mucociliary Clearance ◽

High Flow ◽

Nasal Cannula ◽

Adult Patients ◽

Positive Pressure ◽

High Flow Nasal Cannula ◽

Fraction Of Inspired Oxygen ◽

Effective Use ◽

Inspired Oxygen

High-flow nasal cannula (HFNC) oxygen therapy has several physiological advantages over traditional oxygen therapy devices, including decreased nasopharyngeal resistance, washing out of the nasopharyngeal dead space, generation of positive pressure in the pharynx, increasing alveolar recruitment in the lungs, humidification of the airways, increased fraction of inspired oxygen and improved mucociliary clearance. Recently, the use of HFNC in treating adult critical illness patients has significantly increased, and it is now being used in many patients with a range of different disease conditions. However, there are no established guidelines to direct the safe and effective use of HFNC for these patients. This review article summarizes the available published literature on the positive physiological effects, mechanisms of action, and the clinical applications of HFNC, compared with traditional oxygen therapy devices. The available literature suggests that HFNC oxygen therapy is an effective modality for the early treatment of critically adult patients.

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Awake craniotomy using a high-flow nasal cannula with oxygen reserve index monitoring - A report of two cases -

Anesthesia and Pain Medicine ◽

10.17085/apm.21022 ◽

2021 ◽

Vol 16 (4) ◽

pp. 338-343

Author(s):

Joonhee Gook ◽

Ji-Hye Kwon ◽

Keoungah Kim ◽

Jung Won Choi ◽

Ik Soo Chung ◽

...

Keyword(s):

High Flow ◽

Nasal Cannula ◽

Awake Craniotomy ◽

Anesthesia Care ◽

High Flow Nasal Cannula ◽

Monitored Anesthesia Care ◽

Cortical Areas ◽

Fraction Of Inspired Oxygen ◽

Improve Patient ◽

Inspired Oxygen

Background: Awake craniotomy is a well-tolerated procedure for the resection of brain tumors residing within or close to the eloquent cortical areas. Monitored anesthesia care (MAC) is a dominant anesthetic approach for awake craniotomy; however, it is associated with inherent challenges such as desaturation and hypercapnia, which may lead to various complications. The prevention of respiratory insufficiency is important for successful awake craniotomy. As measures to avoid respiratory depression, the use of high-flow nasal cannula (HFNC) can improve patient oxygenation and monitor the oxygen reserve index (ORi) to detect hypoxia earlier. Case: We report two cases of awake craniotomy with MAC using HFNC and ORi. We adjusted the fraction of inspired oxygen of the HFNC according to the ORi level. The patient underwent successful awake craniotomy without a desaturation event or additional airway intervention. Conclusions: Combined HFNC and ORi monitoring may provide adequate oxygen reserves in patients undergoing awake craniotomy.

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Factors affecting FiO 2 and PEEP during high‐flow nasal cannula oxygen therapy: A bench study

The Clinical Respiratory Journal ◽

10.1111/crj.13087 ◽

2019 ◽

Vol 13 (12) ◽

pp. 758-764 ◽

Cited By ~ 1

Author(s):

Yu‐Han Sun ◽

Bing Dai ◽

Yun Peng ◽

Wei Tan ◽

Hong‐Wen Zhao

Keyword(s):

Oxygen Therapy ◽

High Flow ◽

Nasal Cannula ◽

High Flow Nasal Cannula ◽

Factors Affecting ◽

Bench Study

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Factors affecting the outcome of the usage of high-flow nasal cannula on severe or critically ill COVID-19 patients: a multicentric study from a developing nation

Asian Journal of Medical and Biological Research ◽

10.3329/ajmbr.v7i3.56136 ◽

2021 ◽

Vol 7 (3) ◽

pp. 260-272

Author(s):

Moumita Das ◽

Shuva Das ◽

AFM T Bhuiyan ◽

Sudipta Deb Nath ◽

Rajdeep Biswas ◽

...

Keyword(s):

Critically Ill ◽

High Flow ◽

Nasal Cannula ◽

High Flow Nasal Cannula ◽

Biochemical Tests ◽

Hypoxemic Respiratory Failure ◽

Acute Hypoxemic Respiratory Failure ◽

Multicentric Study ◽

Factors Affecting ◽

Very High

In resource-constrained settings, High-Flow Nasal Cannula (HFNC) can reduce the burden on mechanical ventilation in COVID-19 induced Acute Hypoxemic Respiratory Failure (AHRF). The aim was to observe the factors those might affect the outcome of the usage of HFNC on severe/critically ill COVID-19 patients. This is a multicentric prospective observational study. We observed rRT-PCR positive severe/critically ill ICU patients requiring HFNC for more than six hours. Statistical analysis was done to correlate between factors and outcome. Weaning from HFNC was successful in 47.5% of patients. The death rate was higher in ≥ 50 years older (56.50%), and patients with asthma (60.57%), COPD (60.00%), and CKD (68.42%). Fever (91.67%), cough (72.5%), and dyspnea (67.5%) were the most common symptoms. Mortality rates were higher for patients with raised blood sugar, creatinine levels. Severely systemic inflammatory response was seen very high for the expired patients. On HFNC, percent saturation of oxygen (SpO2) and partial pressure of oxygen (PaO2) progression was significantly high for the surviving patients requiring less inspired fraction of oxygen (FiO2%). The survival rate was higher for the patients using both HFNC and non-rebreather mask (NRM) concomitantly. While after HFNC- SpO2% and FiO2% were significantly related with outcome of the HFNC only treated patients, duration of hospital stay and on HFNC- FiO2% affected the HFNC + NRM treated patients’ outcome. HFNC could save more lives of critically ill AHRF patients who otherwise might need invasive or noninvasive ventilation. Some biochemical tests were observed to have association with the prognosis of the disease though HFNC was given to all. Survival benefit of dual HFNC and NRM therapy needs future study. Asian J. Med. Biol. Res. 2021, 7 (3), 260-272

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Acute Responses to Oxygen Delivery via High Flow Nasal Cannula in Patients with Severe Chronic Obstructive

Journal of Clinical Medicine ◽

10.3390/jcm10091814 ◽

2021 ◽

Vol 10 (9) ◽

pp. 1814

Author(s):

Amy H. Attaway ◽

Jihane Faress ◽

Frank Jacono ◽

Srinivasan Dasarathy

Keyword(s):

Flow Rate ◽

Oxygen Delivery ◽

High Flow ◽

Nasal Cannula ◽

Chronic Obstructive ◽

Dependent Manner ◽

High Flow Nasal Cannula ◽

Oxygen Fraction ◽

Copd Patients ◽

Severe Copd

Differences in oxygen delivery methods to treat hypoxemia have the potential to worsen CO2 retention in chronic obstructive lung disease (COPD). Oxygen administration using high flow nasal cannula (HFNC) has multiple physiological benefits in treating respiratory failure including reductions in PaCO2 in a flow-dependent manner. We hypothesized that patients with COPD would develop worsening hypercapnia if oxygen fraction was increased without increasing flow rate. We evaluated the acute response to HFNC in subjects with severe COPD when flow remained constant and inspired oxygen was increased. In total, 11 subjects with severe COPD (FEV1 < 50%) on supplemental oxygen with baseline normocapnia (PaCO2 < 45 mm Hg; n = 5) and hypercapnia (PaCO2 ≥ 45 mm Hg; n = 6) were studied. Arterial blood gas responses were studied at three timepoints: Baseline, HFNC at a flow rate of 30 L/min at resting oxygen supplementation for 1 h, and FiO2 30% above baseline with the same flow rate for the next hour. The primary endpoint was the change in PaCO2 from baseline. No significant changes in PaCO2 were noted in response to HFNC applied at baseline FiO2 in the normocapnic and hypercapnic group. At HFNC with FiO2 30% above baseline, the normocapnic group did not show a change in PaCO2 (baseline: 38.9 ± 1.8 mm Hg; HFNC at higher FiO2: 38.8 ± 3.1 mm Hg; p = 0.93), but the hypercapnic group demonstrated significant increase in PaCO2 (baseline: 58.2 ± 9.3 mm Hg; HFNC at higher FiO2: 63.3 ± 10.9 mm Hg; p = 0.025). We observed worsening hypercapnia in severe COPD patients and baseline hypercapnia who received increased oxygen fraction when flow remained constant. These data show the need for careful titration of oxygen therapy in COPD patients, particularly those with baseline hypercapnia when flow rate is unchanged.

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