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

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.

scholarly journals SPO2/FiO2 as a predictor of high-flow nasal cannula outcomes in children with acute hypoxemic respiratory failure: A retrospective study

2021 ◽  
Author(s):  
Ga Eun Kim ◽  
Sun Ha Choi ◽  
Mi Reu Park ◽  
Jae Hwa Jung ◽  
Myeongjee Lee ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Respiratory Distress ◽  
Odds Ratio ◽  
High Flow ◽  
High Flow Nasal Cannula ◽  
Hypoxemic Respiratory Failure ◽  
Acute Hypoxemic Respiratory Failure ◽  
Fraction Of Inspired Oxygen ◽  
Oxygen Ratio ◽  
Inspired Oxygen

Abstract Background: High-flow nasal cannula (HFNC) is a useful treatment modality for respiratory distress in children, as it provides effective oxygenation and reduces the work required for breathing. This study aimed to determine whether the oxygen saturation to fraction of inspired oxygen ratio (S/F) is a better predictor of HFNC outcomes than the arterial oxygen partial pressure to fraction of inspired oxygen ratio (P/F) in children with acute hypoxemic respiratory failure (AHRF).Methods: This study included children treated with HFNC for AHRF between April 2013 and March 2019 at the Severance Children’s Hospital in Korea. HFNC failure was defined as the need for mechanical ventilation due to worsening respiratory distress, whereas HFNC success was defined as the improvement of respiratory distress. We analyzed trends in S/F and P/F during HFNC oxygen therapy. A nomogram was constructed based on predictive factors identified via univariate analysis, and was externally validated using independent data.Results: A total of 139 patients with arterial blood gas data were included in the S/F and P/F analysis. There was a good correlation between S/F and P/F (P<0.001). The S/F at HFNC initiation was <230 and showed a high prediction accuracy for HFNC failure (area under the receiver operating characteristic curve: 0.751). Univariate analyses identified S/F <230 at HFNC initiation, S/F <200 at 2 h (odds ratio, 12.83; 95% confidence interval, 5.06-35.84), and hemato-oncologic disease (odds ratio, 3.79; 95% confidence interval, 1.12-12.78) as significant predictive factors for HFNC failure. These factors were used to construct a nomogram, which was shown to be highly predictive of HFNC outcomes; the concordance index of the exploratory and validation groups were 0.765 and 0.831, respectively.Conclusions: S/F may be used as a predictor of HFNC outcomes. Our nomogram with S/F for HFNC failure within 2 h may be used to prevent delayed intubation in children with AHRF.

scholarly journals The Double-Trunk Mask Improves Oxygenation During High-Flow Nasal Cannula Therapy for Acute Hypoxemic Respiratory Failure

2019 ◽  
Vol 64 (8) ◽  
pp. 908-914 ◽  
Author(s):  
Frédéric Duprez ◽  
Arnaud Bruyneel ◽  
Shahram Machayekhi ◽  
Marie Droguet ◽  
Yves Bouckaert ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
High Flow ◽  
Nasal Cannula ◽  
High Flow Nasal Cannula ◽  
Hypoxemic Respiratory Failure ◽  
Acute Hypoxemic Respiratory Failure

Is high-flow nasal cannula oxygenation more effective than noninvasive ventilation or conventional oxygen therapy in treating acute hypoxemic respiratory failure in COVID-19 patients?

2020 ◽  
Vol 54 ◽  
Author(s):  
Cary Amiel G. Villanueva ◽  
Marie Gene D. Cruz ◽  
Lia M. Palileo-Villanueva
Keyword(s):  
Respiratory Failure ◽  
Noninvasive Ventilation ◽  
Observational Studies ◽  
Oxygen Therapy ◽  
High Flow ◽  
Nasal Cannula ◽  
Respiratory Support ◽  
High Flow Nasal Cannula ◽  
Hypoxemic Respiratory Failure ◽  
Acute Hypoxemic Respiratory Failure

KEY FINDINGSVery low-quality evidence suggests lower mortality (based on five observational studies) but higher failurerate of respiratory support (based on two observational studies) in COVID-19 patients given high-flow nasalcannula (HFNC) oxygen compared with noninvasive ventilation (NIV) and conventional oxygenation therapy.Randomized controlled trials (RCT) are urgently needed in this area.• Respiratory failure accounts for about half of deaths in patients with COVID-19.• High-flow nasal cannula (HFNC) oxygen therapy reduces the need for escalating respiratory support and improvespatient comfort compared with conventional oxygen therapy among those with acute respiratory failure.• Mortality was consistently lower in COVID-19 patients who received HFNC rather than NIV or conventionaloxygen therapy (COT) across 5 very low-quality retrospective observational studies from China.• Several international guidelines recommend the use of HFNC oxygen therapy in COVID-19 patients whodevelop acute hypoxemic respiratory failure. However, local guidelines from the Philippine Society forMicrobiology and Infectious Diseases (PSMID) and the Philippine College of Chest Physicians (PCCP) recommendagainst HFNC due to risks of transmission and paucity of direct evidence for efficacy.• Additional infection control precautions, i.e. wearing a surgical mask over the cannula, and locating in a negativepressure room, are recommended whenever using HFNC or NIV.• There are at least two ongoing trials due to be completed by the second quarter of 2021 comparingHFNC oxygenation with NIV or COT in COVID-19 patients.

scholarly journals High-flow nasal cannula for respiratory failure in adult patients

2021 ◽  
Vol 36 (4) ◽  
pp. 275-285
Author(s):  
SeungYong Park
Keyword(s):  
Respiratory Failure ◽  
Chronic Obstructive Lung Disease ◽  
High Flow ◽  
Nasal Cannula ◽  
Low Flow ◽  
Chronic Obstructive ◽  
High Flow Nasal Cannula ◽  
Hypoxemic Respiratory Failure ◽  
Non Invasive Ventilation ◽  
Fraction Of Inspired Oxygen

The high-flow nasal cannula (HFNC) has been recently used in several clinical settings for oxygenation in adults. In particular, the advantages of HFNC compared with low-flow oxygen systems or non-invasive ventilation include enhanced comfort, increased humidification of secretions to facilitate expectoration, washout of nasopharyngeal dead space to improve the efficiency of ventilation, provision of a small positive end-inspiratory pressure effect, and fixed and rapid delivery of an accurate fraction of inspired oxygen (FiO2) by minimizing the entrainment of room air. HFNC has been successfully used in critically ill patients with several conditions, such as hypoxemic respiratory failure, hypercapneic respiratory failure (exacerbation of chronic obstructive lung disease), post-extubation respiratory failure, pre-intubation oxygenation, and others. However, the indications are not absolute, and much of the proven benefit remains subjective and physiologic. This review discusses the practical application and clinical uses of HFNC in adults, including its unique respiratory physiologic effects, device settings, and clinical indications.

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