Nasal High-Flow for Weaning Preterm Newborns with Risk of Chronic Lung Disease from nCPAP

2021 ◽  
Author(s):  
Angela Gregoraci Fernández ◽  
Juan José Comuñas Gómez ◽  
Olalla Rodriguez-Losada ◽  
Vanessa Flores España ◽  
Anna Gros Turpin ◽  
...  
Keyword(s):  
Oxygen Therapy ◽  
High Flow ◽  
Patient Comfort ◽  
Very Preterm ◽  
Nasal Injury ◽  
Key Points ◽  
Preterm Babies ◽  
Nasal High Flow Therapy ◽  
Outcome Duration ◽  
Group Flow

Objective The aim of the study is to compare the duration of oxygen therapy by using two methods of weaning from nasal continuous positive airway pressure (nCPAP) in very preterm babies. Study Design Between April 2014 and December 2016, 90 preterm <32 weeks and birthweight >1,000 g who, after at least 7 days on nCPAP, were clinically stable on <6 cm H2O and FiO2 <30% were randomly assigned to weaning directly from nCPAP or with nasal high flow therapy (nHFT). In the nCPAP group, pressure was gradually reduced until the infant was stable on 4 cm H2O and then discontinued. In the nHFT group, flow rate was reduced until the infant was stable at 3.l pm and then discontinued. Results Eighty-four infants completed the study. There were no differences between the groups for the primary outcome, duration of oxygen therapy (median 33 [14–48] versus 28 [15–37] days; p = 0.17). The incidence of moderate-to-severe bronchopulmonary dysplasia was similar. Weaning time was shorter in the nCPAP group (p = 0.02), but the failure rate was slightly higher although non-significant. In the nHFT group, we observed better perception of patient comfort and a lower incidence of severe nasal injury. Conclusion Weaning by nHFT compared with weaning directly off nCPAP does not prolong duration of oxygen therapy. Rather, it is associated with better perceptions of infant comfort among parents and lower rates of severe nasal injury. Key Points

Severe Acute Asthma (Status Asthmaticus)

2020 ◽  
Keyword(s):  
Oxygen Saturation ◽  
Magnesium Sulfate ◽  
Oxygen Therapy ◽  
Status Asthmaticus ◽  
Acute Asthma ◽  
High Flow ◽  
Key Points ◽  
High Flow Oxygen ◽  
Asthma Status ◽  
Severe Acute Asthma

Key Points Initiate high- flow oxygen therapy to maintain oxygen saturation of greater than 90%.Dexamethasone is as effective as methylprednisolone and should be given as soon as possible.Intravenous magnesium sulfate is a useful adjunct if therapy with β-agonists and anti-cholinergics are not effective initially.

scholarly journals Nasal high flow therapy: a novel treatment rather than a more expensive oxygen device

2017 ◽  
Vol 26 (145) ◽  
pp. 170028 ◽  
Author(s):  
Eleni Ischaki ◽  
Ioannis Pantazopoulos ◽  
Spyros Zakynthinos
Keyword(s):  
Respiratory Failure ◽  
Work Of Breathing ◽  
High Flow ◽  
Patient Comfort ◽  
Beneficial Effects ◽  
Oxygen Fraction ◽  
Anatomical Dead Space ◽  
Nasal High Flow Therapy ◽  
Positive Results ◽  
Inspiratory Oxygen

Nasal high flow is a promising novel oxygen delivery device, whose mechanisms of action offer some beneficial effects over conventional oxygen systems. The administration of a high flow of heated and humidified gas mixture promotes higher and more stable inspiratory oxygen fraction values, decreases anatomical dead space and generates a positive airway pressure that can reduce the work of breathing and enhance patient comfort and tolerance. Nasal high flow has been used as a prophylactic tool or as a treatment device mostly in patients with acute hypoxaemic respiratory failure, with the majority of studies showing positive results. Recently, its clinical indications have been expanded to post-extubated patients in intensive care or following surgery, for pre- and peri-oxygenation during intubation, during bronchoscopy, in immunocompromised patients and in patients with “do not intubate” status. In the present review, we differentiate studies that suggest an advantage (benefit) from other studies that do not suggest an advantage (no benefit) compared to conventional oxygen devices or noninvasive ventilation, and propose an algorithm in cases of nasal high flow application in patients with acute hypoxaemic respiratory failure of almost any cause.

scholarly journals High-flow oxygen therapy versus non-invasive ventilation: a randomised physiological cross-over study of alveolar recruitment in acute respiratory failure

2021 ◽  
pp. 00373-2021
Author(s):  
Elise Artaud-Macari ◽  
Michael Bubenheim ◽  
Gurvan Le Bouar ◽  
Dorothée Carpentier ◽  
Steven Grangé ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Oxygen Therapy ◽  
High Flow ◽  
Alveolar Recruitment ◽  
Patient Comfort ◽  
Invasive Ventilation ◽  
Lung Volumes ◽  
Non Invasive ◽  
Non Invasive Ventilation

High-flow nasal cannula (HFNC) oxygen therapy has recently shown clinical benefits in hypoxemic acute respiratory failure (ARF) patients, while the interest of non-invasive ventilation (NIV) remains debated. The primary endpoint was to compare alveolar recruitment using global end-expiratory electrical lung impedance (EELI) between HFNC and NIV. Secondary endpoints compared regional EELI, lung volumes (global and regional tidal volume variation (TV)), respiratory parameters, hemodynamic tolerance, dyspnea and patient comfort between HFNC and NIV, relative to face mask (FM).A prospective randomised cross-over physiological study was conducted in patients with hypoxemic ARF due to pneumonia. They received alternately HFNC, NIV and FM.Sixteen patients were included. Global EELI was 4083 with NIV and 2921 with HFNC (p=0.4). Compared to FM, NIV and HFNC significantly increased global EELI by 1810.5 (95%CI: (857; 2646)) and 826 (95%CI: (399.5; 2361)) respectively. Global and regional TV increased significantly with NIV compared to HFNC or FM, but not between HFNC and FM. NIV yielded a significantly higher SpO2/ FiO2 ratio compared to HFNC (p=0.03). No significant difference was observed between HFNC, NIV and FM for dyspnea. Patient comfort score with FM was not significantly different than with HFNC (p=0.1) but was lower with NIV (p=0.001).This study suggests a potential benefit of HFNC and NIV on alveolar recruitment in patients with hypoxemic ARF. In contrast with HFNC, NIV increased lung volumes which may contribute to overdistension and its potentially deleterious effect in these patients.

High Flow Oxygen Therapy and the Pressure to Feed Infants With Acute Respiratory Illness

2020 ◽  
Vol 5 (4) ◽  
pp. 1006-1010
Author(s):  
Jennifer Raminick ◽  
Hema Desai
Keyword(s):  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Oxygen Therapy ◽  
Respiratory Illness ◽  
High Flow ◽  
Oral Feeding ◽  
Respiratory Support ◽  
Acute Respiratory Illness ◽  
High Flow Oxygen

Purpose Infants hospitalized for an acute respiratory illness often require the use of noninvasive respiratory support during the initial stage to improve their breathing. High flow oxygen therapy (HFOT) is becoming a more popular means of noninvasive respiratory support, often used to treat respiratory syncytial virus/bronchiolitis. These infants present with tachypnea and coughing, resulting in difficulties in coordinating sucking and swallowing. However, they are often allowed to feed orally despite having high respiratory rate, increased work of breathing and on HFOT, placing them at risk for aspiration. Feeding therapists who work with these infants have raised concerns that HFOT creates an additional risk factor for swallowing dysfunction, especially with infants who have compromised airways or other comorbidities. There is emerging literature concluding changes in pharyngeal pressures with HFOT, as well as aspiration in preterm neonates who are on nasal continuous positive airway pressure. However, there is no existing research exploring the effect of HFOT on swallowing in infants with acute respiratory illness. This discussion will present findings from literature on HFOT, oral feeding in the acutely ill infant population, and present clinical practice guidelines for safe feeding during critical care admission for acute respiratory illness. Conclusion Guidelines for safety of oral feeds for infants with acute respiratory illness on HFOT do not exist. However, providers and parents continue to want to provide oral feeds despite clinical signs of respiratory distress and coughing. To address this challenge, we initiated a process change to use clinical bedside evaluation and a “cross-systems approach” to provide recommendations for safer oral feeds while on HFOT as the infant is recovering from illness. Use of standardized feeding evaluation and protocol have improved consistency of practice within our department. However, further research is still necessary to develop clinical practice guidelines for safe oral feeding for infants on HFOT.

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