High-flow nasal cannula oxygen therapy for outpatients undergoing flexible bronchoscopy: a randomised controlled trial

Thorax ◽  
2021 ◽  
pp. thoraxjnl-2021-217116
Author(s):  
Federico Longhini ◽  
Corrado Pelaia ◽  
Eugenio Garofalo ◽  
Andrea Bruni ◽  
Roberta Placida ◽  
...  
Keyword(s):  
Gas Exchange ◽  
Lung Volume ◽  
Controlled Trial ◽  
Blood Gases ◽  
High Flow ◽  
Nasal Cannula ◽  
Flexible Bronchoscopy ◽  
High Flow Nasal Cannula ◽  
Arterial Blood ◽  
Randomised Controlled

IntroductionHigh-flow nasal cannula (HFNC) provides benefits to patients undergoing flexible bronchoscopy (FOB). We compared the effects of HFNC versus standard therapy (ST) on gas exchange, lung volume and diaphragm function in patients undergoing FOB for bronchoalveolar lavage (BAL).Methods36 outpatients were randomised to ST or HFNC. Arterial blood gases, episodes of severe desaturation, changes of end-expiratory lung impedance (ΔEELI), diaphragm ultrasound were recorded. Measurements were done at baseline (T0), after bronchoscope insertion (T1), at the end of the procedure (T2) and 10 min afterwards (T3).ResultsArterial partial oxygen pressure (PaO2) was not different between T0 (10.8 (95% CI 8.7 to 12.0) kPa and T2 (11.1 (95% CI 10.4 to 12.0) kPa) with HFNC, while decreased from 11.1 (95% CI 10.5 to 12.1) to 9.1 (95% CI 8.4 to 9.8) kPa with ST. At T2, PaO2 was significantly higher with HFNC than with ST (p<0.001). Also, with HFNC, compared with ST, fewer desaturations occurred (11% vs 56%; p<0.01). ΔEELI was no different at the different time points with HFNC, while with ST there was a significant decrease at T1 (−170 (95% CI −382 to −32) mL, p=0.003), T2 (−211 (95% CI −425 to −148) mL, p<0.001) and T3 (−213 (95% CI −398 to −81) mL, p<0.001), as opposed to T0. EELI was lower with ST than HFNC at T1 (p=0.006), T2 (p=0.001) and T3 (p=0.002). Diaphragm displacement was no different between groups (p=0.748), while the thickening fraction significantly increased at T1 and T2 with ST only (p<0.01).ConclusionsDuring FOB for BAL, HFNC improves gas exchange, avoiding loss of end-expiratory lung volume and preventing increase of diaphragm activation.Trial registration numberNCT04016480.

scholarly journals Effects of flow rate on transnasal pulmonary aerosol delivery of bronchodilators via high-flow nasal cannula for patients with COPD and asthma: protocol for a randomised controlled trial

BMJ Open ◽  
2019 ◽  
Vol 9 (6) ◽  
pp. e028584
Author(s):  
Jie Li ◽  
Jian Luo ◽  
Yibing Chen ◽  
Lixing Xie ◽  
James B Fink
Keyword(s):  
Randomised Controlled Trial ◽  
Gas Flow ◽  
Controlled Trial ◽  
High Flow ◽  
Nasal Cannula ◽  
Dose Inhaler ◽  
High Flow Nasal Cannula ◽  
Fill Volume ◽  
Randomised Controlled

IntroductionBoth in vitro and in vivo radiolabelled studies on nebulisation via high-flow nasal cannula showed that inhaled dose decreases as the administered gas flow increases. In our previous in vitro study, we investigated the effects of the ratio of gas flow to subject’s peak inspiratory flow (GF:IF) on the aerosol deposition, which increased as the GF:IF decreased, with an optimal GF:IF between 0.1 and 0.5 producing a stable ‘lung’ deposition in both quiet and distressed breathing. Thus, we aim to validate our in vitro findings in subjects with reversible airflow limitations by assessing their response to inhaled bronchodilator.Methods and analysisThis is a single-centre, randomised controlled trial. Subjects with chronic obstructive pulmonary disease or asthma with positive response to 400μg albuterol via metered dose inhaler and valved holding chamber will be enrolled and consented. After a washout period (1–3 days), subjects will be randomly assigned to inhale albuterol with one of three gas flows: 50 L/min, GF:IF=1.0 and GF:IF=0.5. In each arm, subjects will inhale 2 mL saline, followed by escalating doubling doses (0.5, 1, 2 and 4 mg) of albuterol in a fill volume of 2 mL, delivered by a vibrating mesh nebuliser via heated nasal cannula set up at 37°C. An interval of 30 min between each dose of albuterol, with spirometry measured at baseline and after each inhalation. Titration will be terminated if forced expiratory volume in 1 s improvement is <5%, or adverse event is observed.Ethics and disseminationThis trial has been approved by the Ethic Committee of People’s Liberation Army General Hospital, Beijing, China (no. S2018-200-01). The results will be disseminated through peer-reviewed journals, national and international conferences.Trial registration numberNCT03739359; Pre-results.

scholarly journals Benefits of High-Flow Nasal Cannula Therapy for Acute Pulmonary Edema in Patients with Heart Failure in the Emergency Department: A Prospective Multi-Center Randomized Controlled Trial

2020 ◽  
Vol 9 (6) ◽  
pp. 1937 ◽  
Author(s):  
Dong Ryul Ko ◽  
Jinho Beom ◽  
Hye Sun Lee ◽  
Je Sung You ◽  
Hyun Soo Chung ◽  
...  
Keyword(s):  
Heart Failure ◽  
Emergency Department ◽  
Pulmonary Edema ◽  
Oxygen Therapy ◽  
Controlled Trial ◽  
High Flow ◽  
Nasal Cannula ◽  
High Flow Nasal Cannula ◽  
Arterial Blood Gas ◽  
Arterial Blood

Heart failure patients with pulmonary edema presenting to the emergency department (ED) require an effective approach to deliver sufficient oxygen and reduce the rate of intubation and mechanical ventilation in the ED; conventional oxygen therapy has proven ineffective in delivering enough oxygen to the tissues. We aimed to identify whether high-flow nasal cannula (HFNC) therapy over time improved the respiratory rate (RR), lactate clearance, and certain arterial blood gas (ABG) parameters, in comparison with conventional oxygen therapy, in patients with cardiogenic pulmonary edema. This prospective, multi-institutional, and interventional study (clinical trial, reference KCT0004578) conducted between 2016 and 2019 included adult patients diagnosed with heart failure within the previous year and pulmonary edema confirmed at admission. Patients were randomly assigned to the conventional or HFNC group and treated with the goal of maintaining oxygen saturation (SpO2) ≥ 93. We obtained RR, SpO2, lactate levels, and ABG parameters at baseline and 30 and 60 min after randomization. All parameters showed greater improvement with HFNC therapy than with conventional therapy. Significant changes in ABG parameters were achieved within 30 min. HFNC therapy could therefore be considered as initial oxygen therapy. Physicians may consider advanced ventilation if there is no significant improvement in ABG parameters within 30 min of HFNC therapy.

scholarly journals Randomised controlled trial of polysomnographic titration of noninvasive ventilation

2019 ◽  
Vol 53 (5) ◽  
pp. 1802118 ◽  
Author(s):  
Liam M. Hannan ◽  
Linda Rautela ◽  
David J. Berlowitz ◽  
Christine F. McDonald ◽  
Jennifer M. Cori ◽  
...  
Keyword(s):  
Gas Exchange ◽  
Noninvasive Ventilation ◽  
Controlled Trial ◽  
Blood Gases ◽  
Neuromuscular Disorder ◽  
Carbon Dioxide Tension ◽  
Sleep Disruption ◽  
Arterial Blood ◽  
Treatment Naïve ◽  
Randomised Controlled

Noninvasive ventilation (NIV) settings determined during wakefulness may produce patient–ventilator asynchrony (PVA) during sleep, causing sleep disruption and limiting tolerance. This study investigated whether NIV titrated with polysomnography (PSG) is associated with less PVA and sleep disruption than therapy titrated during daytime alone.Treatment-naive individuals referred for NIV were randomised to control (daytime titration followed by sham polysomnographic titration) or PSG (daytime titration followed by polysomnographic titration) groups. Primary outcomes were PVA and arousal indices on PSG at 10 weeks. Secondary outcomes included adherence, gas exchange, symptoms and health-related quality of life (HRQoL).In total, 60 participants were randomised. Most (88.3%) had a neuromuscular disorder and respiratory muscle weakness but minor derangements in daytime arterial blood gases. PVA events were less frequent in those undergoing polysomnographic titration (median (interquartile range (IQR)): PSG 25.7 (12–68) events·h−1versuscontrol 41.0 (28–182) events·h−1; p=0.046), but arousals were not significantly different (median (IQR): PSG 11.4 (9–19) arousals·h−1versuscontrol 14.6 (11–19) arousals·h−1; p=0.258). Overall adherence was not different except in those with poor early adherence (<4 h·day−1) who increased their use after polysomnographic titration (mean difference: PSG 95 (95% CI 29–161) min·day−1versuscontrol −23 (95% CI −86–39) min·day−1; p=0.01). Arterial carbon dioxide tension, somnolence and sleep quality improved in both groups. There were no differences in nocturnal gas exchange or overall measures of HRQoL.NIV titrated with PSG is associated with less PVA but not less sleep disruption when compared with therapy titrated during daytime alone.

Changes in arterial blood gases after use of high-flow nasal cannula therapy in the ED

2015 ◽  
Vol 33 (10) ◽  
pp. 1344-1349 ◽  
Author(s):  
Jin Hee Jeong ◽  
Dong Hoon Kim ◽  
Seong Chun Kim ◽  
Changwoo Kang ◽  
Soo Hoon Lee ◽  
...  
Keyword(s):  
Blood Gases ◽  
High Flow ◽  
Nasal Cannula ◽  
Arterial Blood Gases ◽  
High Flow Nasal Cannula ◽  
Arterial Blood
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