Physiological Responses and Perceived Comfort to High Flow Nasal Cannula Therapy in Awake Adults: Effects of Flow Magnitude and Temperature

2021 ◽  
Author(s):  
Indra Narang ◽  
Jayne C. Carberry ◽  
Jane E. Butler ◽  
Simon C. Gandevia ◽  
Alan K.I. Chiang ◽  
...  
Keyword(s):  
Muscle Activity ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Upper Airway ◽  
High Flow ◽  
Nasal Cannula ◽  
Respiratory Support ◽  
High Flow Nasal Cannula ◽  
Genioglossus Muscle ◽  
Obstructive Sleep

Clinical use of heated, high flow nasal cannula (HFNC) for non-invasive respiratory support is increasing and may have a therapeutic role in stabilizing the upper airway in obstructive sleep apnea (OSA). However, physiological mechanisms by which HFNC therapy may improve upper-airway function and effects of different temperature modes are unclear. Accordingly, this study aimed to determine effects of incremental flows and temperature modes (heated and non-heated) of HFNC on upper airway muscle activity (genioglossus), pharyngeal airway pressure, breathing parameters and perceived comfort. Six participants (2 females, aged 35±14 years) were studied during wakefulness in supine position and received HFNC at variable flows (0-60 L/min) during heated (37ºC) and non-heated (21ºC) modes. Breathing parameters via calibrated Respitrace inductance bands (chest and abdomen), upper-airway pressures via airway transducers, and genioglossus muscle activity via intra-muscular bipolar fine wire electrodes were measured. Comfort levels during HFNC were quantified using a visual analogue scale. Increasing HFNC flows did not increase genioglossus muscle activation despite increased negative epiglottic pressure swings (p=0.009). HFNC provided ~7cmH2O positive airway pressure at 60 L/min in non-heated and heated modes. In addition, increasing the magnitude of HFNC flow reduced breathing frequency (p=0.045), increased expiratory time (p=0.040), increased peak inspiratory flow (p=0.002), and increased discomfort (p=0.004). Greater discomfort occurred at higher flows in non-heated versus heated mode (p=0.034). These findings provide novel insight into key physiological changes that occur with HFNC for respiratory support and indicate the primary mechanism for improved upper-airway stability is positive airway pressure, not increased pharyngeal muscle activity.

Comparison between Continuous positive Airway Pressure (CPAP) and High Flow Nasal Cannula (HFNC) in Management of Bronchiolitis and community acquired pneumonia in Infants and Young Children

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Tarek Ahmed Abdel Gawad ◽  
Ahmad Mostafa Allam ◽  
Sarah Ali El Sayed
Keyword(s):  
Respiratory Failure ◽  
Continuous Positive Airway Pressure ◽  
Acute Respiratory Failure ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Community Acquired Pneumonia ◽  
High Flow ◽  
Nasal Cannula ◽  
Respiratory Support ◽  
High Flow Nasal Cannula

Abstract Background Acute respiratory failure develops in infants with bronchiolitis and Community acquired pneumonia (CAP) because of hypoxemia, due to mismatch between ventilation and perfusion. Nasal continuous airway pressure (nCPAP) and high-flow nasal cannula (HFNC) improve the work of breathing and oxygenation .High flow nasal cannula (HFNC), also called heated humidified high flow nasal cannula (HHHFNC), is a new non-invasive ventilation therapy that seems to be well tolerated in infants with hypoxemic respiratory failure. Aim To compare the effectiveness and the outcome of Heated Humidified High Flow Nasal Cannula (HFNC) versus Nasal Continuous Positive Airway Pressure (NCPAP), as a primary mode of respiratory support, in patients with respiratory failure due to pneumonia or bronchiolitis at PICU regarding demographic data, length of admission, increasing of positive pressure and need of intubation. Patients and Methods observational study was conducted on 40 patients with acute respiratory failure due to either bronchiolitis or community acquired pneumonia (CAP), admitted to Paediatric ICU, Children Hospital, Ain Shams University, in the time period between February 2018 to July 2019. The patients, aged between 1 month to 5 years, were subjected to detailed clinical history and examination.All patients received continuous monitoring of electrocardiograph ,pulse oximetry and respiratory rate .The patients were treated either with (HFNC) Humidified high flow nasal cannula or continuous positive airway pressure (CPAP). Studied groups were compared regarding demographic data, increasing in respiratory support ,need of intubation, fate and length of admission during PICU stay. Results HFNC was as efficient as CPAP in lowering RR(respiratory rate) and HR(heart rate) in infants with bronchiolitis and community acquired pneumonia. Thus HFNC group was as significant as NCPAP group in treatment of bronchiolitis and CAP regarding length of admission ,increasing of positive pressure and need of iintubation in PICU . Conclusion This study concluded that HFNC is as efficient as nCPAP for initial respiratory support in young infants, hospitalized in a PICU for moderate to severe acute respiratory failure.

scholarly journals The Effect of the Treatment with Heated Humidified High-Flow Nasal Cannula on Neonatal Respiratory Distress Syndrome in China: A Single-Center Experience

2017 ◽  
Vol 2017 ◽  
pp. 1-6 ◽  
Author(s):  
Ge Zheng ◽  
Xiao-qiu Huang ◽  
Hui-hui Zhao ◽  
Guo-Xing Jin ◽  
Bin Wang
Keyword(s):  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Airway Pressure ◽  
Distress Syndrome ◽  
Positive Airway Pressure ◽  
High Flow ◽  
Nasal Cannula ◽  
Respiratory Support ◽  
High Flow Nasal Cannula ◽  
Neonatal Respiratory Distress

Background. Noninvasive respiratory support is considered the optimal method of providing assistance to preterm babies with breathing problems, including nasal continuous positive airway pressure (NCPAP) and humidified high flow nasal cannula (HHHFNC). The evidence of the efficacy and safety of HHHFNC used as the primary respiratory support for respiratory distress syndrome (RDS) is insufficient in low- and middle-income countries. Objective. To investigate the effect of heated humidified high flow nasal cannula on neonatal respiratory distress syndrome compared with nasal continuous positive airway pressure. Methods. An observational cross-sectional study was performed at a tertiary neonatal intensive care unit in suburban Wenzhou, China, in the period between January 2014 and December 2015. Results. A total of 128 infants were enrolled in the study: 65 in the HHHFNC group and 63 in the NCPAP group. The respiratory support with HHHFNC was similar to that with NCPAP with regard to the primary outcome. There is no significant difference between two groups in secondary outcomes. Comparing with NCPAP group, the incidence of nasal damage was lower in HHHFNC group. Conclusions. HHHFNC is an effective and well-tolerated strategy as the primary treatment of mild to moderate RDS in preterm infants older than 28 weeks of GA.

scholarly journals P162 Heated humidified high flow nasal cannula versus continuous positive airway pressure therapy for obstructive sleep apnoea in children: the patients’ perspective

2021 ◽  
Vol 2 (Supplement_1) ◽  
pp. A74-A74
Author(s):  
M Wong ◽  
E Taylor ◽  
R Longland ◽  
M Leclerc ◽  
G Williams ◽  
...  
Keyword(s):  
Continuous Positive Airway Pressure ◽  
Obstructive Sleep Apnoea ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Sleep Apnoea ◽  
High Flow ◽  
Nasal Cannula ◽  
Comfort Level ◽  
High Flow Nasal Cannula ◽  
Obstructive Sleep

Abstract Introduction Approximately 30% of otherwise healthy children will have residual obstructive sleep apnoea (OSA) after first line therapy with adenotonsillectomy (AT) with lower success rates in children with risk factors. Continuous positive airway pressure (CPAP) is often the next treatment option and, whilst highly effective therapy, can be challenging to sustain in children. A pilot study is underway at our centre to evaluate the efficacy of heated humidified high flow nasal cannula therapy (HFNC) compared to CPAP in children with residual OSA. A secondary aim of this study is to determine which therapy (HFNC versus CPAP) the patients prefer. This abstract will report preliminary findings. Methods Children under 18 years old identified as requiring a CPAP trial for residual OSA management were invited to undergo an additional polysomnography, where they underwent a trial of HFNC overnight, which was undertaken in a similar manner to the CPAP trial. Participants and caregivers completed a questionnaire regarding comfort level following both the HFNC and CPAP titration nights. Results 11 participants (4 males) between 4 months and 15 years old have completed the study to date. Using an 11-point Likert scale, the average reported comfort level grading for HFNC was 1.5 points higher than CPAP. Discussion This preliminary data suggests that on average caregivers and participants found HFNC more comfortable than CPAP. Alternative therapies such as HFNC may be effective in managing OSA and may be better tolerated in children non-adherent to CPAP.

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