Nasal high-flow oxygen in patients with hypoxic respiratory failure: effect on functional and subjective respiratory parameters compared to conventional oxygen therapy and noninvasive ventilation

The objective: to evaluate the effect of high-flow oxygen and non-invasive ventilation on the mortality rate in adults with severe respiratory failure caused by the new coronavirus infection in the intensive care unit (ICU).Subjects and methods. A one-center retrospective study was conducted. Electronic medical files of patients treated in the ICU from April 1 to May 25, 2020, were analyzed. Totally, 101 medical files were selected, further, they were divided into two groups. Group 1 (n = 49) included patients who received oxygen insufflation, and should it fail, they received traditional artificial ventilation. No non-invasive respiratory therapy was used in this group. Group 2 (n = 52) included patients who received high-flow oxygen therapy and non-invasive ventilation. The mortality rate in the groups made a primary endpoint for assessing the impact of high-flow oxygen therapy and non-invasive ventilation. The following parameters were also analyzed: drug therapy, the number of patients in whom non-invasive techniques were used taking into account the frequency of cases when these techniques failed, and the number of patients in whom artificial ventilation was initiated.Results. In Group 2, non-invasive methods of respiratory therapy were used in 31 (60%) cases. High-flow oxygen therapy was used in 19 (36%) of them; in 13 cases this method allowed weaning them from the high flow. Non-invasive ventilation was used in 18 cases, in 12 patients it was used due to progressing severe respiratory failure during humidified oxygen insufflation, in 6 patients – after the failed high-flow oxygen therapy. In Group 1, 25 (51%) patients were intubated and transferred to artificial ventilation, in Group 2, 10 (19.2%) underwent the same. The lethal outcome was registered in 23 (47%) cases in Group 1, and in 10 (19.2%) in Group 2 (p = 0.004). Analysis of drug therapy in the groups revealed the difference in the prescription of pathogenetic therapy. Logistic regression demonstrated the effectiveness of the combination of tocilizumab + a glucocorticoid in reducing the frequency of lethal cases (p = 0.001).Conclusion. The use of non-invasive respiratory support in adults with severe respiratory failure caused by the new coronavirus infection combined with therapy by tocilizumab + a glucocorticoid can reduce the incidence of lethal cases.

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High flow nasal cannula oxygen therapy in adults with COVID-19 respiratory failure. A case report

Monaldi Archives for Chest Disease ◽

10.4081/monaldi.2020.1323 ◽

2020 ◽

Vol 90 (2) ◽

Cited By ~ 1

Author(s):

Vasileios Karamouzos ◽

Fotini Fligou ◽

Charalambos Gogos ◽

Dimitrios Velissaris

Keyword(s):

Respiratory Failure ◽

Oxygen Therapy ◽

Virus Disease ◽

High Flow ◽

Nasal Cannula ◽

High Flow Nasal Cannula ◽

Non Invasive ◽

Corona Virus ◽

Non Invasive Ventilation ◽

Hypoxic Respiratory Failure

The novel corona virus (SARS-CoV-2) continuous to spread around the globe causing high mortality, tremendous stress on healthcare systems and an unprecedented disruption of everyday life with unpredictable socioeconomic ramifications. The diseaseis typically affecting the respiratory system and some patients will develop refractory hypoxemic respiratory insufficiency requiring mechanical ventilation. The role of non-invasive ventilation (NIV), high flow nasal cannula (HFNC) or continuous positive airway pressure devices (C-PAP) in the treatment of the 2019 corona virus disease (COVID-19) is not yet clear. We hereby report a case of a 44-year-old COVID-19 positive male patient suffering from hypoxic respiratory failure that was successfully treated with high flow nasal cannula oxygen therapy in a negative pressure intensive care room. Although specific criteria for the use of high flow nasal canula devices COVID-19 are not available at this time, clinicians could use this non-invasive modality as analternative method of respiratory support in selected patients presenting with respiratory failure.

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High Flow Oxygen in Pregnancy With Severe Acute Hypoxic Respiratory Failure Due to Community-Acquired Steptococcus Pneumoniae

CHEST Journal ◽

10.1016/j.chest.2017.08.328 ◽

2017 ◽

Vol 152 (4) ◽

pp. A302

Author(s):

Catherine Stadler ◽

Jagadish Akella

Keyword(s):

Respiratory Failure ◽

High Flow ◽

High Flow Oxygen ◽

Hypoxic Respiratory Failure ◽

In Pregnancy

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Nasal high-flow oxygen versus noninvasive ventilation in acute exacerbation of COPD: protocol for a randomised noninferiority clinical trial

ERJ Open Research ◽

10.1183/23120541.00114-2020 ◽

2020 ◽

Vol 6 (4) ◽

pp. 00114-2020

Author(s):

Athanasia Papalampidou ◽

Eleni Bibaki ◽

Stylianos Boutlas ◽

Ioannis Pantazopoulos ◽

Nikolaos Athanasiou ◽

...

Keyword(s):

Respiratory Failure ◽

Noninvasive Ventilation ◽

High Flow ◽

Line Treatment ◽

First Line ◽

Hypercapnic Respiratory Failure ◽

Acute Exacerbation Of Copd ◽

High Flow Oxygen ◽

Exacerbation Of Copd ◽

First Line Treatment

BackgroundNoninvasive ventilation (NIV) is considered as the first-line treatment for acute exacerbation of COPD (AECOPD) complicated by respiratory acidosis. Recent studies demonstrate a role of nasal high-flow oxygen (NHF) in AECOPD as an alternative treatment in patients intolerant to NIV or with contraindications to it.AimThe study aimed to evaluate whether NHF respiratory support is noninferior compared to NIV in respect to treatment failure, defined as need for intubation or change to alternative treatment group, in patients with AECOPD and mild-to-moderate acute or acute-on-chronic hypercapnic respiratory failure.MethodsWe designed a multicentre, prospective, randomised trial on patients with AECOPD, who have pH<7.35 but >7.25 and PaCO2 >45 mmHg, in whom NIV is indicated as a first-line treatment. According to power analysis, 498 participants will be required for establishing noninferiority of NHF compared to NIV. Patients will be randomly assigned to receive NIV or NHF. Treatment will be adjusted to maintain SpO2 between 88%–92% for both groups. Arterial blood gases, respiratory variables, comfort, dyspnoea score and any pulmonary or extrapulmonary complications will be assessed at baseline, before treatment initiation, and at 1, 2, 4, 6, 12, 24, 48 h, then once daily from day 3 to patient discharge, intubation or death.ConclusionGiven the increasing number of studies demonstrating the physiological effects of NHF in COPD patients, we hypothesise that NHF respiratory support will be noninferior to NIV in patients with AECOPD and mild-to-moderate acute or acute on chronic hypercapnic respiratory failure.

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