High-flow oxygen therapy through nasal cannulae versus low-flow oxygen therapy via Venturi mask after extubation in adult, critically ill patients

Abstract Background Impaired immune response has been described to be the cause of the development of COVID-19 related respiratory failure. Further studies are needed to understand the immunopathogenesis and to enable an improved stratification of patients that are at risk for critical illness. Methods 32 severely ill hospitalized COVID19 patients were recruited in our center at the University Hospital Heidelberg. We performed a comprehensive analysis of immune phenotype, cytokine and chemokine profiling and leukocyte transcripts in severe COVID-19 patients comparing critically ill patients requiring mechanical ventilation and high flow oxygen therapy and non-critically ill patient receiving low flow oxygen therapy. Results Critically ill patients exhibited low levels of CD8 T cells and myeloid dendritic cells. We noted a pronounced CCR6 + TH17 phenotype in CD4 central memory cells and elevated circulating levels of IL-17 in the critical group. Gene expression of leukocytes derived from critically ill patients was characterized by an upregulation of proinflammatory cytokines and reduction of IFN-responsive genes upon stimulation with toll-like receptor 7/8 agonist. When correlating clinical improvement and immune kinetics, we found that CD8 T cell subsets and myeloid dendritic cells significantly increased after disconnection from the ventilator. Conclusion Critical illness was characterized by a TH17-mediated response and dysfunctional IFN-associated response, indicating an impaired capacity to mount antiviral responses during SARS-CoV-2 severe infection.

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Main Topic Related with Humidification: Discomfort Associated with Underhumidified High-Flow Oxygen Therapy in Critically Ill Patients

Humidification in the Intensive Care Unit ◽

10.1007/978-3-642-02974-5_8 ◽

2011 ◽

pp. 67-71

Author(s):

Gerald Chanques ◽

Samir Jaber

Keyword(s):

Critically Ill ◽

Critically Ill Patients ◽

Oxygen Therapy ◽

High Flow ◽

Main Topic ◽

High Flow Oxygen

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Applications of Nasal High-Flow Oxygen Therapy in Critically ill Adult Patients

Lung ◽

10.1007/s00408-016-9885-0 ◽

2016 ◽

Vol 194 (5) ◽

pp. 705-714 ◽

Cited By ~ 2

Author(s):

Jahan Porhomayon ◽

Ali A. El-Solh ◽

Leili Pourafkari ◽

Philippe Jaoude ◽

Nader D. Nader

Keyword(s):

Critically Ill ◽

Oxygen Therapy ◽

High Flow ◽

Adult Patients ◽

High Flow Oxygen

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Prone positioning of patients with moderate hypoxia due to COVID-19: A multicenter pragmatic randomized trial [COVID-PRONE]

10.1101/2021.11.05.21264590 ◽

2021 ◽

Author(s):

Mike Fralick ◽

Michael Colacci ◽

Laveena Munshi ◽

Kevin Venus ◽

Lee Fidler ◽

...

Keyword(s):

Respiratory Failure ◽

Critically Ill ◽

Median Time ◽

Critically Ill Patients ◽

Primary Outcome ◽

Standard Of Care ◽

High Flow ◽

Hospital Death ◽

Prone Positioning ◽

High Flow Oxygen

What is already known on this topic: Prone positioning is considered standard of care for mechanically ventilated patients who have severe acute respiratory distress syndrome. Recent data suggest prone positioning is beneficial for patients with COVID-19 who are requiring high flow oxygen. It is unknown of prone positioning is beneficial for patients not on high flow oxygen. What this study adds: Prone positioning is generally not well tolerated and innovative approaches are needed to improve adherence. Clinical and physiologic outcomes were not improved with prone positioning among hypoxic but not critically ill patients hospitalized with COVID-19. Objectives: To assess the effectiveness of prone positioning to reduce the risk of death or respiratory failure in non-critically ill patients hospitalized with COVID-19 Design: Pragmatic randomized clinical trial of prone positioning of patients hospitalized with COVID-19 across 15 hospitals in Canada and the United States from May 2020 until May 2021. Settings: Patients were eligible is they had a laboratory-confirmed or a clinically highly suspected diagnosis of COVID-19, required supplemental oxygen (up to 50% fraction of inspired oxygen [FiO2]), and were able to independently prone with verbal instruction. (NCT04383613). Main Outcome Measures: The primary outcome was a composite of in-hospital death, mechanical ventilation, or worsening respiratory failure defined as requiring at least 60% FiO2 for at least 24 hours. Secondary outcomes included the change in the ratio of oxygen saturation to FiO2 (S/F ratio). Results: A total of 248 patients were included. The trial was stopped early on the basis of futility for the pre-specified primary outcome. The median time from hospital admission until randomization was 1 day, the median age of patients was 56 years (interquartile range [IQR] 45,65), 36% were female, and 90% of patients were receiving oxygen via nasal prongs at the time of randomization. The median time spent prone in the first 72 hours was 6 hours total (IQR 1.5,12.8) for the prone arm compared to 0 hours (0,2) in the control arm. The risk of the primary outcome was similar between the prone group (18 [14.3%] events) and the standard care group (17 [13.9%] events), odds ratio 0.92 (95% CI 0.44 to 1.92). The change in the S/F ratio after 72 hours was similar for patients randomized to prone compared to standard of care. Conclusion: Among hypoxic but not critically patients with COVID-19 in hospital, a multifaceted intervention to increase prone positioning did not improve outcomes. Adherence to prone positioning was poor, despite multiple efforts. Subsequent trials of prone positioning should aim to develop strategies to improve adherence to awake prone positioning.

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Electromyographic swallowing study during high flow oxygen therapy compared with low flow oxygen therapy in post-extubated patients

10.1183/13993003.congress-2019.pa4021 ◽

2019 ◽

Author(s):

Sarita Thawanaphong ◽

Wasuwat Kitisomprayoonkul ◽

Kannit Pongpipatpaiboon ◽

Napplika Kongpolprom

Keyword(s):

Oxygen Therapy ◽

High Flow ◽

Low Flow ◽

High Flow Oxygen

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High flow conditioned oxygen therapy for prevention of reintubation in critically ill patients at high risk for extubation failure: a multicenter randomised controlled trial

Intensive Care Medicine Experimental ◽

10.1186/2197-425x-3-s1-a823 ◽

2015 ◽

Vol 3 (S1) ◽

Author(s):

G Hernandez ◽

C Vaquero ◽

P Gonzalez ◽

L Colinas ◽

S Garcia ◽

...

Keyword(s):

High Risk ◽

Randomised Controlled Trial ◽

Critically Ill ◽

Critically Ill Patients ◽

Oxygen Therapy ◽

Controlled Trial ◽

Extubation Failure ◽

High Flow ◽

Randomised Controlled

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Safety and clinical outcomes of remdesivir in hospitalised COVID-19 patients: a retrospective analysis of active surveillance database

BMC Infectious Diseases ◽

10.1186/s12879-021-07004-8 ◽

2022 ◽

Vol 22 (1) ◽

Author(s):

Vaishali Gupte ◽

Rashmi Hegde ◽

Sandesh Sawant ◽

Kabil Kalathingal ◽

Sonali Jadhav ◽

...

Keyword(s):

Mechanical Ventilation ◽

Retrospective Analysis ◽

Clinical Outcomes ◽

Oxygen Therapy ◽

High Flow ◽

Low Flow ◽

Invasive Ventilation ◽

Non Invasive ◽

Non Invasive Ventilation ◽

High Flow Oxygen

Abstract Background Real-world data on safety and clinical outcomes of remdesivir in COVID-19 management is scant. We present findings of data analysis conducted for assessing the safety and clinical outcomes of remdesivir treatment for COVID-19 in India. Methods This retrospective analysis used data from an active surveillance programme database of hospitalised patients with COVID-19 who were receiving remdesivir. Results Of the 2329 patients included, 67.40% were men. Diabetes (29.69%) and hypertension (20.33%) were the most common comorbidities. At remdesivir initiation, 2272 (97.55%) patients were receiving oxygen therapy. Remdesivir was administered for 5 days in 65.38% of patients. Antibiotics (64.90%) and steroids (47.90%) were the most common concomitant medications. Remdesivir was overall well tolerated, and total 119 adverse events were reported; most common were nausea and vomiting in 45.40% and increased liver enzymes in 14.28% patients. 84% of patients were cured/improved, 6.77% died and 9.16% showed no improvement in their clinical status at data collection. Subgroup analyses showed that the mortality rate was significantly lower in patients < 60 years old than in those > 60 years old. Amongst patients on oxygen therapy, the cure/improvement rate was significantly higher in those receiving standard low-flow oxygen than in those receiving mechanical ventilation, non-invasive ventilation, or high-flow oxygen. Factors that were associated with higher mortality were age > 60 years, cardiac disease, diabetes high flow oxygen, non-invasive ventilation and mechanical ventilation. Conclusion Our analysis showed that remdesivir is well tolerated and has an acceptable safety profile. The clinical outcome of cure/improvement was 84%, with a higher improvement in patients < 60 years old and on standard low-flow oxygen.

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