The application of an oxygen mask, without supplemental oxygen, improved oxygenation in patients with severe COVID-19 already treated with high-flow nasal cannula

Abstract Background Endoscopic retrograde cholangiopancreatography (ERCP) is an increasingly common intervention in the treatment of pancreatico-biliary disorders. Patients are often elderly with complex co-morbidities. While monitored anaesthesia care with sedation is commonly used for most cases, few would require general anaesthesia with an endotracheal tube. Both low flow and high flow nasal cannulas (HFNC) are established ways of delivering supplemental oxygen, but it is unclear whether one technique is better than the other. HFNC seems a promising tool for advanced procedures but evidence to support its application in high-risk ERCP cases is limited. The rate of oxygen desaturation during endoscopy has been reported to be as high as 11-50%, and the method of oxygen delivery for ERCP merits further study. Methods/design This is a prospective, randomised, multi-centre trial comparing the efficacy of oxygen supplementation through high flow nasal cannula versus low flow nasal cannula during ERCP, in a cohort of patients at risk of adverse respiratory events. A total of 132 patients will be recruited across three sites and randomly assigned to either the low flow or the HFNC group. The primary outcome is the proportion of patients experiencing hypoxia, defined by any event of SpO2 <90%. The secondary outcomes include parameters centred on oxygenation, requirement of airway manoeuvres, successful completion of procedure, perioperative complications, patient satisfaction, and cost analysis of the consumables. An intention-to-treat principle will be applied while analysing. Discussion The demand for ERCPs is likely to increase in the future with the aging population. Our study results may lead to improved outcomes and reduce airway related complications in patients undergoing ERCPs. The results will be presented at national and international meetings and published in per-reviewed journals.

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High-flow nasal cannula versus standard oxygen therapy assisting sedation during endoscopic retrograde cholangiopancreatography in high risk cases (OTHER): study protocol of a randomised multicentric trial

10.21203/rs.3.rs-19310/v1 ◽

2020 ◽

Author(s):

Venkatesan Thiruvenkatarajan ◽

Ashok Dharmalingam ◽

Gilberto Arenas ◽

Medhat Wahba ◽

Reinhard Steiner ◽

...

Keyword(s):

High Risk ◽

Endoscopic Retrograde Cholangiopancreatography ◽

Perioperative Complications ◽

Supplemental Oxygen ◽

High Flow ◽

Nasal Cannula ◽

Low Flow ◽

High Flow Nasal Cannula ◽

Endoscopic Retrograde ◽

Study Results

Abstract Background Endoscopic retrograde cholangiopancreatography (ERCP) is an increasingly common intervention in the treatment of pancreatico-biliary disorders. Patients are often elderly with complex co-morbidities. While monitored anaesthesia care with sedation is commonly used for most cases, few would require general anaesthesia with an endotracheal tube. Both low flow and high flow nasal cannulas (HFNC) are established ways of delivering supplemental oxygen, but it is unclear whether one technique is better than the other. HFNC seems a promising tool for advanced procedures but evidence to support its application in high-risk ERCP cases is limited. The rate of oxygen desaturation during endoscopy has been reported to be as high as 11-50%, and the method of oxygen delivery for ERCP merits further study.Methods/design This is a prospective, randomised, multi-centre trial comparing the efficacy of oxygen supplementation through high flow nasal cannula versus low flow nasal cannula during ERCP, in a cohort of patients at risk of adverse respiratory events. A total of 132 patients will be recruited across three sites and randomly assigned to either the low flow or the HFNC group. The primary outcome is the proportion of patients experiencing hypoxia, defined by any event of SpO2 <90%. The secondary outcomes include parameters centred on oxygenation, requirement of airway manoeuvres, successful completion of procedure, perioperative complications, patient satisfaction, and cost analysis of the consumables. An intention-to-treat principle will be applied while analysing.Discussion The demand for ERCPs is likely to increase in the future with the aging population. Our study results may lead to improved outcomes and reduce airway related complications in patients undergoing ERCPs. The results will be presented at national and international meetings and published in per-reviewed journals.Trial registration: www.ANZCTR.org.au CTRN12619000397112, Registered on on March 12, 2019.

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Clinical Progress Note: High Flow Nasal Cannula Therapy for Bronchiolitis Outside the ICU in Infants

Journal of Hospital Medicine ◽

10.12788/jhm.3328 ◽

2019 ◽

Vol 15 (01) ◽

pp. 49-50 ◽

Cited By ~ 1

Author(s):

Laura Piper ◽

Erika L Stalets ◽

Angela M Statile

Keyword(s):

The United States ◽

Supplemental Oxygen ◽

High Flow ◽

Nasal Cannula ◽

High Flow Nasal Cannula ◽

Flow Rates ◽

Common Indication ◽

Heated Air ◽

Inpatient Settings ◽

Infant Hospitalization

Viral bronchiolitis is the most common indication for infant hospitalization in the United States.1 The treatment mainstay remains supportive care, including supplemental oxygen when indicated.1 High flow nasal cannula (HFNC) therapy delivers humidified, heated air blended with oxygen, allowing much higher flow rates than standard nasal cannula therapy and is being used more frequently in inpatient settings.

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Pneumomediastinum in a patient with COVID-19 due to diffuse alveolar damage

BMJ Case Reports ◽

10.1136/bcr-2021-242527 ◽

2021 ◽

Vol 14 (5) ◽

pp. e242527

Author(s):

Frank Heijboer ◽

Laurien Oswald ◽

Sander Cretier ◽

Gert-Jan Braunstahl

Keyword(s):

Diffuse Alveolar Damage ◽

Supplemental Oxygen ◽

High Flow ◽

Nasal Cannula ◽

Positive End Expiratory Pressure ◽

High Flow Nasal Cannula ◽

Progressive Dyspnoea

A 74-year-old man with COVID-19 was admitted and experienced progressive dyspnoea while receiving supplemental oxygen via high-flow nasal cannula (HFNC). A CT of the thorax showed a pneumomediastinum. The HFNC was temporally interrupted, since it was uncertain whether the positive end-expiratory pressure of the HFNC could be the cause of the pneumomediastinum. After restart of the HFNC, there was no increase of symptoms. We suggest that the pneumomediastinum was the result of COVID-19-related alveolar damage, and not due to the use of HFNC. This observation is relevant since HFNC is often used in the treatment of severe COVID-19 pneumonia.

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Nasal Cannula, CPAP, and High-Flow Nasal Cannula: Effect of Flow on Temperature, Humidity, Pressure, and Resistance

Biomedical Instrumentation & Technology ◽

10.2345/0899-8205-45.1.69 ◽

2011 ◽

Vol 45 (1) ◽

pp. 69-74 ◽

Cited By ~ 29

Author(s):

Gordon Y. Chang ◽

Cynthia A. Cox ◽

Thomas H. Shaffer

Keyword(s):

Positive Airway Pressure ◽

Work Of Breathing ◽

Supplemental Oxygen ◽

High Flow ◽

Nasal Cannula ◽

In Vivo Studies ◽

High Flow Nasal Cannula ◽

Potential Benefits ◽

Flow Pressure

Abstract Background: Delivery of warm, humidified, supplemental oxygen via high-flow nasal cannula has several potential benefits; however, the high-flow range may not maintain humidification and temperature and in some cases may cause excessive expiratory pressure loading. Objective: To compare the effect of flow on temperature, humidity, pressure, and resistance in nasal cannula (NC), continuous positive airway pressure (CPAP), and high-flow nasal cannula (HFNC) in a clinical setting. Methods: The three delivery systems were tested in the nursery using each instrument's recommended specifications and flow ranges (0–3 L/min and 0–8 L/min). Flow, pressure, temperature, and humidity were measured, and resistance was calculated. Results: For all devices at 0–3 L/min, there was a difference (p<0.01) in temperature (NC 35.9°C > CPAP 34.5°C > HFNC 34.0°C), humidity (HFNC 82% > CPAP 77% > NC 57%), pressure (HFNC 22 cmH2O > NC 4 cmH2O > CPAP 3 cmH2O), and resistance (HFNC 636 cmH2O/L/sec > NC 270 cmH2O/L/sec > CPAP 93 cmH2O/L/sec) as a function of flow. For HFNC and CPAP at 0–8 L/min, there was a difference (p<0.01) in temperature (CPAP 34.5°C > HFNC 34.0°C) in humidity (HFNC 83 % > CPAP 76 %), pressure (HFNC 56 cmH2O > CPAP 14 cmH2O) and resistance (HFNC 783 cmH2O/L/sec > CPAP 280 cmH2O/L/sec) as a function of flow. Conclusions: Gas delivered by HFNC was more humid than NC and CPAP. However, the higher pressure and resistance delivered by the HFNC system may have clinical relevance, such as increased work of breathing, and warrants further in vivo studies.

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Effectiveness of high-flow nasal cannula during exercise training in subjects with chronic respiratory failure

10.21203/rs.3.rs-55544/v2 ◽

2020 ◽

Author(s):

Yuichi Chihara ◽

Tomomasa Tsuboi ◽

Kensuke Sumi ◽

Atsuo Sato

Keyword(s):

Respiratory Failure ◽

Exercise Training ◽

Supplemental Oxygen ◽

Constant Load ◽

High Flow ◽

Nasal Cannula ◽

Walking Distance ◽

High Flow Nasal Cannula ◽

Flow Through ◽

Oxygen Group

Abstract Backgrounds: There are no clinical data comparing the effect of exercise training using high fraction of inspired oxygen (FIO2) in combination with high flow through a high-flow nasal cannula (HFNC) with that of ordinary supplemental oxygen on exercise capacity in subjects with chronic respiratory failure (CRF) receiving long-term oxygen therapy (LTOT). The aim of this study was to compare the effect of 4 weeks of exercise training using high FIO2 in combination with high flow through an HFNC or supplemental oxygen via a nasal cannula on the 6-min walking distance of patients with CRF receiving LTOT.Methods: In this randomized study, 32 patients with CRF due to chronic obstructive pulmonary disease, interstitial pulmonary fibrosis, or bronchiectasis receiving LTOT were assigned to undergo 4 weeks of exercise training on a cycle ergometer using an HFNC (flow: 50 L/min) with a FIO2 of 1.0 (HFNC group; n=16) or ordinary supplemental oxygen via a nasal cannula (flow: 6 L/min) (oxygen group; n=16). Before and after 4 weeks of exercise training, a 6-min walking test, constant-load test, and blood sampling were performed.Results: Prior to exercise training, the endurance time of the constant-load exercise test using an HFNC was significantly longer than that reported with prescribed oxygen in daily LTOT (p=0.004) or a 6 L/min nasal cannula (p=0.0003). Following 4 weeks of exercise training, change in the 6-min walking distance was significantly greater in the HFNC versus the oxygen group (55.2±69.6 m vs. —0.5±87.3 m, respectively; p=0.04). The plasma levels of adrenaline, noradrenaline, and serum C-reactive protein were significantly decreased only in the HFNC group, after 4 weeks of exercise training.Conclusions: Despite heterogeneity in the effect among patients, exercise training using high FIO2 in combination with high flow through an HFNC is a potentially superior exercise training modality for CRF patients receiving LTOT.Clinical Trial Registration ― http://www.clinicaltrials.gov. Unique identifier:　NCT02804243. Registered 13 June 2016.

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Effectiveness of High-Flow Nasal Cannula on Pulmonary Rehabilitation in Subjects with Chronic Respiratory Failure

10.21203/rs.3.rs-55544/v1 ◽

2020 ◽

Author(s):

Yuichi Chihara ◽

Tomomasa Tsuboi ◽

Kensuke Sumi ◽

Atsuo Sato

Keyword(s):

Respiratory Failure ◽

Exercise Training ◽

Supplemental Oxygen ◽

Constant Load ◽

High Flow ◽

Nasal Cannula ◽

Chronic Respiratory Failure ◽

High Flow Nasal Cannula ◽

Flow Through ◽

Oxygen Group

Abstract Backgrounds: There are no clinical data comparing the effect of exercise training using both high fraction of inspired oxygen (FIO2) and high flow through a high-flow nasal cannula (HFNC) with that of ordinary supplemental oxygen on exercise capacity in subjects with chronic respiratory failure (CRF) receiving long-term oxygen therapy (LTOT). Methods: In this randomized study, 32 patients with CRF receiving LTOT were assigned to undergo 4 weeks of exercise training on a cycle ergometer using an HFNC (flow: 50 L/min) with a FIO2 of 1.0 (HFNC group; n=16) or ordinary supplemental oxygen via a nasal cannula (flow: 6 L/min) (oxygen group; n=16). Before and after 4 weeks of exercise training, a 6-min walking test, constant-load test, and blood sampling were performed. Results: Prior to exercise training, the endurance time of the constant-load exercise test using an HFNC was significantly longer than that reported with prescribed oxygen in daily LTOT (p=0.004) or a 6 L/min nasal cannula (p=0.0003). Following 4 weeks of exercise training, change in the 6-min walking distance was significantly greater in the HFNC versus the oxygen group (55.2±69.6 m vs. —0.5±87.3 m, respectively; p=0.04). The plasma levels of adrenaline, noradrenaline, and serum C-reactive protein were significantly decreased only in the HFNC group, after 4 weeks of exercise training. Conclusions: Despite heterogeneity in the effect among patients, exercise training using both high FIO2 and high flow through an HFNC is a potentially superior exercise training modality for CRF patients receiving LTOT.Clinical Trial Registration ― http://www.clinicaltrials.gov. Unique identifier:　NCT02804243. Registered 13 June 2016.

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