A combination of Bohr and Haldane effects provide a physiologic explanation for the increase in arterial oxygen saturation when a face mask is added to a high-flow nasal cannula in severely hypoxemic COVID-19 patients

Abstract Background Hypoxemia frequently occurs during bronchoscopy. High-flow nasal cannula (HFNC) oxygen therapy may be a feasible alternative to prevent the deterioration of gas exchange during bronchoscopy. With the convenience of clinical use in mind, we modified an HFNC using a single cannula. This clinical trial was designed to test the hypothesis that a modified HFNC would decrease the proportion of patients with a single moment of peripheral arterial oxygen saturation (SpO2) < 90% during bronchoscopy. Methods In this single-center, prospective randomized controlled trial, hospitalized patients in the respiratory department in need of diagnostic bronchoscopy were randomly assigned to a modified HFNC oxygen therapy group or a conventional oxygen therapy (COT) group. The primary outcome was the proportion of patients with a single moment of SpO2 < 90% during bronchoscopy. Results Eight hundred and twelve patients were randomized to the modified HFNC (n = 406) or COT (n = 406) group. Twenty-four patients were unable to cooperate or comply with bronchoscopy. Thus, 788 patients were included in the analysis. The proportion of patients with a single moment of SpO2 < 90% during bronchoscopy in the modified HFNC group was significantly lower than that in the COT group (12.5% vs. 28.8%, p < 0.001). There were no significant differences in the fraction of inspired oxygen between the two groups. The lowest SpO2 during bronchoscopy and 5 min after bronchoscopy in the modified HFNC group was significantly higher than that in the COT group. Multivariate analysis showed that a baseline forced vital capacity (FVC) < 2.7 L (OR, 0.276; 95% CI, 0.083–0.919, p = 0.036) and a volume of fluid instilled > 60 ml (OR, 1.034; 95% CI, 1.002–1.067, p = 0.036) were independent risk factors for hypoxemia during bronchoscopy in the modified HFNC group. Conclusions A modified HFNC could decrease the proportion of patients with a single moment of SpO2 < 90% during bronchoscopy. A lower baseline FVC and large-volume bronchoalveolar lavage may predict desaturation during bronchoscopy when using a modified HFNC. Trial registration ClinicalTrials. Gov: NCT02606188. Registered 17 November 2015.

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Comment on Treatment of carbon monoxide poisoning: high-flow nasal cannula versus non-rebreather face mask

Clinical Toxicology ◽

10.1080/15563650.2020.1862144 ◽

2021 ◽

pp. 1-2

Author(s):

Sarah Mahonski ◽

Mark K. Su

Keyword(s):

Carbon Monoxide ◽

Carbon Monoxide Poisoning ◽

Face Mask ◽

High Flow ◽

Nasal Cannula ◽

High Flow Nasal Cannula

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Comparison of arousal responses to tracheal and face mask occlusions in sleeping newborn piglets

Journal of Applied Physiology ◽

10.1152/jappl.1992.72.6.2482 ◽

1992 ◽

Vol 72 (6) ◽

pp. 2482-2486 ◽

Cited By ~ 4

Author(s):

K. J. Barrington ◽

R. G. Allen

Keyword(s):

Oxygen Saturation ◽

Potential Role ◽

Arterial Oxygen Saturation ◽

Upper Airway ◽

Face Mask ◽

Arterial Oxygen ◽

Active Sleep ◽

Quiet Sleep ◽

Tracheal Occlusion ◽

Newborn Piglets

The arousal responses after occlusion of the airway at the mid-trachea were compared with the responses after occlusion of the airway in a face mask in chronically instrumented 3- to 5-day-old piglets. For each site of occlusion arousal latency was significantly longer from active sleep than from quiet sleep. There was a significant increase in the frequency of early arousals after face mask occlusions compared with tracheal occlusions in both sleep states. During quiet sleep the frequency of arousal by 1 s after occlusion was 0.55 with face mask occlusions compared with 0.28 with tracheal occlusion (P less than 0.01). During active sleep the frequency of arousal by 3 s after a face mask occlusion was 0.32 compared with 0.08 after tracheal occlusion (P less than 0.05). Arousal from quiet sleep occurred before changes in arterial oxygen saturation. During active sleep mean saturation at arousal was not different between face mask and tracheal occlusions. Exposure of the upper airway to the pressures generated during airway occlusions results in earlier arousal in both quiet and active sleep, indicating a potential role for upper airway mechanoreceptors in initiating arousal in the newborn piglet.

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Is aerosol delivery by high‐flow nasal cannula in children an effective alternative to face mask aerosol nebulization?

Pediatric Pulmonology ◽

10.1002/ppul.24480 ◽

2019 ◽

Vol 54 (12) ◽

pp. 1873-1874 ◽

Cited By ~ 1

Author(s):

Sajith Kesavan ◽

Israel Amirav

Keyword(s):

Face Mask ◽

High Flow ◽

Nasal Cannula ◽

Effective Alternative ◽

Aerosol Delivery ◽

High Flow Nasal Cannula

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High Flow Nasal Cannula Oxygenation

JMS SKIMS ◽

10.33883/jms.v23i3.784 ◽

2020 ◽

Vol 23 (3) ◽

Author(s):

Tajamul Hussain Shah ◽

Suhail Mantoo ◽

Rafi Ahmad Jan

Keyword(s):

Face Mask ◽

High Flow ◽

Nasal Cannula ◽

Respiratory Support ◽

Low Flow ◽

Invasive Ventilation ◽

High Flow Nasal Cannula ◽

Non Invasive ◽

Non Invasive Ventilation ◽

Flow Devices

High Flow Nasal Cannula Oxygenation The current pandemic of COVID-19 caused by novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) tested the healthcare infrastructure throughout the globe at all possible levels. Early reports suggest about 20% of patients infected with SARS-CoV-2 require hospitalization and 5-8% require admission to intensive care unit (ICU) due to severe disease.Supplementation of oxygen provided by various conventional oxygen therapy (COT) devices (like nasal prongs, face mask, venture mask or non-rebreather mask) may not be sufficient in cases of worsening respiratory failure. One form of escalating respiratory support in such patients is a high flow nasal oxygenation device. High flow nasal cannula oxygenation (HFNC) is a form of non invasive respiratory support. It acts as a bridge between low flow devices and non invasive ventilation and may reduce the need for intubation.

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Hemoptysis due to a large endobronchial mass successful regression after the use of high flow nasal cannula

Monaldi Archives for Chest Disease ◽

10.4081/monaldi.2020.1321 ◽

2020 ◽

Vol 90 (3) ◽

Author(s):

Paola Pierucci ◽

Nicolino Ambrosino ◽

Annalisa Carlucci ◽

Salvatore Grasso ◽

Giovanna Elisiana Carpagnano ◽

...

Keyword(s):

Respiratory Failure ◽

Oxygen Saturation ◽

Main Bronchus ◽

Large Mass ◽

High Flow ◽

Nasal Cannula ◽

High Flow Nasal Cannula ◽

High Flow Oxygen ◽

The Right ◽

Positive Results

In recent years, high flow nasal cannula is being increasingly used. Most studies showed positive results when used in hypoxaemic respiratory failure. Its use in a patient with a large endobronchial mass has not yet being described. We report a patient who presented with hemoptysis and hypoxaemic respiratory failure second to a large mass obstructing the right main bronchus. High flow oxygen via nasal cannula was initiated with a quick improvement of the hemoptysis and the oxygen saturation. Thus, allowing the patient to be rapidly stabilized.

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High flow nasal cannula oxygenation in COVID-19 related acute respiratory distress syndrome: a safe way to avoid endotracheal intubation?

Therapeutic Advances in Respiratory Disease ◽

10.1177/17534666211019555 ◽

2021 ◽

Vol 15 ◽

pp. 175346662110195

Author(s):

Agathe Delbove ◽

Ambroise Foubert ◽

François Mateos ◽

Tiphaine Guy ◽

Marie Gousseff

Keyword(s):

Acute Respiratory Distress Syndrome ◽

Hospital Mortality ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Healthcare Workers ◽

Distress Syndrome ◽

High Flow ◽

Nasal Cannula ◽

Arterial Oxygen ◽

High Flow Nasal Cannula

Backgrounds: High flow nasal cannula (HFNC) is an alternative therapy for acute respiratory distress syndrome (ARDS) due to coronavirus disease 2019 (COVID-19). This study aimed first to describe outcomes of patients suffering from COVID-19-related ARDS treated with HFNC; secondly to evaluate safety of HFNC (patients and healthcare workers) and compare patients according to respiratory outcome. Methods: A retrospective cohort was conducted in French general hospital intensive care unit (ICU). Patients were included if receiving HFNC for hypoxemia (saturation pulse oxygen (SpO2) <92% under oxygen ⩾6 L/min) associated with ARDS and positive SARS-CoV-2 polymerase chain reaction (PCR). Main clinical characteristics and outcomes are described in patients: (a) with do not intubate order (HFNC-DNIO); (b) who did not need intubation (HFNC-only); and (c) eventually intubated (HFNC-intubation). Medians are presented with (1st–3rd) interquartile range. Results: From 26 February to 30 June 2020, 46 patients of median age 75 (70–79) years were included. In the HFNC-DNIO group ( n = 11), partial arterial oxygen pressure (PaO2)/inhaled fraction of oxygen (FiO2) ratio median worst PaO2/FiO2 ratio was 109 (102–172) and hospital mortality was 54.5%. Except the HFNC-DNIO patients ( n = 35), 20 patients (57%) were eventually intubated (HFNC-intubation group) and 15 were only treated by HFNC (HFNC-only). HFNC-intubation patients presented higher worst respiratory rates per minute in ICU [37 (34–41) versus 33 (24–34) min, p < 0.05] and worsened ICU admission PaO2/FiO2 ratios [121 (103–169) versus 191 (162–219), p < 0.001] compared with HFNC-only patients. Hospital mortality was 35% ( n = 7/20) in HFNC-intubation group, 0% in HFNC-only group with a global mortality of these two groups of 20% ( n = 7/35). Among tests performed in healthcare workers, 1/12 PCR in symptomatic healthcare workers and 1.8% serologies in asymptomatic healthcare workers were positive. After review of each case, COVID-19 was likely to be acquired outside hospital. Conclusions: HFNC seems to be useful for COVID-19-related ARDS and safe for healthcare workers. ARDS severity with PaO2/FiO2 <150 associated with respiratory rate >35/min could be regarded as a predictor of intubation. The reviews of this paper are available via the supplemental material section.

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