scholarly journals Predictors of successful separation from high-flow nasal oxygen therapy in patients with acute respiratory failure: a retrospective monocenter study

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Maeva Rodriguez ◽  
Arnaud W. Thille ◽  
Florence Boissier ◽  
Anne Veinstein ◽  
Delphine Chatellier ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Respiratory Rate ◽  
Oxygen Therapy ◽  
Preventive Treatment ◽  
High Flow ◽  
Multicenter Studies ◽  
First Line Therapy ◽  
Successful Separation ◽  
Fraction Of Inspired Oxygen

Abstract Background High-flow nasal oxygen therapy (HFOT) is a promising first-line therapy for acute respiratory failure. However, its weaning has never been investigated and could lead to unnecessary prolonged intensive-care unit (ICU) stay. The aim of this study is to assess predictors of successful separation from HFOT in critically ill patients. We performed a retrospective monocenter observational study over a 2-year period including all patients treated with HFOT for acute respiratory failure in the ICU. Those who died or were intubated without prior HFOT separation attempt, who were treated with non-invasive ventilation at the time of HFOT separation, or who received HFOT as a preventive treatment during the post-extubation period were excluded. Results From the 190 patients analyzed, 168 (88%) were successfully separated from HFOT at the first attempt. Patients who failed separation from HFOT at the first attempt had longer ICU length of stay than those who succeeded: 10 days (7–12) vs. 5 (4–8), p < 0.0001. Fraction of inspired oxygen (FiO2) ≤ 40% and a respiratory rate-oxygenation (ROX) index (calculated as the ratio of SpO2/FiO2 to the respiratory rate) ≥ 9.2 predicted successful separation from HFOT with sensitivity of 85% and 84%, respectively. Conclusions FiO2 ≤ 40% and ROX index ≥ 9.2 were two predictors of successful separation from HFOT at the bedside. Prospective multicenter studies are needed to confirm these results.

scholarly journals Comparison of high-flow nasal oxygen therapy and non-invasive ventilation in ICU patients with acute respiratory failure and a do-not-intubate orders: a multicentre prospective study OXYPAL

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e045659
Author(s):  
René Robert ◽  
Denis Frasca ◽  
Julie Badin ◽  
C Girault ◽  
Christophe Guitton ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Oxygen Therapy ◽  
High Flow ◽  
Invasive Ventilation ◽  
Clinical Practices ◽  
Icu Patients ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
Registration Number

IntroductionA palliative approach to intensive care unit (ICU) patients with acute respiratory failure and a do-not-intubate order corresponds to a poorly evaluated target for non-invasive oxygenation treatments. Survival alone should not be the only target; it also matters to avoid discomfort and to restore the patient’s quality of life. We aim to conduct a prospective multicentre observational study to analyse clinical practices and their impact on outcomes of palliative high-flow nasal oxygen therapy (HFOT) and non-invasive ventilation (NIV) in ICU patients with do-not-intubate orders.Methods and analysisThis is an investigator-initiated, multicentre prospective observational cohort study comparing the three following strategies of oxygenation: HFOT alone, NIV alternating with HFOT and NIV alternating with standard oxygen in patients admitted in the ICU for acute respiratory failure with a do-not-intubate order. The primary outcome is the hospital survival within 14 days after ICU admission in patients weaned from NIV and HFOT. The sample size was estimated at a minimum of 330 patients divided into three groups according to the oxygenation strategy applied. The analysis takes into account confounding factors by modelling a propensity score.Ethics and disseminationThe study has been approved by the ethics committee and patients will be included after informed consent. The results will be submitted for publication in peer-reviewed journals.Trial registration numberNCT03673631

High‐flow nasal cannula oxygen therapy for acute respiratory failure in a non‐intensive geriatric setting

2018 ◽  
Vol 18 (12) ◽  
pp. 1652-1653 ◽  
Author(s):  
Filippo Luca Fimognari ◽  
Massimo Rizzo ◽  
Olga Cuccurullo ◽  
Giovanna Cristiano ◽  
Roberto Ricchio ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Oxygen Therapy ◽  
High Flow ◽  
Nasal Cannula ◽  
High Flow Nasal Cannula

Predictors of Failure of Noninvasive Ventilation in Critically Ill Children

2021 ◽  
Author(s):  
Alyson K. Baker ◽  
Andrew L. Beardsley ◽  
Brian D. Leland ◽  
Elizabeth A. Moser ◽  
Riad L. Lutfi ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Respiratory Rate ◽  
Noninvasive Ventilation ◽  
Pediatric Intensive Care ◽  
Critically Ill Children ◽  
Clinical Predictors ◽  
Failure Group ◽  
Logistic Organ Dysfunction ◽  
Fraction Of Inspired Oxygen

AbstractNoninvasive ventilation (NIV) is a common modality employed to treat acute respiratory failure. Most data guiding its use is extrapolated from adult studies. We sought to identify clinical predictors associated with failure of NIV, defined as requiring intubation. This single-center retrospective observational study included children admitted to pediatric intensive care unit (PICU) between July 2014 and June 2016 treated with NIV, excluding postextubation. A total of 148 patients was included. Twenty-seven (18%) failed NIV. There was no difference between the two groups with regard to age, gender, comorbidities, or etiology of acute respiratory failure. Those that failed had higher admission pediatric risk of mortality (p = 0.01) and pediatric logistic organ dysfunction (p = 0.002) scores and higher fraction of inspired oxygen (FiO2; p = 0.009) at NIV initiation. Failure was associated with lack of improvement in tachypnea. At 6 hours of NIV, the failure group had worsening tachypnea with a median increase in respiratory rate of 8%, while the success group had a median reduction of 18% (p = 0.06). Multivariable Cox's proportional hazard models revealed FiO2 at initiation and worsening respiratory rate at 1- and 6-hour significant risks for failure of NIV. Failure was associated with a significantly longer PICU length of stay (success [2.8 days interquartile range (IQR): 1.7, 5.5] vs. failure [10.6 days IQR: 5.6, 13.2], p < 0.001). NIV can be successfully employed to treat acute respiratory failure in pediatric patients. There should be heightened concern for NIV failure in hypoxemic patients whose tachypnea is unresponsive to NIV. A trend toward improvement should be closely monitored.

scholarly journals High-flow nasal cannula oxygen therapy in acute respiratory failure at Emergency Departments: A systematic review

2020 ◽  
Vol 38 (7) ◽  
pp. 1508-1514
Author(s):  
Nicolas Marjanovic ◽  
Jérémy Guénézan ◽  
Jean-Pierre Frat ◽  
Olivier Mimoz ◽  
Arnaud W. Thille
Keyword(s):  
Systematic Review ◽  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Emergency Departments ◽  
Oxygen Therapy ◽  
High Flow ◽  
Nasal Cannula ◽  
High Flow Nasal Cannula

The Effect of High-Flow Nasal Cannula Oxygen Therapy on Mortality and Intubation Rate in Acute Respiratory Failure

2017 ◽  
Vol 45 (4) ◽  
pp. e449-e456 ◽  
Author(s):  
Thalia Monro-Somerville ◽  
Malcolm Sim ◽  
James Ruddy ◽  
Mark Vilas ◽  
Michael A. Gillies
Keyword(s):  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Oxygen Therapy ◽  
High Flow ◽  
Nasal Cannula ◽  
Intubation Rate ◽  
High Flow Nasal Cannula

scholarly journals High flow nasal cannula in asthmatic children with suspected COVID-19

2021 ◽  
Vol 34 ◽  
Author(s):  
Valéria Cabral Neves ◽  
Joyce de Oliveira de Souza ◽  
Adriana Koliski ◽  
Bruno Silva Miranda ◽  
Debora Carla Chong e Silva
Keyword(s):  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Respiratory Rate ◽  
Clinical Data ◽  
Invasive Mechanical Ventilation ◽  
High Flow ◽  
Nasal Cannula ◽  
High Flow Nasal Cannula ◽  
Gradual Improvement ◽  
Arterial Blood

Abstract Introduction: The use of a high-flow nasal cannula as an alternative treatment for acute respiratory failure can reduce the need for invasive mechanical ventilation and the duration of hospital stays. Objective: The present study aimed to describe the use of a high-flow nasal cannula in pediatric asthmatic patients with acute respiratory failure and suspected COVID-19. Methods: To carry out this research, data were collected from medical records, including three patients with asthma diagnoses. The variables studied were: personal data (name, age in months, sex, weight, and color), clinical data (physical examination, PRAM score, respiratory rate, heart rate, and peripheral oxygen saturation), diagnosis, history of the current disease, chest, and laboratory radiography (arterial blood gases and reverse-transcriptase polymerase chain reaction). Clinical data were compared before and after using a high-flow nasal cannula. Results: After the application of the therapy, a gradual improvement in heart, respiratory rate, PaO2/FiO2 ratio, and the Pediatric Respiratory Assessment Measure score was observed. Conclusion: The simple and quick use of a high-flow nasal cannula in pediatric patients with asthma can be safe and efficient in improving their respiratory condition and reducing the need for intubation.

scholarly journals How to treat patients with acute respiratory failure? Conventional oxygen therapy versus high-flow nasal cannula in the emergency department

2019 ◽  
pp. 102490791988624
Author(s):  
Mustafa Gedikloglu ◽  
Muge Gulen ◽  
Salim Satar ◽  
Yahya Kemal Icen ◽  
Akkan Avci ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Oxygen Therapy ◽  
Vital Signs ◽  
High Flow ◽  
Nasal Cannula ◽  
Blood Gas ◽  
High Flow Nasal Cannula ◽  
Arterial Blood Gas ◽  
Arterial Blood

Objective: To investigate whether high-flow nasal cannula oxygen therapy could reduce the rate of endotracheal intubation and improve arterial blood gas values, vital signs, and clinical outcomes of patients with hypoxemic acute respiratory failure as compared with conventional oxygen therapy alone. Methods: This retrospective, observational study was performed in the 15-month study period and included adult patients with tachypnea and hypoxemia, whose vital signs and arterial blood gas were monitored. The high-flow nasal cannula oxygen group consisted of patients admitted to the emergency department with acute respiratory failure when high-flow nasal cannula oxygen treatment was available in the hospital, while the conventional oxygen therapy group consisted of patients who have presented to the emergency department with acute respiratory failure in the absence of high-flow nasal cannula oxygen device in the hospital. The primary outcome of the study was improvement in vital signs and arterial blood gas values within first and fourth hours of the treatment. The second outcome was the need for intubation in the emergency department, length of hospital stay, and hospital mortality. Results: The decrease in the pulse and respiratory rate of high-flow nasal cannula oxygen–treated group was significantly greater than the conventional oxygen therapy group on the first and fourth hours of treatment (p < 0.001). PaO2 values were significantly higher in the high-flow nasal cannula oxygen group at the first and fourth hours of treatment (p ⩽ 0.001). Likewise, mean SaO2 levels of patients receiving high-flow nasal cannula oxygen treatment was significantly higher than those of patients in the conventional oxygen therapy group (p = 0.006 at 1 h and p < 0.001 at 4 h). In the hypercapnic patients, the decrease in PaCO2 and increase in pH and PaO2 values were significantly greater in high-flow nasal cannula oxygen group (p < 0.001). The difference between the groups regarding the need for invasive mechanical ventilation was not statistically significant (p = 0.179). Conclusion: High-flow nasal cannula oxygen treatment has been associated with favorable effects in vital signs and arterial blood gas values in patients with acute respiratory failure. High-flow nasal cannula oxygen might be considered as the first-line therapy for patients with hypoxemic and/or hypercapnic acute respiratory failure.

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