scholarly journals Should the Pendulum Swing Back? More Transfers to the ICU After Implementing Ward-Based High-Flow Nasal Cannula Initiation Protocols for Bronchiolitis

10.12788/3462 ◽  
2020 ◽  
Vol 15 (6) ◽  
pp. 381-382
Author(s):  
Daniel J Sklansky ◽  
Sanjay Mahant
Keyword(s):  
Oxygen Therapy ◽  
Work Of Breathing ◽  
High Flow ◽  
Nasal Cannula ◽  
Large Trial ◽  
High Flow Nasal Cannula ◽  
Pendulum Swing ◽  
Weak Evidence ◽  
Early Use ◽  
The One

As an appealing, physiologically plausible treatment, humidified oxygen delivery via high-flow nasal cannula (HFNC) has been rapidly adopted for the treatment of bronchiolitis despite weak evidence supporting its routine and early use in hypoxemic infants.1 Although HFNC use has been associated with decreased work of breathing and lower rates of progression to invasive ventilation in some studies, the one large trial published on the topic found no difference between early HFNC and standard oxygen therapy on length of stay in hospital, duration of oxygen therapy, or rates of intubation.2,3 No adequately powered studies have examined the effect of ward-based HFNC initiation on ICU transfer, an outcome that it is designed to prevent.

scholarly journals High-flow nasal cannula oxygen therapy as an emerging option for respiratory failure: the present and the future

2020 ◽  
Vol 11 ◽  
pp. 204062232092010
Author(s):  
Lucia Spicuzza ◽  
Matteo Schisano
Keyword(s):  
Respiratory Failure ◽  
Oxygen Therapy ◽  
De Novo ◽  
Work Of Breathing ◽  
High Flow ◽  
Nasal Cannula ◽  
Chronic Obstructive ◽  
High Flow Nasal Cannula ◽  
Obstructive Pulmonary Disease ◽  
Chronic Respiratory Diseases

Conventional oxygen therapy (COT) and noninvasive ventilation (NIV) have been considered for decades as frontline treatment for acute or chronic respiratory failure. However, COT can be insufficient in severe hypoxaemia whereas NIV, although highly effective, is poorly tolerated by patients and its use requires a specific expertise. High-flow nasal cannula (HFNC) is an emerging technique, designed to provide oxygen at high flows with an optimal degree of heat and humidification, which is well tolerated and easy to use in all clinical settings. Physiologically, HFNC reduces the anatomical dead space and improves carbon dioxide wash-out, reduces the work of breathing, and generates a positive end-expiratory pressure and a constant fraction of inspired oxygen. Clinically, HFNC effectively reduces dyspnoea and improves oxygenation in respiratory failure from a variety of aetiologies, thus avoiding escalation to more invasive supports. In recent years it has been adopted to treat de novo hypoxaemic respiratory failure, exacerbation of chronic obstructive pulmonary disease (COPD), postintubation hypoxaemia and used for palliative respiratory care. While the use of HFNC in acute respiratory failure is now routine as an alternative to COT and sometimes NIV, new potential applications in patients with chronic respiratory diseases (e.g. domiciliary treatment of patients with stable COPD), are currently under evaluation and will become a topic of great interest in the coming years.

scholarly journals Is high flow nasal cannula as an effective oxygen delivery alternative in intensive care unit?

2019 ◽  
Vol 6 (2) ◽  
pp. 460
Author(s):  
Amrish Patel ◽  
Jitesh Atram ◽  
H. S. Dumra ◽  
Mansi Dandnaik ◽  
Gopal Raval
Keyword(s):  
Intensive Care ◽  
Respiratory Failure ◽  
Respiratory Rate ◽  
Oxygen Delivery ◽  
Oxygen Therapy ◽  
Work Of Breathing ◽  
High Flow ◽  
Nasal Cannula ◽  
Comfort Level ◽  
High Flow Nasal Cannula

Background: High-flow nasal cannula (HFNC) oxygen therapy is carried out using an air/oxygen blender, active humidifier, single heated tube, and nasal cannula. It is an oxygen delivery system which uses air blender to deliver accurate oxygen concentration to the patient from 21% to 100% at desired temperature. It can be administered via wide bore nasal cannula or to the tracheostomy tube via connector. It can give upto 60L/min flow hence can generate positive end expiratory pressure between 2 to 7 cmH20. By providing humidified oxygen along with the high flow rates it satisfies air hunger and reduces work of breathing for the patient.Methods: This is a retrospective observational study. Patients with persistent hypoxia in spite of conventional oxygen therapy were treated with HFNC. Patients with possible need for immediate invasive ventilator support were excluded. Clinical respiratory parameters and oxygenation were compared under conventional and HFNC oxygen therapy.Results: Thirty patients, aged more than 18 years admitted in intensive respiratory care unit with acute hypoxemic respiratory failure from June 2017 to January 2018 were included in the study. Study period was of 6 months. Etiology of acute respiratory failure (ARF) was mainly pneumonia (n = 17), interstitial lung disease (n = 5), bronchial asthma (n=3) and others (n = 5). There was statistically significant reduction in respiratory rate (29.40 before Vs 23.50 after; P- <0.0001) and significant improvement in comfort level of the patient after HFNC therapy. Median duration of HFNC was 48 hrs (24-360) hours. Five patients were intubated later on and 4 died in the intensive care unit.Conclusions: Use of HFNC in patients with persistent ARF was associated with significant and sustained improvement of clinical parameters (respiratory rate). It can be used comfortably for prolonged periods.

scholarly journals A Narrative Summary of High Flow Nasal Cannula Therapy in the Adult Population

2017 ◽  
Author(s):  
Joshua Gonzales ◽  
Kevin Collins ◽  
Christopher Russian
Keyword(s):  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Oxygen Therapy ◽  
Work Of Breathing ◽  
High Flow ◽  
Nasal Cannula ◽  
Positive Pressure ◽  
High Flow Nasal Cannula ◽  
Non Invasive ◽  
Clinical Benefits

Purpose: The aim of this narrative review is to outline the mechanism of action of HFNC therapy, the clinical benefits of its use, cautions of its clinical application and limitations of previous research. Methods: A literature review was conducted using the following databases as sources: Medline, PubMed, and Google Scholar. Only publications written in English were used in this clinical review. Keywords used in the search included the following: high-flow nasal cannula, heated humidified oxygen, oxygen therapy, non-invasive ventilation, and respiratory failure. Results: The literature reveals HFNC therapy significantly decreased the use of mechanical ventilation (invasive or non-invasive) in patients experiencing respiratory failure. HFNC therapy was better tolerated by patients and decreased the patient’s work of breathing when compared to a conventional oxygen therapy (i.e., non-rebreather oxygen mask). Other clinical benefits of using HFNC when changing a patient from conventional facemask oxygen therapy to a HFNC device are significant improvements in PaO2, respiratory rate and overall comfort. Conclusions: High flow nasal cannula (HFNC) therapy serves as an alternative to conventional oxygen therapy to deliver elevated concentrations of oxygen to patients experiencing acute respiratory failure. Information detailed in this article suggests HFNC therapy is an effective therapy for improving a patient’s oxygenation status when experiencing acute respiratory failure in adults. The literature reveals, it is reasonable to initiate HFNC in adults with acute hypoxemic respiratory failure without hypercapnia, as an alternative to standard oxygen therapy or noninvasive positive pressure ventilation.

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