Effect of thermal helium oxygen mixture оn сentral hemodynamics and oxygen transport in patients with acute hypercapnic respiratory failure with chronic obstructive pulmonary disease

2020 ◽  
Vol 30 (4) ◽  
pp. 421-426
Author(s):  
L. V. Shogenova ◽  
A. G. Chuchalin ◽  
A. A. Panin
Keyword(s):  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Partial Pressure ◽  
Oxygen Transport ◽  
Venous Blood ◽  
High Flow ◽  
Oxygen Mixture ◽  
Arterial Blood ◽  
High Flow Oxygen ◽  
Hypercapnic Acute Respiratory Failure

The aim of this study is to assessment of the rapid effects of t-He/O2 in comparison with the effective level of high-flow oxygen therapy (HPO) on the main indicators of oxygen transport, central and pulmonary hemodynamics in patients with chronic obstructive pulmonary disease (COPD) with hypercapnic acute respiratory failure.Methods. A total of 33 (29 male, 4 female) patients were included in a randomized, comparative study with exacerbation of COPD and acute respiratory failure, admitted to the department of anesthesiology and intensive care of D.D.Pletnev City Teaching Hospital, Moscow Healthcare Department, between March and May 2017. Patients were divided into two groups: the 1st group – 18 patients (15 male, 3 female) receiving t-He/O2 (He – 70%, O2 – 30% at a temperature of 70 °C; the 2nd group – 15 patients (14 male, 1 female) receiving high-flow oxygen therapy with FiO2 – 30% through a Venturi mask for the treatment of ODN against the background of basic therapy of the underlying disease, according to the recommendations of GOLD 2016. Assessment of oxygen transport, central and pulmonary hemodynamics was carried out through the definition of indicators: saturation of hemoglobin of arterial blood with oxygen (SaO2), saturation of venous blood hemoglobin with oxygen (SvO2), partial pressure of arterial blood oxygen (РaO2), partial pressure of arterial blood carbon dioxide (РaCO2), partial pressure of mixed venous blood oxygen (РvO2), partial pressure of mixed venous blood carbon dioxide (РvCO2),mean pulmonary artery pressure (MPAP), cardiac output (SV), heart index (CI), pulmonary vascular resistance (RVRI), impact volume index (SVI), pulmonary vascular resistance index (RVRI), left ventricular shock index (LVSW), right ventricular shock index (RVSW), system speed of oxygen delivery (DO2), the coeffiCIent of extraction of oxygen (ExO2), shunt fractions (venous mixing) (Qs / Qt)).Results. Short-term inhalation with a thermal helium-oxygen mixture in patients with COPD with hypercapnic acute respiratory failure is accompanied by an increase in SaO2 94,1 (92,8; 97,5) initially 86,1 (85,9; 88,1), РаО2 (78,1 (74,8; 80,1) initially 55,2 (52,5; 65,3)), decline РаСО2 (57,4 (54,2; 66.4) initially 65,4 (58,1; 67,2)). Thermal helium-oxygen mixture leads to stabilization of hemodynamics, improving the work of the right and left heart: decline MPAP 28,2 (24,3; 32,8) initially 43,3 (40,1; 49,5), RVRI (285,3 (258,4; 362,7) initially 592,1 (498,2; 623,5)), RVSW (16,2 (14,1; 21,4) initially 25,8 (21,8; 32)), HR 91,1 (86,4; 98,7) initially 115 ((105; 118) to increase LVSW (58,2 (49,8; 62,4) initially 35,5 (28,9; 42,1)), SVI 36,2 (31,8; 42,1) initially 31,5 (28,4; 36,2). Elimination of arterial hypoxemia and a positive effect on hemodynamics ensures adequate oxygen transport to tissues, which is expressed in the normalization of DO2 values DO2 (980,4 (858,45; 1208) initially 280,3 (270,34; 387,4)) и ExO2 (27,8 (25,6; 34,5) initially 32,1 (30,7; 39,8) and decline Qs/Qt. (28,7 (18,6; 35,4) initially 42,8 (39,2; 49,1).Conclusion. Short-term therapy of patients with COPD with hypercapnic acute respiratory failure using the t-He/O2 method, in comparison with high-flow oxygen therapy, improves blood oxygenation and hemodynamics. Elimination of arterial hypoxemia and a positive effect on hemodynamics made it possible to ensure adequate oxygen transport to tissues, which was expressed in the normalization of transport values, oxygen delivery, and a decrease in the shunt fraction.

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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