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 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 Title High Flow Nasal cannula oxygen therapy in a general pediatric (non-intensive care) setting

2019 ◽  
Author(s):  
Louise Kooiman ◽  
Roelien Reimink ◽  
Veerle Langenhorst ◽  
Paul Brand ◽  
Jolita Bekhof
Keyword(s):  
Intensive Care ◽  
Respiratory Failure ◽  
Treatment Failure ◽  
Hospital Admissions ◽  
Work Of Breathing ◽  
High Flow ◽  
Nasal Cannula ◽  
Early Warning Score ◽  
High Flow Nasal Cannula ◽  
Vital Functions

Abstract Background: High flow nasal cannula therapy (HFNC) is being used increasingly for oxygen delivery in children with impending respiratory failure, however solid evidence of its effectiveness is sparse. Moreover, data on safety regarding its use outside of the Pediatric Intensive Care Unit (PICU), with flowrates exceeding 1 L/kg is lacking. Methods: Retrospective chart review at the pediatric ward of Isala, a general teaching hospital in Zwolle, The Netherlands, 100 km away from the nearest PICU. All children <18 years with impending respiratory failure treated with HFNC between January 2015 and May 2016 were included. A flowrate of 2 L/kg/minute for the first 10 kg was used; with 0.5 L/kg for every kg >10 kg and a maximum of 50 L/min. A pediatric early warning score (PEWS) comprising vital functions and work of breathing (0-28 points) was used to assess severity of respiratory distress. Treatment failure was defined as referral to the PICU. Results: In the 16-month study period HFNC was used during 41 hospital admissions in 39 patients (64.1% male), median age 6.3 months (interquartile range, IQR 3–20.6). Median (IQR) PEWS at the start of HFNC was 8.5 (7–10). Patients were diagnosed with bronchiolitis (70.7%), pneumonia (24.4%) or asthma (4.9%). In 18 cases (43.9%) HFNC failed, with referral to a PICU. No clinical variables (age, comorbidity, PEWS at admission or start of HFNC) nor improvement of the PEWS after 2 hours of HFNC were associated with treatment failure. We found no association between treatment failure and the start of HFNC at an earlier stage or at lower PEWS (odds ratio 1.03; 95% confidence interval 0.82-1.30; p=0.80). There were no safety issues, no cases with air leak or other complications. Conclusions: This small study suggests that HFNC can be safely used and initiated in a general pediatric department. We were unable to find clinical factors that predicted HFNC success. We recommend not to restrict evaluation of the effect of HFNC in studies to short-term (2 hours), but also after longer duration, at least 24 hours.

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.

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

Use of High-Flow Nasal Cannula in Patients With Pneumonia and Hypoxemic Respiratory Failure at Altitudes Above 2600 m: What Is the Best Predictor of Success?

2021 ◽  
pp. 088506662110575
Author(s):  
Molano Franco Daniel ◽  
Gómez Duque Mario ◽  
Beltrán Edgar ◽  
Villabon Mario ◽  
Hurtado Alejandra ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Failure ◽  
Respiratory Rate ◽  
High Flow ◽  
Nasal Cannula ◽  
High Flow Nasal Cannula ◽  
Multicenter Cohort Study ◽  
Hypoxemic Respiratory Failure ◽  
Severity Scores ◽  
High Flow Oxygen

Introduction: The use of high-flow nasal cannulas (HFNC) in patients with hypoxemic ventilatory failure reduces the need for mechanical ventilation and does not increase mortality when intubation is promptly applied. The aim of the study is to describe the behavior of HFNC in patients who live at high altitudes, and the performance of predictors of success/failure of this strategy. Methods: Prospective multicenter cohort study, with patients aged over 18 years recruited for 12 months in 2020 to 21. All had a diagnosis of hypoxemic respiratory failure secondary to pneumonia, were admitted to intensive care units, and were receiving initial management with a high-flow nasal cannula. The variables assessed included need for intubation, mortality in ICU, and the validation of SaO2, respiratory rate (RR) and ROX index (IROX) as predictors of HFNC success / failure. Results: One hundred and six patients were recruited, with a mean age of 59 years and a success rate of 74.5%. Patients with treatment failure were more likely to be obese (BMI 27.2 vs 25.5; OR: 1.03; 95% CI: .95-1.1) and had higher severity scores at admission (APACHE II 12 vs 20; OR 1.15; 95% CI: 1.06-1.24). Respiratory rates after 12 (AUC .81 CI: .70-.92) and 18 h (AUC .85 CI: .72-0.90) of HFNC use were the best predictors of failure, performing better than those that included oxygenation. ICU mortality was higher in the failure group (6% vs 29%; OR 8.8; 95% CI:1.75-44.7). Conclusions: High-flow oxygen cannula therapy in patients with hypoxemic respiratory failure living at altitudes above 2600 m is associated with low rates of therapy failure and a reduced need for mechanical ventilation in the ICU. The geographical conditions and secondary physiological changes influence the performance of the traditionally validated predictors of therapy success. Respiratory rate <30 proved to be the best indicator of early success of the device at 12 h of use.

scholarly journals High flow nasal cannula oxygen therapy in adults with COVID-19 respiratory failure. A case report

2020 ◽  
Vol 90 (2) ◽  
Author(s):  
Vasileios Karamouzos ◽  
Fotini Fligou ◽  
Charalambos Gogos ◽  
Dimitrios Velissaris
Keyword(s):  
Respiratory Failure ◽  
Oxygen Therapy ◽  
Virus Disease ◽  
High Flow ◽  
Nasal Cannula ◽  
High Flow Nasal Cannula ◽  
Non Invasive ◽  
Corona Virus ◽  
Non Invasive Ventilation ◽  
Hypoxic Respiratory Failure

The novel corona virus (SARS-CoV-2) continuous to spread around the globe causing high mortality, tremendous stress on healthcare systems and an unprecedented disruption of everyday life with unpredictable socioeconomic ramifications. The diseaseis typically affecting the respiratory system and some patients will develop refractory hypoxemic respiratory insufficiency requiring mechanical ventilation. The role of non-invasive ventilation (NIV), high flow nasal cannula (HFNC) or continuous positive airway pressure devices (C-PAP) in the treatment of the 2019 corona virus disease (COVID-19) is not yet clear. We hereby report a case of a 44-year-old COVID-19 positive male patient suffering from hypoxic respiratory failure that was successfully treated with high flow nasal cannula oxygen therapy in a negative pressure intensive care room. Although specific criteria for the use of high flow nasal canula devices COVID-19 are not available at this time, clinicians could use this non-invasive modality as analternative method of respiratory support in selected patients presenting with respiratory failure.

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

scholarly journals High-Flow Nasal Cannula: A Promising Oxygen Therapy for Patients with Severe Bronchial Asthma Complicated with Respiratory Failure

2020 ◽  
Vol 2020 ◽  
pp. 1-7 ◽  
Author(s):  
Wanru Geng ◽  
Wuliji Batu ◽  
Shuhong You ◽  
Zhaohui Tong ◽  
Hangyong He
Keyword(s):  
Respiratory Failure ◽  
Bronchial Asthma ◽  
Oxygen Therapy ◽  
Response Rate ◽  
High Flow ◽  
Nasal Cannula ◽  
High Flow Nasal Cannula ◽  
Therapy Technique ◽  
Significant Difference ◽  
Life Threatening

Severe bronchial asthma complicated with respiratory failure, a common critical illness in respiratory medicine, may be life-threatening. High-flow nasal cannula (HFNC) is a novel oxygen therapy technique developed in recent years. HFNC was applied in this study for treating adult patients with severe bronchial asthma complicated with respiratory failure. Its efficacy was analyzed comparatively to conventional oxygen therapy (COT). HFNC and COT were randomly performed based on conventional treatment. The HFNC group was similar to COT-treated patients in terms of response rate, with no significant difference in efficacy between the two groups. In patients with bronchial asthma, effectively increased PO2 and reduced PCO2 were observed after treatment in both groups. However, HFNC was more efficient than COT in elevating PO2 in patients with severe bronchial asthma complicated with respiratory failure, while no statistically significant difference in PCO2 reduction was found between the two groups. Heart rate (HR) and respiratory rate (RR) between the two groups on admission (0 h) and at 2, 8, 24, and 48 h after admission were compared. Both indicators significantly decreased with time. No significant differences in HR and RR were found between the groups at 0, 2, and 8 h after admission. However, these indicators were significantly lower in the HFNC group compared with the COT group at 24 and 48 h after admission. HFNC could significantly elevate PO2 and reduce HR and RR. Thus, it is a promising option for patients with severe bronchial asthma complicated with respiratory failure.

Is high-flow nasal cannula oxygenation more effective than noninvasive ventilation or conventional oxygen therapy in treating acute hypoxemic respiratory failure in COVID-19 patients?

2020 ◽  
Vol 54 ◽  
Author(s):  
Cary Amiel G. Villanueva ◽  
Marie Gene D. Cruz ◽  
Lia M. Palileo-Villanueva
Keyword(s):  
Respiratory Failure ◽  
Noninvasive Ventilation ◽  
Observational Studies ◽  
Oxygen Therapy ◽  
High Flow ◽  
Nasal Cannula ◽  
Respiratory Support ◽  
High Flow Nasal Cannula ◽  
Hypoxemic Respiratory Failure ◽  
Acute Hypoxemic Respiratory Failure

KEY FINDINGSVery low-quality evidence suggests lower mortality (based on five observational studies) but higher failurerate of respiratory support (based on two observational studies) in COVID-19 patients given high-flow nasalcannula (HFNC) oxygen compared with noninvasive ventilation (NIV) and conventional oxygenation therapy.Randomized controlled trials (RCT) are urgently needed in this area.• Respiratory failure accounts for about half of deaths in patients with COVID-19.• High-flow nasal cannula (HFNC) oxygen therapy reduces the need for escalating respiratory support and improvespatient comfort compared with conventional oxygen therapy among those with acute respiratory failure.• Mortality was consistently lower in COVID-19 patients who received HFNC rather than NIV or conventionaloxygen therapy (COT) across 5 very low-quality retrospective observational studies from China.• Several international guidelines recommend the use of HFNC oxygen therapy in COVID-19 patients whodevelop acute hypoxemic respiratory failure. However, local guidelines from the Philippine Society forMicrobiology and Infectious Diseases (PSMID) and the Philippine College of Chest Physicians (PCCP) recommendagainst HFNC due to risks of transmission and paucity of direct evidence for efficacy.• Additional infection control precautions, i.e. wearing a surgical mask over the cannula, and locating in a negativepressure room, are recommended whenever using HFNC or NIV.• There are at least two ongoing trials due to be completed by the second quarter of 2021 comparingHFNC oxygenation with NIV or COT in COVID-19 patients.

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