Respiratory management of acute exacerbation of interstitial pneumonia using high-flow nasal cannula oxygen therapy: a single center cohort study

A 33-year-old pregnant woman was referred to our hospital with respiratory distress at 30 weeks of gestation. Chest computed tomography (CT) scans revealed pulmonary infiltrates along the bronchovascular bundles and ground-glass opacities in both lungs. Despite immediate treatment with steroid pulse therapy for suspected interstitial pneumonia, the patient’s condition worsened. Respiratory distress was slightly alleviated after the initiation of high-flow nasal cannula (HFNC) oxygen therapy (40 L/min, FiO2 40%). We suspected clinically amyopathic dermatomyositis (CADM) complicating rapidly progressive refractory interstitial pneumonia. In order to save the life of the patient, the use of combination therapy with immunosuppressants was necessary. The patient underwent emergency cesarean section and was immediately treated with immunosuppressants while continuing HFNC oxygen therapy. The neonate was treated in the neonatal intensive care unit. The patient’s condition improved after 7 days of hospitalization; by this time, she was positive for myositis-specific autoantibodies and was diagnosed with interstitial pneumonia preceding dermatomyositis. This condition can be potentially fatal within a few months of onset and therefore requires early combination immunosuppressive therapy. This case demonstrates the usefulness of HFNC oxygen therapy for respiratory management as it negates the need for intubation and allows for various treatments to be quickly performed.

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Tolerance and Safety of Humidified High-Flow Nasal Cannula Oxygen Therapy in Patients Hospitalized with an Acute Exacerbation of Chronic Obstructive Pulmonary Disease (COPD)

10.1164/ajrccm-conference.2019.199.1_meetingabstracts.a3327 ◽

2019 ◽

Author(s):

A. Pandya ◽

G. Criner ◽

J. So ◽

M.R. Jacobs ◽

J. Thomas ◽

...

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Pulmonary Disease ◽

Acute Exacerbation ◽

Oxygen Therapy ◽

High Flow ◽

Nasal Cannula ◽

Chronic Obstructive ◽

High Flow Nasal Cannula ◽

Obstructive Pulmonary Disease

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The perioperative application of High Flow Nasal Cannula: a single center experience

Journal of Anesthesia & Critical Care Open Access ◽

10.15406/jaccoa.2020.12.00422 ◽

2020 ◽

Vol 12 (1) ◽

pp. 1-5

Author(s):

Ibtesam A. Hilmi ◽

Philip C. Carullo ◽

Dennis P. Phillips ◽

Ezeldeen Abuelkasem

Keyword(s):

Oxygen Therapy ◽

Case Reports ◽

High Flow ◽

Nasal Cannula ◽

Single Center ◽

High Flow Nasal Cannula ◽

Anesthesia Practice ◽

Single Center Experience ◽

Complex Patients ◽

Clinical Scenarios

The physiologic benefits of high-flow nasal cannula (HFNC) therapy are well documented in the intensive care literature, yet only a handful of case reports describe its perioperative use. Our single center experience explored comprehensive applications of HFNC in the perioperative setting. Over a ten-month period, HFNC was used in the care of 85 medically complex patients either as an adjuvant or main oxygen therapy during induction of general anesthesia, maintenance of deep intraoperative sedation, and during early postoperative care. Here, we illustrate clinical scenarios in which HFNC therapy made patient care safer and describe a framework for integrating this technology into the anesthesia practice at our institution.

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