scholarly journals High-flow nasal cannula versus standard oxygen therapy assisting sedation during endoscopic retrograde cholangiopancreatography in high risk cases (OTHER): study protocol of a randomised multicentric trial

2020 ◽  
Author(s):  
Venkatesan Thiruvenkatarajan ◽  
Ashok Dharmalingam ◽  
Gilberto Arenas ◽  
Medhat Wahba ◽  
Reinhard Steiner ◽  
...  
Keyword(s):  
High Risk ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Perioperative Complications ◽  
Supplemental Oxygen ◽  
High Flow ◽  
Nasal Cannula ◽  
Low Flow ◽  
High Flow Nasal Cannula ◽  
Endoscopic Retrograde ◽  
Study Results

Abstract Background Endoscopic retrograde cholangiopancreatography (ERCP) is an increasingly common intervention in the treatment of pancreatico-biliary disorders. Patients are often elderly with complex co-morbidities. While monitored anaesthesia care with sedation is commonly used for most cases, few would require general anaesthesia with an endotracheal tube. Both low flow and high flow nasal cannulas (HFNC) are established ways of delivering supplemental oxygen, but it is unclear whether one technique is better than the other. HFNC seems a promising tool for advanced procedures but evidence to support its application in high-risk ERCP cases is limited. The rate of oxygen desaturation during endoscopy has been reported to be as high as 11-50%, and the method of oxygen delivery for ERCP merits further study. Methods/design This is a prospective, randomised, multi-centre trial comparing the efficacy of oxygen supplementation through high flow nasal cannula versus low flow nasal cannula during ERCP, in a cohort of patients at risk of adverse respiratory events. A total of 132 patients will be recruited across three sites and randomly assigned to either the low flow or the HFNC group. The primary outcome is the proportion of patients experiencing hypoxia, defined by any event of SpO2 <90%. The secondary outcomes include parameters centred on oxygenation, requirement of airway manoeuvres, successful completion of procedure, perioperative complications, patient satisfaction, and cost analysis of the consumables. An intention-to-treat principle will be applied while analysing. Discussion The demand for ERCPs is likely to increase in the future with the aging population. Our study results may lead to improved outcomes and reduce airway related complications in patients undergoing ERCPs. The results will be presented at national and international meetings and published in per-reviewed journals.

scholarly journals High-flow nasal cannula versus standard oxygen therapy assisting sedation during endoscopic retrograde cholangiopancreatography in high risk cases (OTHER): study protocol of a randomised multicentric trial

2020 ◽  
Author(s):  
Venkatesan Thiruvenkatarajan ◽  
Ashok Dharmalingam ◽  
Gilberto Arenas ◽  
Medhat Wahba ◽  
Reinhard Steiner ◽  
...  
Keyword(s):  
High Risk ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Perioperative Complications ◽  
Supplemental Oxygen ◽  
High Flow ◽  
Nasal Cannula ◽  
Low Flow ◽  
High Flow Nasal Cannula ◽  
Endoscopic Retrograde ◽  
Study Results

Abstract Background Endoscopic retrograde cholangiopancreatography (ERCP) is an increasingly common intervention in the treatment of pancreatico-biliary disorders. Patients are often elderly with complex co-morbidities. While monitored anaesthesia care with sedation is commonly used for most cases, few would require general anaesthesia with an endotracheal tube. Both low flow and high flow nasal cannulas (HFNC) are established ways of delivering supplemental oxygen, but it is unclear whether one technique is better than the other. HFNC seems a promising tool for advanced procedures but evidence to support its application in high-risk ERCP cases is limited. The rate of oxygen desaturation during endoscopy has been reported to be as high as 11-50%, and the method of oxygen delivery for ERCP merits further study.Methods/design This is a prospective, randomised, multi-centre trial comparing the efficacy of oxygen supplementation through high flow nasal cannula versus low flow nasal cannula during ERCP, in a cohort of patients at risk of adverse respiratory events. A total of 132 patients will be recruited across three sites and randomly assigned to either the low flow or the HFNC group. The primary outcome is the proportion of patients experiencing hypoxia, defined by any event of SpO2 <90%. The secondary outcomes include parameters centred on oxygenation, requirement of airway manoeuvres, successful completion of procedure, perioperative complications, patient satisfaction, and cost analysis of the consumables. An intention-to-treat principle will be applied while analysing.Discussion The demand for ERCPs is likely to increase in the future with the aging population. Our study results may lead to improved outcomes and reduce airway related complications in patients undergoing ERCPs. The results will be presented at national and international meetings and published in per-reviewed journals.Trial registration: www.ANZCTR.org.au CTRN12619000397112, Registered on on March 12, 2019.

Respiratory Drive in Patients with Sepsis and Septic Shock: Modulation by High-flow Nasal Cannula

2021 ◽  
Author(s):  
Tommaso Mauri ◽  
Elena Spinelli ◽  
Bertrand Pavlovsky ◽  
Domenico Luca Grieco ◽  
Irene Ottaviani ◽  
...  
Keyword(s):  
Septic Shock ◽  
Esophageal Pressure ◽  
Lung Compliance ◽  
High Flow ◽  
Nasal Cannula ◽  
Low Flow ◽  
Respiratory Drive ◽  
High Flow Nasal Cannula ◽  
Impedance Tomography ◽  
Sepsis And Septic Shock

Background Experimental and pilot clinical data suggest that spontaneously breathing patients with sepsis and septic shock may present increased respiratory drive and effort, even in the absence of pulmonary infection. The study hypothesis was that respiratory drive and effort may be increased in septic patients and correlated with extrapulmonary determinant and that high-flow nasal cannula may modulate drive and effort. Methods Twenty-five nonintubated patients with extrapulmonary sepsis or septic shock were enrolled. Each patient underwent three consecutive steps: low-flow oxygen at baseline, high-flow nasal cannula, and then low-flow oxygen again. Arterial blood gases, esophageal pressure, and electrical impedance tomography data were recorded toward the end of each step. Respiratory effort was measured as the negative swing of esophageal pressure (ΔPes); drive was quantified as the change in esophageal pressure during the first 500 ms from start of inspiration (P0.5). Dynamic lung compliance was calculated as the tidal volume measured by electrical impedance tomography, divided by ΔPes. The results are presented as medians [25th to 75th percentile]. Results Thirteen patients (52%) were in septic shock. The Sequential Organ Failure Assessment score was 5 [4 to 9]. During low-flow oxygen at baseline, respiratory drive and effort were elevated and significantly correlated with arterial lactate (r = 0.46, P = 0.034) and inversely with dynamic lung compliance (r = –0.735, P &lt; 0.001). Noninvasive support by high-flow nasal cannula induced a significant decrease of respiratory drive (P0.5: 6.0 [4.4 to 9.0] vs. 4.3 [3.5 to 6.6] vs. 6.6 [4.9 to 10.7] cm H2O, P &lt; 0.001) and effort (ΔPes: 8.0 [6.0 to 11.5] vs. 5.5 [4.5 to 8.0] vs. 7.5 [6.0 to 12.6] cm H2O, P &lt; 0.001). Oxygenation and arterial carbon dioxide levels remained stable during all study phases. Conclusions Patients with sepsis and septic shock of extrapulmonary origin present elevated respiratory drive and effort, which can be effectively reduced by high-flow nasal cannula. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

Readiness Assessment for Extubation Planning in the Intensive Care Unit: A Quality Improvement Initiative

2021 ◽  
Vol 41 (3) ◽  
pp. 42-48
Author(s):  
Jace D. Johnny
Keyword(s):  
High Risk ◽  
Failure Rate ◽  
Noninvasive Ventilation ◽  
Extubation Failure ◽  
High Flow ◽  
Nasal Cannula ◽  
High Flow Nasal Cannula ◽  
Prophylactic Measure ◽  
High Risk Patients ◽  
Risk Patients

Background Extubation failure is the reintubation of patients meeting criteria for weaning from mechanical ventilation. Extubation failure is correlated with mortality, prolonged mechanical ventilation, and longer hospital stays. Noninvasive ventilation or high-flow nasal cannula oxygen therapy after extubation is recommended to prevent extubation failure in high-risk patients. Local Problem The extubation failure rate is unknown. Prophylactic measures (noninvasive ventilation or high-flow nasal cannula) after extubation are not commonly used and vary among clinicians. The objective was to assess extubation planning readiness by determining extubation failure rate, identifying high-risk patients, and determining prophylactic measure compliance. Methods A quality improvement initiative included an evidence-based extubation failure risk assessment that identified high-risk patients and determined prophylactic measure compliance. A 2-year retrospective medical record review was used to determine baseline patient characteristics and extubation failure rate. Results Extubation failure rate within the retrospective cohort was 13 of 146 patients (8.9%). Extubation failure did not correlate with previously identified risk factors; however, 150 identified patients were excluded from analysis. During risk assessment integration, the extubation failure rate was 3 of 37 patients (8.1%) despite identifying 24 high-risk patients (65%). Few high-risk patients received prophylactic measures (noninvasive ventilation, 17%; high-flow nasal cannula, 12%). Conclusions Extubation failure should be routinely measured because of its effects on patient outcomes. This project reveals the multifactorial nature of extubation failure. Further research is needed to assess patients’ risk and account for acute conditions. This project used best practice guidelines for routine patient care and added transparency to a previously unmeasured event.

Prognostic factors for extubation failure in high risk patients using high-flow nasal cannula

2019 ◽  
Author(s):  
Paulina Ezcurra ◽  
María Sofia Venuti ◽  
Emiliano Gogniat ◽  
Marcela Ducrey ◽  
Jose Dianti ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
High Risk ◽  
Extubation Failure ◽  
High Flow ◽  
Nasal Cannula ◽  
High Flow Nasal Cannula ◽  
High Risk Patients ◽  
Risk Patients

scholarly journals High Flow Nasal Cannula Oxygenation

JMS SKIMS ◽  
2020 ◽  
Vol 23 (3) ◽  
Author(s):  
Tajamul Hussain Shah ◽  
Suhail Mantoo ◽  
Rafi Ahmad Jan
Keyword(s):  
Face Mask ◽  
High Flow ◽  
Nasal Cannula ◽  
Respiratory Support ◽  
Low Flow ◽  
Invasive Ventilation ◽  
High Flow Nasal Cannula ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
Flow Devices

High Flow Nasal Cannula Oxygenation The current pandemic of COVID-19 caused by novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) tested the healthcare infrastructure throughout the globe at all possible levels. Early reports suggest about 20% of patients infected with SARS-CoV-2 require hospitalization and 5-8% require admission to intensive care unit (ICU) due to severe disease.Supplementation of oxygen provided by various conventional oxygen therapy (COT) devices (like nasal prongs, face mask, venture mask or non-rebreather mask) may not be sufficient in cases of worsening respiratory failure. One form of escalating respiratory support in such patients is a high flow nasal oxygenation device. High flow nasal cannula oxygenation (HFNC) is a form of non invasive respiratory support. It acts as a bridge between low flow devices and non invasive ventilation and may reduce the need for intubation.

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