scholarly journals High Flow Nasal Cannula Oxygen in Patients With Haematological Malignancy: A Retrospective Observational Study

2021 ◽  
Author(s):  
Simon Tetlow ◽  
Rathai Anandanadesan ◽  
Leila Taheri ◽  
Eirini Pagkalidou ◽  
Hugues De Lavallade ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Haematological Malignancy ◽  
Invasive Mechanical Ventilation ◽  
High Flow ◽  
Nasal Cannula ◽  
High Flow Nasal Cannula ◽  
Limited Evidence ◽  
Icu Admission ◽  
Non Invasive ◽  
Critical Care Outreach

Abstract BackgroundPatients with haematological malignancies (HM) face high rates of Intensive Care Unit (ICU) admission and mortality. High flow nasal cannula oxygen (HFNCO) is increasingly used to support HM patients in ward settings, but there is limited evidence on the safety and efficacy of HFNCO in this group. MethodsWe retrospectively reviewed all HM patients receiving ward-based HFNCO, supervised by a critical care outreach service (CCOS), from January 2014 - January 2019. ResultsWe included 130 consecutive patients. Forty-three (33.1%) were weaned off HFNCO without ICU admission. Eighty-seven (66.9%) were admitted to ICU, 20 (23.3%) required non-invasive and 34 (39.5%) invasive mechanical ventilation. ICU and hospital mortality were 42% and 55% respectively. Initial FiO2 <0.4 (OR 0.27, 95% CI 0.09-0.81, p=0.019) and HFNCO use on the ward >1 day (OR 0.16, 95% CI 0.04, 0.59, p=0.006) were associated with reduced likelihood for ICU admission. Invasive ventilation was associated with reduced survival (OR 0.27, 95%CI 0.1-0.7, p=0.007). No significant adverse events were reported.ConclusionHM patients receiving ward-based HFNCO have higher rates of ICU admission, but comparable hospital mortality to those requiring CCOS review without respiratory support. Results should be interpreted cautiously, as the model proposed depends on the existence of CCOS.

scholarly journals Risk Categories in COVID-19 Based on Degrees of Inflammation: Data on More Than 17,000 Patients from the Spanish SEMI-COVID-19 Registry

2021 ◽  
Vol 10 (10) ◽  
pp. 2214
Author(s):  
Manuel Rubio-Rivas ◽  
Xavier Corbella ◽  
Francesc Formiga ◽  
Estela Menéndez Fernández ◽  
María Martín Escalante ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
High Risk ◽  
Hospital Mortality ◽  
Invasive Mechanical Ventilation ◽  
High Flow ◽  
Nasal Cannula ◽  
High Flow Nasal Cannula ◽  
Icu Admission ◽  
Inflammatory Parameters ◽  
Risk Categories

(1) Background: The inflammation or cytokine storm that accompanies COVID-19 marks the prognosis. This study aimed to identify three risk categories based on inflammatory parameters on admission. (2) Methods: Retrospective cohort study of patients diagnosed with COVID-19, collected and followed-up from 1 March to 31 July 2020, from the nationwide Spanish SEMI-COVID-19 Registry. The three categories of low, intermediate, and high risk were determined by taking into consideration the terciles of the total lymphocyte count and the values of C-reactive protein, lactate dehydrogenase, ferritin, and D-dimer taken at the time of admission. (3) Results: A total of 17,122 patients were included in the study. The high-risk group was older (57.9 vs. 64.2 vs. 70.4 years; p < 0.001) and predominantly male (37.5% vs. 46.9% vs. 60.1%; p < 0.001). They had a higher degree of dependence in daily tasks prior to admission (moderate-severe dependency in 10.8% vs. 14.1% vs. 17%; p < 0.001), arterial hypertension (36.9% vs. 45.2% vs. 52.8%; p < 0.001), dyslipidemia (28.4% vs. 37% vs. 40.6%; p < 0.001), diabetes mellitus (11.9% vs. 17.1% vs. 20.5%; p < 0.001), ischemic heart disease (3.7% vs. 6.5% vs. 8.4%; p < 0.001), heart failure (3.4% vs. 5.2% vs. 7.6%; p < 0.001), liver disease (1.1% vs. 3% vs. 3.9%; p = 0.002), chronic renal failure (2.3% vs. 3.6% vs. 6.7%; p < 0.001), cancer (6.5% vs. 7.2% vs. 11.1%; p < 0.001), and chronic obstructive pulmonary disease (5.7% vs. 5.4% vs. 7.1%; p < 0.001). They presented more frequently with fever, dyspnea, and vomiting. These patients more frequently required high flow nasal cannula (3.1% vs. 4.4% vs. 9.7%; p < 0.001), non-invasive mechanical ventilation (0.9% vs. 3% vs. 6.3%; p < 0.001), invasive mechanical ventilation (0.6% vs. 2.7% vs. 8.7%; p < 0.001), and ICU admission (0.9% vs. 3.6% vs. 10.6%; p < 0.001), and had a higher percentage of in-hospital mortality (2.3% vs. 6.2% vs. 23.9%; p < 0.001). The three risk categories proved to be an independent risk factor in multivariate analyses. (4) Conclusion: The present study identifies three risk categories for the requirement of high flow nasal cannula, mechanical ventilation, ICU admission, and in-hospital mortality based on lymphopenia and inflammatory parameters.

scholarly journals The Role of High Flow Nasal Cannula in COVID-19 Associated Pneumomediastinum and Pneumothorax

Healthcare ◽  
2021 ◽  
Vol 9 (6) ◽  
pp. 620
Author(s):  
Francesca Simioli ◽  
Anna Annunziata ◽  
Giorgio Emanuele Polistina ◽  
Antonietta Coppola ◽  
Valentina Di Spirito ◽  
...  
Keyword(s):  
Subcutaneous Emphysema ◽  
Invasive Mechanical Ventilation ◽  
High Flow ◽  
Nasal Cannula ◽  
High Flow Nasal Cannula ◽  
High Resolution Computed Tomography ◽  
Positive Role ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
Critical Patients

Background: Pneumomediastinum, subcutaneous emphysema and pneumothorax are not rarely observed during the COVID-19 pandemic. Such complications can worsen gas exchange and the overall prognosis in critical patients. The aim of this study is to investigate what predisposing factors are related to pneumomediastinum and pneumothorax in SARS-CoV2-Acute Respiratory Distress Syndrome (ARDS), what symptoms may predict a severe and potentially fatal complication and what therapeutical approach may provide a better outcome. Methods: In this single center cohort study, we recorded data from 45 critically ill COVID-19 patients who developed one or more complicating events among pneumomediastinum, subcutaneous emphysema and pneumothorax. All patients showed ARDS and underwent non-invasive ventilation (NIV) at baseline. Patients with mild to moderate ARDS and pneumomediastinum/pneumothorax (n = 25) received High Flow Nasal Cannula (HFNC), while patients with severe ARDS and pneumomediastinum/pneumothorax underwent HFNC (n = 10) or invasive mechanical ventilation (IMV) (n = 10). Results: Pneumomediastinum/pneumothorax developed in 10.5% of subjects affected by SARS-coV2-ARDS. Dyspnea affected 40% and cough affected 37% of subjects. High resolution computed tomography of the chest showed bilateral diffuse ground glass opacities (GGO) in 100% of subjects. Traction bronchiolectasis, reticulation, crazy paving and distortion were observed in 64%. Furthermore, 36% showed subcutaneous emphysema. Non-severe ARDS cases received HFNC, and 76% patients recovered from pneumomediastinum/pneumothorax over a median follow up of 5 days. Among severe ARDS cases the recovery rate of pneumomediastinum/pneumothorax was 70% with the HFNC approach, and 10% with IMV. Conclusion: HFNC is a safe and effective ventilatory approach for critical COVID-19 and has a positive role in associated complications such as pneumomediastinum and pneumothorax.

scholarly journals High flow nasal cannula versus non-invasive ventilation in severe asthma: two years prospective observational study.

2021 ◽  
Author(s):  
Carolina Solé-Delgado ◽  
Alberto García-Salido ◽  
Ainhoa Gochi-Valdovinos ◽  
Anthony González-Brabin ◽  
Maria García ◽  
...  
Keyword(s):  
Observational Study ◽  
Severe Asthma ◽  
Prospective Observational Study ◽  
Invasive Mechanical Ventilation ◽  
High Flow ◽  
Nasal Cannula ◽  
Respiratory Support ◽  
High Flow Nasal Cannula ◽  
Non Invasive ◽  
Respiratory Management

Background: in recent years, High Flow Nasal Cannula (HFNC) has been considered an alternative to non-invasive mechanical ventilation (NIMV) in severe asthma respiratory management in children. Objective: to describe the use of HFNC in children with severe asthma admitted to pediatric critical care unit (PICU). To compare its clinical characteristic and evolution with those receiving NIMV or other respiratory support. Methods: prospective observational study done in children admitted to PICU with severe asthma (October 2017 to October 2019). Data collected: epidemiological, clinical, respiratory support, thorax x-ray, pharmacological treatments and days of admission. Patients were divided into groups: 1) Only HFNC 2) HFNC and NIMV, and 3) Only NIMV. Results: Seventy-six patients included, 39 girls. The median age was two years and one month (range 160). The median pulmonary score was 5 (range 7). PICU admission lengths a median of 3 days (range 9), hospital 6 days (range 23). There were no epidemiological or clinical differences between groups. Children with only HNFC showed a shorter time of PICU days (p 0,025) and none of them required NIMV. In the group receiving both modalities, NIMV was used first and then HFNC in all cases. Children with HFNC showed higher SaO2/FiO2 ratio (p=0,025) and lower PCO2 level (p=0,032). There were no deaths. Conclusions: in our study the HFNC did not require escalation to NIMV and did not increase the length of PICU or hospital days. Normal initial blood gases and absence of high oxygen requirements were useful to select responders to HNFC.

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 Protocolized Post-Extubation Respiratory Support to prevent reintubation: protocol and statistical analysis plan for a clinical trial

BMJ Open ◽  
2019 ◽  
Vol 9 (8) ◽  
pp. e030476 ◽  
Author(s):  
Jonathan Dale Casey ◽  
Erin R Vaughan ◽  
Bradley D Lloyd ◽  
Peter A Bilas ◽  
Eric J Hall ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Usual Care ◽  
Invasive Mechanical Ventilation ◽  
High Flow ◽  
Respiratory Support ◽  
Invasive Ventilation ◽  
High Flow Nasal Cannula ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
Risk Patients

IntroductionFollowing extubation from invasive mechanical ventilation, nearly one in seven critically ill adults requires reintubation. Reintubation is independently associated with increased mortality. Postextubation respiratory support (non-invasive ventilation or high-flow nasal cannula applied at the time of extubation) has been reported in small-to-moderate-sized trials to reduce reintubation rates among hypercapnic patients, high-risk patients without hypercapnia and low-risk patients without hypercapnia. It is unknown whether protocolised provision of postextubation respiratory support to every patient undergoing extubation would reduce the overall reintubation rate, compared with usual care.Methods and analysisThe Protocolized Post-Extubation Respiratory Support (PROPER) trial is a pragmatic, cluster cross-over trial being conducted between 1 October 2017 and 31 March 2019 in the medical intensive care unit of Vanderbilt University Medical Center. PROPER compares usual care versus protocolized post-extubation respiratory support (a respiratory therapist-driven protocol that advises the provision of non-invasive ventilation or high-flow nasal cannula based on patient characteristics). For the duration of the trial, the unit is divided into two clusters. One cluster receives protocolised support and the other receives usual care. Each cluster crosses over between treatment group assignments every 3 months. All adults undergoing extubation from invasive mechanical ventilation are enrolled except those who received less than 12 hours of mechanical ventilation, have ‘Do Not Intubate’ orders, or have been previously reintubated during the hospitalisation. The anticipated enrolment is approximately 630 patients. The primary outcome is reintubation within 96 hours of extubation.Ethics and disseminationThe trial was approved by the Vanderbilt Institutional Review Board. The results will be submitted for publication in a peer-reviewed journal and presented at one or more scientific conferences.Trial registration numberNCT03288311.

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