scholarly journals Effects of High Flow Nasal Cannula on the Coordination between Swallowing and Breathing in Postextubation Patients, a Randomized Crossover Study

2021 ◽  
Author(s):  
Pornpan Rattanajiajaroen ◽  
Napplika Kongpolprom
Keyword(s):  
Crossover Study ◽  
Oxygen Therapy ◽  
Invasive Mechanical Ventilation ◽  
High Flow ◽  
Low Flow ◽  
Protective Mechanisms ◽  
The Mean ◽  
Risk Of Aspiration ◽  
To Receive ◽  
Respiratory Phases

Abstract Background: Timing of swallows in relation to respiratory phases is associated with aspiration events. Oxygen therapy possibly affects the timing of swallows, which may alter airway protective mechanisms.Objectives: To compare the coordination between swallowing and respiration during water infusion in post-extubation patients using high flow nasal oxygen(HFNO) with the coordination in those using low flow nasal oxygen(LFNO).Methods: We conducted a randomized controlled crossover study in post-extubation patients. The patients extubated within 48 hours were randomly assigned into two groups, namely HFNO and LFNO. The eligible patients in each group received either HFNO with FiO2 35%, flow 50 LPM and temperature 34˚ C or LFNO 5 LPM for 5 minutes. The coordination between swallowing and respiration was observed during continuous infusion of 10 ml of water in one minute for three times. Respiratory phases and swallowing were monitored using ECG-derived respiratory signals and submental EMG, respectively. The swallowing frequency and timing of swallows in relation to respiratory phases were recorded. The coordination between swallowing and respiration was classified into 4 patterns, namely I ,E ,I-E and E-I swallows. (I; inspiration and E; expiration) Subsequently, after the 5 minute washout period, the patients were switched to receive the other type of oxygen therapy with the same procedure. Wilcoxon Signed Ranks Test was used for statistical analysis.Results: A total of 22 patients with the mean age of 55.8 years were enrolled into the study. The major indication for invasive mechanical ventilation was pneumonia with the median duration of endotracheal intubation of 2.5 days. The median of total swallowing numbers (three minutes) were 18.5 in the HFNO period and 21 in the LFNO period (p = 0.158). The most common swallowing pattern was E swallow. The patients using HFNO had higher numbers of E-swallow pattern (74.3% in HFNO vs 67.6% in LFNO; p = 0.048) and lower numbers of I-swallow pattern (14.3% in HFNO vs 23.1% in LFNO; p = 0.044). The numbers of other swallowing patterns were not different between 2 groups.Conclusions: Compared with LFNO, HFNO significantly increased the E-swallow and decreased the I- swallow in post-extubation patients. The findings indicated that HFNO might reduce the risk of aspiration during the post-extubation period.

scholarly journals Effects of high flow nasal cannula on the coordination between swallowing and breathing in postextubation patients, a randomized crossover study

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Pornpan Rattanajiajaroen ◽  
Napplika Kongpolprom
Keyword(s):  
Clinical Trial ◽  
Crossover Study ◽  
Oxygen Therapy ◽  
Invasive Mechanical Ventilation ◽  
High Flow ◽  
Low Flow ◽  
Rank Test ◽  
Protective Mechanisms ◽  
Signed Rank Test ◽  
Respiratory Phases

Abstract Background Timing of swallows in relation to respiratory phases is associated with aspiration events. Oxygen therapy possibly affects the timing of swallows, which may alter airway protective mechanisms. Objectives To compare the coordination between swallowing and respiration during water infusion in post-extubation patients using high flow nasal oxygen (HFNO) with the coordination in those using low flow nasal oxygen (LFNO). Methods We conducted a randomized controlled crossover study in post-extubation patients. The patients extubated within 48 h were randomly assigned to two groups, namely, HFNO and LFNO. The eligible patients in each group received either HFNO with fraction of inspired oxygen (FiO2) 0.35, flow 50 L per minute (LPM), and temperature 34 °C or LFNO 5 LPM for 5 min. The coordination between swallowing and respiration was observed during continuous infusion of 10-ml water one minute three times. Respiratory phases and swallowing were monitored using electrocardiogram (EKG)-derived respiratory signals and submental electromyography (EMG), respectively. The swallowing frequency and timing of swallows in relation to respiratory phases were recorded. The coordination between swallowing and respiration was classified into 4 patterns, namely I, E, I-E, and E-I swallows. (I; inspiration and E; expiration) Subsequently, after a 5-min washout period, the patients were switched to the other type of oxygen therapy using the same procedure. The Wilcoxon Signed-Rank Test was used for statistical analysis. Results A total of 22 patients with a mean age of 56 years were enrolled in the study. The major indication for invasive mechanical ventilation was pneumonia with a median duration of endotracheal intubation of 2.5 days. The median total swallowing numbers (three minutes) were 18.5 times in the HFNO period and 21 times in the LFNO period (p = NS). The most common swallowing pattern was E-swallow. The patients using HFNO had higher numbers of E-swallow pattern (74.3% in HFNO vs 67.6% in LFNO; p = 0.048) and lower numbers of I-swallow pattern (14.3% in HFNO vs 23.1% in LFNO; p = 0.044). The numbers of other swallowing patterns were not different between the 2 groups. Conclusions Compared with LFNO, HFNO significantly increased the E-swallow and decreased the I-swallow in post-extubation patients. The findings indicated that HFNO might reduce a risk of aspiration during the post-extubation period. Clinical trial No.: Thai clinical trial TCTR20200206004 Registered February 4, 2020. URL: http://www.clinicaltrials.in.th/index.php?tp=regtrials&menu=trialsearch&smenu=fulltext&task=search&task2=view1&id=5740.

scholarly journals Update on the Role of High-Flow Nasal Cannula in Infants with Bronchiolitis

Children ◽  
2021 ◽  
Vol 8 (2) ◽  
pp. 66
Author(s):  
Valentina Fainardi ◽  
Lara Abelli ◽  
Maria Muscarà ◽  
Giovanna Pisi ◽  
Nicola Principi ◽  
...  
Keyword(s):  
Oxygen Therapy ◽  
Severe Disease ◽  
Invasive Mechanical Ventilation ◽  
High Flow ◽  
Nasal Cannula ◽  
Low Flow ◽  
High Flow Nasal Cannula ◽  
Multicenter Studies ◽  
Good Tolerability

Bronchiolitis (BR), a lower respiratory tract infection mainly caused by respiratory syncytial virus (RSV), can be very severe. Presently, adequate nutritional support and oxygen therapy remain the only interventions recommended to treat patients with BR. For years, mild BR cases were treated with noninvasive standard oxygen therapy (SOT), i.e., with cold and poorly or totally non-humidified oxygen delivered by an ambient headbox or low-flow nasal cannula. Children with severe disease were intubated and treated with invasive mechanical ventilation (IMV). To improve SOT and overcome the disadvantages of IMV, new measures of noninvasive and more efficient oxygen administration have been studied. Bi-level positive air way pressure (BiPAP), continuous positive airway pressure (CPAP), and high-flow nasal cannula (HFNC) are among them. For its simplicity, good tolerability and safety, and the good results reported in clinical studies, HFNC has become increasingly popular and is now widely used. However, consistent guidelines for initiation and discontinuation of HFNC are lacking. In this narrative review, the role of HFNC to treat infants with BR is discussed. An analysis of the literature showed that, despite its widespread use, the role of HFNC in preventing respiratory failure in children with BR is not precisely defined. It is not established whether it can offer greater benefits compared to SOT and when and in which infants it can replace CPAP or BiPAP. The analysis of the results clearly indicates the need for multicenter studies and official guidelines. In the meantime, HFNC can be considered a safe and effective method to treat children with mild to moderate BR who do not respond to SOT.

Utility of the Nasoseptal “Rescue” Flap Approach: Analysis of 125 Consecutive Patients and Implications for Routine Transsphenoidal Surgery

2019 ◽  
Vol 34 (2) ◽  
pp. 269-275
Author(s):  
Zachary J. Cappello ◽  
Dennis M. Tang ◽  
Christopher R. Roxbury ◽  
Brian C. Lobo ◽  
Hamid Borghei-Razavi ◽  
...  
Keyword(s):  
Transsphenoidal Surgery ◽  
Internal Carotid ◽  
Skull Base Surgery ◽  
Cleveland Clinic ◽  
High Flow ◽  
Low Flow ◽  
Csf Leak ◽  
Nasoseptal Flap ◽  
The Mean ◽  
Csf Leaks

Introduction The nasoseptal flap (NSF) is the reconstructive workhorse for endoscopic skull base surgery (ESBS). However, there is morbidity associated with its use and it is not always required for reconstruction. The bilateral nasoseptal “rescue” flap (NSRF) technique offers a quicker alternative to upfront NSF harvest, yet permits the use of a tailored NSF if needed after the defect has been created. The utility and implications of this strategy have not been well studied. Methods We retrospectively analyzed 125 consecutive transsphenoidal cases where an NSRF approach was used from January 2015 to October 2017 at the Cleveland Clinic. Records were analyzed for conversion to NSF, outcomes, and reconstruction-related complications. Results The mean age of patients included in the study was 51 years, with 51% females. NSRF was converted to full NSF in only 16% of cases. Rationale for conversion included an unanticipated high-flow (7) or low-flow (12) cerebrospinal fluid (CSF) leak and an exposed internal carotid artery (1). NSRF was utilized and converted to formal NSF in 3 patients who had previous remote transsphenoidal surgery. One patient who had an NSRF without a full NSF raised had a postoperative CSF leak; however, no CSF leaks or flap ischemia was noted for those who had full NSFs raised, even in revision surgery. Conclusion NSRF approach provides the reliability and flexibility of vascularized reconstruction, without the perioperative disadvantages of an upfront NSF harvest. The low and successful conversion rate to NSF demonstrates the utility of this strategy which should be incorporated into the standard approach for routine transsphenoidal surgery.

Electromyographic swallowing study during high flow oxygen therapy compared with low flow oxygen therapy in post-extubated patients

2019 ◽  
Author(s):  
Sarita Thawanaphong ◽  
Wasuwat Kitisomprayoonkul ◽  
Kannit Pongpipatpaiboon ◽  
Napplika Kongpolprom
Keyword(s):  
Oxygen Therapy ◽  
High Flow ◽  
Low Flow ◽  
High Flow Oxygen

scholarly journals Awake prone positioning does not reduce the risk of intubation in COVID-19 treated with High-Flow Nasal Oxygen therapy. A multicenter, adjusted cohort study

2020 ◽  
Author(s):  
Carlos Ferrando ◽  
Ricard Mellado-Artigas ◽  
Alfredo Gea ◽  
Egoitz Arruti ◽  
César Aldecoa ◽  
...  
Keyword(s):  
Cohort Study ◽  
Oxygen Therapy ◽  
Invasive Mechanical Ventilation ◽  
Vital Signs ◽  
Logistic Models ◽  
High Flow ◽  
Prone Positioning ◽  
Reactive Protein ◽  
Icu Length Of Stay ◽  
Score Apache

Abstract Background Awake prone positioning (awake-PP) in non-intubated coronavirus disease 2019 (COVID-19) patients could avoid endotracheal intubation, reduce the use of critical care resources, and improve survival. We aimed to examine whether the combination of high-flow nasal oxygen therapy (HFNO) with awake-PP prevents the need for intubation when compared to HFNO alone. Methods Prospective, multicentre, adjusted observational cohort study in consecutive COVID-19 patients with acute respiratory failure (ARF) receiving respiratory support with HFNO from 12 March to 9 June, 2020. Patients were classified as HFNO with or without awake-PP. Logistic models were fitted to predict treatment at baseline using the following variables: age, sex, obesity, non-respiratory sequential organ failure assessment score, APACHE-II, C-reactive protein, days from symptoms onset to HFNO initiation, respiratory rate and peripheral oxyhemoglobin saturation. We compared data on demographics, vital signs, laboratory markers, need for invasive mechanical ventilation, days to intubation, ICU length of stay, and ICU mortality between HFNO patients with and without awake-PP. Results A total of 1076 patients with COVID-19 ARF were admitted, of which 199 patients received HFNO and were analyzed. Fifty-five (27.6%) were pronated during HFNO; 60 (41%) and 22 (40%) patients from the HFNO and HFNO+awake-PP groups were intubated. The use of awake-PP as an adjunctive therapy to HFNO did not reduce the risk of intubation [RR 0.87 (95%CI: 0.53–1.43), p=0.60]. Patients treated with HFNO+awake-PP showed a trend for delay in intubation compared to HFNO alone [median 1 (interquartile range, IQR 1.0-2.5) vs 2 IQR 1.0-3.0] days, (p=0.055), but awake-PP did not affect 28-day mortality [RR 1.04 (95%CI: 0.40–2.72), p=0.92]. Conclusion In patients with COVID-19 ARF treated with HFNO, the use of awake-PP did not reduce the need for intubation or affect mortality.

scholarly journals Safety and clinical outcomes of remdesivir in hospitalised COVID-19 patients: a retrospective analysis of active surveillance database

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Vaishali Gupte ◽  
Rashmi Hegde ◽  
Sandesh Sawant ◽  
Kabil Kalathingal ◽  
Sonali Jadhav ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Retrospective Analysis ◽  
Clinical Outcomes ◽  
Oxygen Therapy ◽  
High Flow ◽  
Low Flow ◽  
Invasive Ventilation ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
High Flow Oxygen

Abstract Background Real-world data on safety and clinical outcomes of remdesivir in COVID-19 management is scant. We present findings of data analysis conducted for assessing the safety and clinical outcomes of remdesivir treatment for COVID-19 in India. Methods This retrospective analysis used data from an active surveillance programme database of hospitalised patients with COVID-19 who were receiving remdesivir. Results Of the 2329 patients included, 67.40% were men. Diabetes (29.69%) and hypertension (20.33%) were the most common comorbidities. At remdesivir initiation, 2272 (97.55%) patients were receiving oxygen therapy. Remdesivir was administered for 5 days in 65.38% of patients. Antibiotics (64.90%) and steroids (47.90%) were the most common concomitant medications. Remdesivir was overall well tolerated, and total 119 adverse events were reported; most common were nausea and vomiting in 45.40% and increased liver enzymes in 14.28% patients. 84% of patients were cured/improved, 6.77% died and 9.16% showed no improvement in their clinical status at data collection. Subgroup analyses showed that the mortality rate was significantly lower in patients < 60 years old than in those > 60 years old. Amongst patients on oxygen therapy, the cure/improvement rate was significantly higher in those receiving standard low-flow oxygen than in those receiving mechanical ventilation, non-invasive ventilation, or high-flow oxygen. Factors that were associated with higher mortality were age > 60 years, cardiac disease, diabetes high flow oxygen, non-invasive ventilation and mechanical ventilation. Conclusion Our analysis showed that remdesivir is well tolerated and has an acceptable safety profile. The clinical outcome of cure/improvement was 84%, with a higher improvement in patients < 60 years old and on standard low-flow oxygen.

scholarly journals Water Yield Responses to Gradual Changes in Forest Structure and Species Composition in a Subboreal Watershed in Northeastern China

Forests ◽  
2019 ◽  
Vol 10 (3) ◽  
pp. 211 ◽  
Author(s):  
Zhengxiang Yu ◽  
Ge Sun ◽  
Tijiu Cai ◽  
Dennis Hallema ◽  
Liangliang Duan
Keyword(s):  
Climate Change ◽  
Species Composition ◽  
Forest Structure ◽  
Northeastern China ◽  
High Flow ◽  
Low Flow ◽  
Water Yield ◽  
Forest Change ◽  
Annual Streamflow ◽  
The Mean

Relationships between forest cover and streamflow have been studied worldwide, but only a few studies have examined how gradual changes in forest structure and species composition due to logging and climate change affect watershed water yield (Q) and flow regimes. In this study, we analyzed long-term (45 years) hydrologic, climate and forest dynamics data from the subboreal Tahe watershed in northeastern China. Our purpose was to evaluate the effects of forest logging and regeneration on changes in forest biomass and species and to quantify the subsequent impact on mean annual streamflow and flow regime under a changing climate. The study watershed was dominated by old-growth larch (Larix gmelinii Rupr.) during the 1970s, but gradually transformed into young deciduous larch mixed with deciduous broad-leaved birch (Betula platyphylla Sukaczev) during the 2010s. During the same period, the watershed experienced climate change with a significant increase in air temperature of 0.028 ℃/year. We applied eight sensitivity-based techniques to separate the effects of climate change on water yield from those due to forest changes. We used flow duration curves (FDCs) to characterize flow regimes by dividing the study into four key periods based on the proportional change of larch and birch trees. We found that the mean annual streamflow decreased by 10 mm (−16 mm attributed to forest change and +6 mm to climate change) between the 1984–1994 period and the 2006–2016 period when the proportion of birch increased by 20% with a similar total forest volume in the later period. The mean annual streamflow increased from 216 mm to 270 mm (+35.5 mm due to forest change vs +17.7 mm due to climate change) when forest volume decreased by 18.7% (17 m3/ha) between the 1970s and 1984–1994. Water yield changed only slightly (3.5 mm) when forest volume increased by 8.7% (6 m3/ha) from 2000 to 2011. In addition, the magnitude of high flow and low flow increased following deforestation and a shift in species composition from a period (1984–1994) with 70% larch with 30% birch to a later period (2006–2016) with 50% larch with 50% birch. Both high flow and low flow decreased coinciding with a reforestation period (2006–2016). Our results highlight complex interactions among climate, forest structure, total biomass, and plant diversity (trees species composition) in influencing watershed hydrology. Further study is needed to examine the effects of ecohydrological processes such as evapotranspiration in larch and birch forests on hydrologic changes across multiple scales.

scholarly journals Influence of Noninvasive Respiratory Support Techniques on Gas Exchange in Cardiac Surgical Patients Suffering from Post-Operative Respiratory Failure

2019 ◽  
Vol 15 (4) ◽  
pp. 21-31 ◽  
Author(s):  
A. A. Eremenko ◽  
Р. V. Polyakova ◽  
M. A. Vyzhigina
Keyword(s):  
Respiratory Failure ◽  
Gas Exchange ◽  
Oxygen Therapy ◽  
High Flow ◽  
Surgical Patients ◽  
Low Flow ◽  
Positive Pressure ◽  
Mask Ventilation ◽  
Air Breathing ◽  
Positive Effect

Respiratory failure (RF) after tracheal extubation occurs in 5–25% of cardiac surgical patients. Various noninvasive respiratory support techniques are available for RF treatment.The purpose of the study is a comparative assessment of the effect on gas exchange of oxygen inhalation through a mask with noninvasive airway positive pressure mask ventilation, and high-flow lung ventilation during post-extubation respiratory failure in cardiac surgical patients.Materials and methods. 52 cardiac surgical patients with post-extubation respiratory failure (mean age 61 (55–67) years) were included in the study. Respiratory failure critera were as follows: PaO2/FiO2 _ 300 mm Hg or SpO2 _ 88% during room air breathing. Exclusion criteria included presentation of pleural effusion in patients, pneumothorax, diaphragm paresis. Every patient was subjected consecutively to arterial blood gases test during room air breathing, low-flow oxygen therapy using a mask with a pre-volume bag, high-flow ventilation (HFNC), and noninvasive positive pressure mask ventilation (NIPPV). Each method was applied during 1 hour prior to the test. Respiratory rate (RR) and capillary blood saturation (SpO2) were monitored throughout the whole study.Results. PaO2/FiO2 during low-flow oxygen therapy was equal to 171 (137–243) mm Hg. At the background of HFNC, this index increased to 235 (183–305) mm Hg (P=0.00004), and upon transfer to NIPPV — to 228 (180–288) mm Hg (P=0.000028). SpO2 during HFNC and NIPPV increased from 95 (93–98)% to 98 (96–99)% (P=0.000006) and 97 (95–98)%, respectively (P=0.000006 and P=0.000069). PaCO2 was higher during oxygen mask breathing compared to air breathing: 41 (37–44) mm Hg and 38 (34–42) mm Hg, correspondingly, P=0.0017. Upon transfer to HFNC, PaCO2 lowered on average by 10% (37 (33–39) mm Hg, P=0.0000001), to NIPPV — by 7% (38 (36–42) mm Hg, P=0,0015). Differences were also significant when compred RR during oxygen mask breathing (20 (16–24) respirations/minute) vs. HFNC (16 (12–20) respirations/minute, P=0.0) and vs. NIPPV (18 (16–20) respirations/minute, P=0.018). Comparison of HFNC vs. NIPPV revealed reliable difference in RR (16 (12–20) respirations/minute against 18 (16-20) respirations/minute, P=0.016), PaCO2 (37 (33–39) mm Hg against 38 (36–42) mm Hg, P=0.0034), and SpO2 (98 (96–99)% against 97 (95–98)%, P=0.022).Conclusion. HFNC and NIPPV exert a similar positive effect on the oxygenating function of lungs and gas exchange in cardiac surgical patients with post-extubation respiratory failure. Compared to NIPPV, high-flow ventilation renders most significant positive effect on elimination of CO2, RR and SpO2, and is better tolerated by patients.

scholarly journals Predictors of Mortality in Critically Ill COVID-19 Patients Demanding High Oxygen Flow: A Thin Line between Inflammation, Cytokine Storm, and Coagulopathy

2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Viseslav Popadic ◽  
Slobodan Klasnja ◽  
Natasa Milic ◽  
Nina Rajovic ◽  
Aleksandra Aleksic ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Serum Albumin ◽  
Critically Ill ◽  
Severity Score ◽  
Oxygen Therapy ◽  
Invasive Mechanical Ventilation ◽  
High Flow ◽  
Predictors Of Mortality ◽  
High Flow Oxygen ◽  
D Dimer

Introduction. Mortality among critically ill COVID-19 patients remains relatively high despite different potential therapeutic modalities being introduced recently. The treatment of critically ill patients is a challenging task, without identified credible predictors of mortality. Methods. We performed an analysis of 160 consecutive patients with confirmed COVID-19 infection admitted to the Respiratory Intensive Care Unit between June 23, 2020, and October 2, 2020, in University Hospital Center Bezanijska kosa, Belgrade, Serbia. Patients on invasive, noninvasive ventilation and high flow oxygen therapy with moderate to severe ARDS, according to the Berlin definition of ARDS, were selected for the study. Demographic data, past medical history, laboratory values, and CT severity score were analyzed to identify predictors of mortality. Univariate and multivariate logistic regression models were used to assess potential predictors of mortality in critically ill COVID-19 patients. Results. The mean patient age was 65.6 years (range, 29–92 years), predominantly men, 68.8%. 107 (66.9%) patients were on invasive mechanical ventilation, 31 (19.3%) on noninvasive, and 22 (13.8%) on high flow oxygen therapy machine. The median total number of ICU days was 10 (25th to 75th percentile: 6–18), while the median total number of hospital stay was 18 (25th to 75th percentile: 12–28). The mortality rate was 60% (96/160). Univariate logistic regression analysis confirmed the significance of age, CRP, and lymphocytes at admission to hospital, serum albumin, D-dimer, and IL-6 at admission to ICU, and CT score. Serum albumin, D-dimer, and IL-6 at admission to ICU were independently associated with mortality in the final multivariate analysis. Conclusion. In the present study of 160 consecutive critically ill COVID-19 patients with moderate to severe ARDS, IL-6, serum albumin, and D-dimer at admission to ICU, accompanied by chest CT severity score, were marked as independent predictors of mortality.

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