Weaning from mechanical ventilation with high flow oxygen therapy via tracheal cannula

Introduction: Application of oxygen at high flows via nasal cannula can be used in patients with hypoxemic respiratory failure and to prevent reintubation. It is well tolerated by the patients and has been associated with lower mortality. However, there is very little data on the use of oxygen at high flows connected to tracheal cannula (HFOTC). Case presentation: We present two patients in whom weaning from mechanical ventilation was difficult and we decided to use HFOTC for weaning. Weaning from mechanical ventilation with HFOTC was successful in both patients and they tolerated long term (4 and 2 days, respectively) ventilatory support with HFOTC without adverse effects. Conclusions: HFOTC might be used during weaning from mechanical ventilation, however, more data is needed to determine the optimal use of this treatment option.

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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?

Journal of Intensive Care Medicine ◽

10.1177/08850666211057503 ◽

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.

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High-flow oxygen via tracheostomy improves oxygenation in patients weaning from mechanical ventilation: a randomised crossover study

Intensive Care Medicine ◽

10.1007/s00134-016-4634-7 ◽

2016 ◽

Vol 43 (3) ◽

pp. 465-467 ◽

Cited By ~ 10

Author(s):

Amanda Corley ◽

Melannie Edwards ◽

Amy J. Spooner ◽

Kimble R. Dunster ◽

Chris Anstey ◽

...

Keyword(s):

Mechanical Ventilation ◽

Crossover Study ◽

High Flow ◽

Weaning From Mechanical Ventilation ◽

High Flow Oxygen

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High-Flow Oxygen Therapy to Speed Weaning From Mechanical Ventilation: A Prospective Randomized Study

American Journal of Critical Care ◽

10.4037/ajcc2019130 ◽

2019 ◽

Vol 28 (5) ◽

pp. 370-376 ◽

Cited By ~ 1

Author(s):

Fen Liu ◽

Qiang Shao ◽

Rong Jiang ◽

Zhenguo Zeng ◽

Yang Liu ◽

...

Keyword(s):

Mechanical Ventilation ◽

Oxygen Therapy ◽

Randomized Study ◽

High Flow ◽

Prospective Randomized Study ◽

Weaning From Mechanical Ventilation ◽

High Flow Oxygen

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Characteristics and outcome of patients set up on high-flow oxygen therapy at home

Therapeutic Advances in Respiratory Disease ◽

10.1177/1753466619879794 ◽

2019 ◽

Vol 13 ◽

pp. 175346661987979 ◽

Cited By ~ 2

Author(s):

Samuel Dolidon ◽

Johann Dupuis ◽

Luis-Carlos Molano Valencia ◽

Mathieu Salaün ◽

Luc Thiberville ◽

...

Keyword(s):

Respiratory Failure ◽

Median Survival ◽

Oxygen Therapy ◽

Airway Disease ◽

High Flow ◽

University Hospital ◽

Hypoxemic Respiratory Failure ◽

High Flow Oxygen ◽

At Home

Background: High-flow oxygen therapy (HFOT) is increasingly used for acute respiratory failure. Few data support its use at home for the treatment of chronic respiratory failure. Our aim was to report the pattern of the use of long-term HFOT in our center and the outcome of patients setup on long-term HFOT. Methods: A retrospective monocentric study including all patients setup on long-term HFOT between January 2011 and April 2018 in Rouen University Hospital was carried out. Patients were divided into two groups, patients with hypoxemic respiratory failure treated with nasal HFOT (nHFOT) and tracheotomized patients treated with tracheal HFOT (tHFOT). Results: A total of 71 patients were established on long-term HFOT. Out of these 43 (61%) were included in the nHFOT group and 28 (39%) were included in the tHFOT group. In the nHFOT group, underlying respiratory diseases were interstitial lung disease ( n = 15, 35%), pulmonary hypertension ( n = 12, 28%), lung cancer ( n = 9, 21%), and chronic airway disease ( n = 7, 16%). In the tHFOT group, the number of admissions for exacerbation decreased by −0.78 per year (–2 to 0) ( p = 0.045). In total, 51 (72%) patients were discharged to their homes and 20 (28%) went to a post-acute re-enablement facility. Median survival following HFOT was 7.5 months. Survival was significantly lower in the nHFOT group with a median survival of 3.6 months whereas median survival was not reached in the tHFOT group ( p < 0.001). Monthly costs associated with home delivery of HFOT were €476 (296–533) with significant differences in costs between the nHFOT group of €520 (408–628) and costs in the tHFOT group of €296 (261–475) ( p < 0.001). Conclusions: The use of long-term HFOT allows very severe patients to be discharged at a reasonable cost from acute care facilities. The reviews of this paper are available via the supplementary material section.

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Non-invasive ventilatory support and high-flow nasal oxygen as first-line treatment of acute hypoxemic respiratory failure and ARDS

Intensive Care Medicine ◽

10.1007/s00134-021-06459-2 ◽

2021 ◽

Author(s):

Domenico Luca Grieco ◽

Salvatore Maurizio Maggiore ◽

Oriol Roca ◽

Elena Spinelli ◽

Bhakti K. Patel ◽

...

Keyword(s):

Respiratory Failure ◽

Ventilatory Support ◽

High Flow ◽

Line Treatment ◽

First Line ◽

Hypoxemic Respiratory Failure ◽

Acute Hypoxemic Respiratory Failure ◽

Non Invasive ◽

First Line Treatment

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High-flow oxygen therapy in acute hypoxemic respiratory failure

South African Respiratory Journal ◽

10.7196/sarj.2015.v21i4.48 ◽

2015 ◽

Vol 21 (4) ◽

pp. 111

Author(s):

Laila Suleman

Keyword(s):

Respiratory Failure ◽

Oxygen Therapy ◽

High Flow ◽

Hypoxemic Respiratory Failure ◽

Acute Hypoxemic Respiratory Failure ◽

High Flow Oxygen

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Noninvasive Oxygenation Strategies in Immunocompromised Patients With Acute Hypoxemic Respiratory Failure: A Pairwise and Network Meta-Analysis of Randomized Controlled Trials

Journal of Intensive Care Medicine ◽

10.1177/0885066619844713 ◽

2019 ◽

Vol 35 (11) ◽

pp. 1216-1225 ◽

Cited By ~ 2

Author(s):

Yazan Zayed ◽

Momen Banifadel ◽

Mahmoud Barbarawi ◽

Babikir Kheiri ◽

Adam Chahine ◽

...

Keyword(s):

Mechanical Ventilation ◽

Oxygen Therapy ◽

Meta Analysis ◽

Invasive Mechanical Ventilation ◽

Controlled Trials ◽

Immunocompromised Patients ◽

Hypoxemic Respiratory Failure ◽

Acute Hypoxemic Respiratory Failure ◽

Randomized Controlled

Introduction: Acute hypoxemic respiratory failure (AHRF) is a leading cause of intensive care unit (ICU) admission among immunocompromised patients. Invasive mechanical ventilation is associated with increased morbidity and mortality. Objective: To evaluate the efficacy of various oxygenation strategies including noninvasive ventilation (NIV), high-flow nasal cannula (HFNC), and conventional oxygen therapy in immunocompromised patients with AHRF. Methods: Electronic databases including PubMed, Embase, and the Cochrane Library were reviewed from inception to December 2018. We included all randomized controlled trials (RCTs) comparing different modalities of initial oxygenation strategies in immunocompromised patients with AHRF. Our primary outcome was the need for intubation and invasive mechanical ventilation while secondary outcomes were ICU acquired infections and short- and long-term mortality. Data were extracted separately and independently by 2 reviewers. We performed a Bayesian network meta-analysis to calculate odds ratio (OR) and Bayesian 95% credible intervals (CrIs). Results: Nine RCTs were included (1570 patients, mean age 61.1 ± 13.8 years with 64% male). Noninvasive ventilation was associated with a significantly reduced intubation rate compared with standard oxygen therapy (OR: 0.53; 95% CrI: 0.26-0.91). There were no significant reductions of intubation between NIV versus HFNC (OR: 0.83; 95% CrI: 0.35-2.11) or HFNC versus standard oxygen therapy (OR: 0.65; 95% CrI: 0.26-1.24). There were no significant differences between all groups regarding short-term (28-day or ICU) mortality or long-term (90-day or hospital) mortality or ICU-acquired infections ( P > 0.05). Conclusion: Among immunocompromised patients with AHRF, NIV was associated with a significant reduction of intubation compared with standard oxygen therapy. There were no significant differences among all oxygenation strategies regarding mortality and ICU-acquired infections.

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