Frederic Vargas1, Mélanie Saint-Leger2, Alexandre Boyer2, Nam H Bui2, Gilles Hilbert3. 1. Service de Réanimation Médicale, Hôpital Pellegrin-Tripode, Bordeaux, France. Centre de Recherche Cardio-thoracique, CIC 0005, Université de Bordeaux, Bordeaux, France. frederic.vargas@chu-bordeaux.fr. 2. Service de Réanimation Médicale, Hôpital Pellegrin-Tripode, Bordeaux, France. 3. Service de Réanimation Médicale, Hôpital Pellegrin-Tripode, Bordeaux, France. Centre de Recherche Cardio-thoracique, CIC 0005, Université de Bordeaux, Bordeaux, France.
Abstract
INTRODUCTION: High-flow nasal cannula (HFNC) can deliver heated and humidified gas (up to 100% oxygen) at a maximum flow of 60 L/min via nasal prongs or cannula. The aim of this study was to assess the short-term physiologic effects of HFNC. Inspiratory muscle effort, gas exchange, dyspnea score, and comfort were evaluated. METHODS: Twelve subjects admitted to the ICU for acute hypoxemic respiratory failure were prospectively included. Four study sessions were performed. The first session consisted of oxygen therapy given through a high-FIO2, non-rebreathing face mask. Recordings were then obtained during periods of HFNC and CPAP at 5 cm H2O in random order, and final measurements were performed during oxygen therapy delivered via a face mask. Each of these 4 periods lasted ∼20 min. RESULTS: Esophageal pressure signals, breathing pattern, gas exchange, comfort, and dyspnea were measured. Compared with the first session, HFNC reduced inspiratory effort (pressure-time product of 156.0 [119.2-194.4] cm H2O × s/min vs 204.2 [149.6-324.7] cm H2O × s/min, P < .01) and breathing frequency (P < .01). No significant differences were observed between HFNC and CPAP for inspiratory effort and breathing frequency. Compared with the first session, PaO2/FIO2 increased significantly with HFNC (167 [157-184] mm Hg vs 156 [110-171] mm Hg, P < .01). CPAP produced significantly greater PaO2/FIO2 improvement than did HFNC. Dyspnea improved with HFNC and CPAP, but this improvement was not significant. Subject comfort was not different across the 4 sessions. CONCLUSIONS: Compared with conventional oxygen therapy, HFNC improved inspiratory effort and oxygenation. In subjects with acute hypoxemic respiratory failure, HFNC is an alternative to conventional oxygen therapy. (ClinicalTrials.gov registration NCT01056952.).
INTRODUCTION: High-flow nasal cannula (HFNC) can deliver heated and humidified gas (up to 100% oxygen) at a maximum flow of 60 L/min via nasal prongs or cannula. The aim of this study was to assess the short-term physiologic effects of HFNC. Inspiratory muscle effort, gas exchange, dyspnea score, and comfort were evaluated. METHODS: Twelve subjects admitted to the ICU for acute hypoxemic respiratory failure were prospectively included. Four study sessions were performed. The first session consisted of oxygen therapy given through a high-FIO2, non-rebreathing face mask. Recordings were then obtained during periods of HFNC and CPAP at 5 cm H2O in random order, and final measurements were performed during oxygen therapy delivered via a face mask. Each of these 4 periods lasted ∼20 min. RESULTS: Esophageal pressure signals, breathing pattern, gas exchange, comfort, and dyspnea were measured. Compared with the first session, HFNC reduced inspiratory effort (pressure-time product of 156.0 [119.2-194.4] cm H2O × s/min vs 204.2 [149.6-324.7] cm H2O × s/min, P < .01) and breathing frequency (P < .01). No significant differences were observed between HFNC and CPAP for inspiratory effort and breathing frequency. Compared with the first session, PaO2/FIO2 increased significantly with HFNC (167 [157-184] mm Hg vs 156 [110-171] mm Hg, P < .01). CPAP produced significantly greater PaO2/FIO2 improvement than did HFNC. Dyspnea improved with HFNC and CPAP, but this improvement was not significant. Subject comfort was not different across the 4 sessions. CONCLUSIONS: Compared with conventional oxygen therapy, HFNC improved inspiratory effort and oxygenation. In subjects with acute hypoxemic respiratory failure, HFNC is an alternative to conventional oxygen therapy. (ClinicalTrials.gov registration NCT01056952.).
Authors: Amanda Corley; Claire M Rickard; Leanne M Aitken; Amy Johnston; Adrian Barnett; John F Fraser; Sharon R Lewis; Andrew F Smith Journal: Cochrane Database Syst Rev Date: 2017-05-30
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