Federico Longhini1, Lara Pisani2, Ramona Lungu3, Vittoria Comellini2, Andrea Bruni4, Eugenio Garofalo4, Maria Laura Vega2, Gianmaria Cammarota3, Stefano Nava2, Paolo Navalesi4. 1. Anesthesia and Intensive Care, Sant'Andrea Hospital, ASL VC, Vercelli, Italy. 2. Department of Clinical, Integrated and Experimental Medicine (DIMES), Respiratory and Critical Care Unit, S. Orsola-Malpighi Hospital, Alma Mater University, Bologna, Italy. 3. Anesthesia and Intensive Care, Maggiore della Carità Hospital, Novara, Italy. 4. Intensive Care Unit, University Hospital Mater Domini, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy.
Abstract
OBJECTIVES:Assessing gas exchange, diaphragm function, respiratory rate, and patient comfort during high-flow oxygen therapy and standard oxygen at the time of noninvasive ventilation discontinuation. DESIGN: Randomized crossover physiologic study. SETTING: Two ICUs. PATIENTS: Thirty chronic obstructive pulmonary disease patients with hypercapnic acute respiratory failure receiving noninvasive ventilation greater than 24 hours. INTERVENTIONS: All patients underwent five 30-minute trials, the first, third, and fifth trial in noninvasive ventilation, whereas the second and fourth were randomly conducted with either standard oxygen and high-flow oxygen therapy. MEASUREMENTS AND MAIN RESULTS:Diaphragm displacement and thickening fraction were determined by sonographic evaluation at the end of each trial. Arterial blood gases, respiratory rate, and patient comfort were also assessed. PaCO2 (p = 0.153) and pH (p = 0.114) were not different among trials, while PaO2 was greater in noninvasive ventilation than with both standard oxygen (p ≤ 0.005) and high-flow oxygen therapy (p ≤ 0.001). The diaphragm displacement was no different among trials (p = 0.875), while its thickening fraction was greater with standard oxygen, compared with high-flow oxygen therapy and all noninvasive ventilation trials (p < 0.001 for all comparisons), without differences between high-flow oxygen therapy and noninvasive ventilation. Respiratory rate also increased with standard oxygen, compared with both high-flow oxygen therapy (p < 0.001) and noninvasive ventilation (p < 0.01). High-flow oxygen therapy improved comfort, compared with standard oxygen (p = 0.004) and noninvasive ventilation (p < 0.001). CONCLUSIONS: At the time of noninvasive ventilation interruption, PaCO2 and diaphragm displacement remained unchanged regardless of the modality of oxygen administration. However, although standard oxygen resulted in a remarkable increase in diaphragm thickening fraction, high-flow oxygen therapy allowed maintaining it unchanged, while improving patient comfort.
RCT Entities:
OBJECTIVES: Assessing gas exchange, diaphragm function, respiratory rate, and patient comfort during high-flow oxygen therapy and standard oxygen at the time of noninvasive ventilation discontinuation. DESIGN: Randomized crossover physiologic study. SETTING: Two ICUs. PATIENTS: Thirty chronic obstructive pulmonary diseasepatients with hypercapnic acute respiratory failure receiving noninvasive ventilation greater than 24 hours. INTERVENTIONS: All patients underwent five 30-minute trials, the first, third, and fifth trial in noninvasive ventilation, whereas the second and fourth were randomly conducted with either standard oxygen and high-flow oxygen therapy. MEASUREMENTS AND MAIN RESULTS: Diaphragm displacement and thickening fraction were determined by sonographic evaluation at the end of each trial. Arterial blood gases, respiratory rate, and patient comfort were also assessed. PaCO2 (p = 0.153) and pH (p = 0.114) were not different among trials, while PaO2 was greater in noninvasive ventilation than with both standard oxygen (p ≤ 0.005) and high-flow oxygen therapy (p ≤ 0.001). The diaphragm displacement was no different among trials (p = 0.875), while its thickening fraction was greater with standard oxygen, compared with high-flow oxygen therapy and all noninvasive ventilation trials (p < 0.001 for all comparisons), without differences between high-flow oxygen therapy and noninvasive ventilation. Respiratory rate also increased with standard oxygen, compared with both high-flow oxygen therapy (p < 0.001) and noninvasive ventilation (p < 0.01). High-flow oxygen therapy improved comfort, compared with standard oxygen (p = 0.004) and noninvasive ventilation (p < 0.001). CONCLUSIONS: At the time of noninvasive ventilation interruption, PaCO2 and diaphragm displacement remained unchanged regardless of the modality of oxygen administration. However, although standard oxygen resulted in a remarkable increase in diaphragm thickening fraction, high-flow oxygen therapy allowed maintaining it unchanged, while improving patient comfort.
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
Authors: Andrea Bruni; Eugenio Garofalo; Valeria Zuccalà; Giuseppe Currò; Carlo Torti; Giuseppe Navarra; Giovambattista De Sarro; Paolo Navalesi; Federico Longhini; Michele Ammendola Journal: World J Emerg Surg Date: 2020-07-02 Impact factor: 5.469
Authors: Eugenio Garofalo; Andrea Bruni; Corrado Pelaia; Giovanni Landoni; Alberto Zangrillo; Massimo Antonelli; Giorgio Conti; Daniele Guerino Biasucci; Giovanna Mercurio; Andrea Cortegiani; Antonino Giarratano; Luigi Vetrugno; Tiziana Bove; Francesco Forfori; Francesco Corradi; Rosanna Vaschetto; Gianmaria Cammarota; Marinella Astuto; Paolo Murabito; Valentina Bellini; Massimo Zambon; Federico Longhini; Paolo Navalesi; Elena Bignami Journal: Ultrasound J Date: 2019-10-03
Authors: Maria Mazzitelli; Eugenio Garofalo; Andrea Bruni; Giorgio Settimo Barreca; Angela Quirino; Aida Giancotti; Francesca Serapide; Ciro Indolfi; Giovanni Matera; Paolo Navalesi; Enrico Maria Trecarichi; Carlo Torti; Federico Longhini Journal: Clin Case Rep Date: 2019-10-21