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Nahum, Avi

doi:10.1186/cc124

Cited by 19 publications

(5 citation statements)

References 39 publications

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“…This phenomenon was thought to be because delivered gas from the HFNC must enter and exit from only the nostrils with the closed-mouth condition; thus, the closed-mouth condition is much less efficient than the open-mouth condition in which delivered gas enters through the nostrils and exits from the oral cavity. In a past study recording capnograms with TGI, intubated and mechanically ventilated patients showed a decrease of PCO 2 during phase 3, and this reduction was said to be associated with the efficiency of reducing dead space ventilation [ 9 , 14 ]. In our study, capnograms recorded at the upper pharynx and oral cavity showed the same PCO 2 decrease at phase 3 but not at the trachea, which meant that HFNC-delivered gas was not able to reach down to the trachea.…”

Section: Discussionmentioning

confidence: 99%

A high-flow nasal cannula system with relatively low flow effectively washes out CO2 from the anatomical dead space in a sophisticated respiratory model made by a 3D printer

Onodera

Akimoto

Suzuki

et al. 2018

ICMx

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BackgroundAlthough clinical studies of the high-flow nasal cannula (HFNC) and its effect on positive end-expiratory pressure (PEEP) have been done, the washout effect has not been well evaluated. Therefore, we made an experimental respiratory model to evaluate the respiratory physiological effect of HFNC.MethodsAn airway model was made by a 3D printer using the craniocervical 3D-CT data of a healthy 32-year-old male. CO2 was infused into four respiratory lung models (normal-lung, open- and closed-mouth models; restrictive- and obstructive-lung, open-mouth models) to maintain the partial pressure of end-tidal CO2 (PETCO2) at 40 mmHg. HFNC flow was changed from 10 to 60 L/min. Capnograms were recorded at the upper pharynx, oral cavity, subglottic, and inlet sites of each lung model.ResultsWith the normal-lung, open-mouth model, 10 L/min of HFNC flow decreased the subglottic PETCO2 to 30 mmHg. Increasing the HFNC flow did not further decrease the subglottic PETCO2. With the normal-lung, closed-mouth model, HFNC flow of 40 L/min was required to decrease the PETCO2 at all sites. Subglottic PETCO2 reached 30 mmHg with an HFNC flow of 60 L/min. In the obstructive-lung, open-mouth model, PETCO2 at all sites had the same trend as in the normal-lung, open-mouth model. In the restrictive-lung, open-mouth model, 20 L/min of HFNC flow decreased the subglottic PETCO2 to 25 mmHg, and it did not decrease further. As HFNC flow was increased, PEEP up to 7 cmH2O was gradually generated in the open-mouth models and up to 17 cmH2O in the normal-lung, closed-mouth model.ConclusionsThe washout effect of the HFNC was effective with relatively low flow in the open-mouth models. The closed-mouth model needed more flow to generate a washout effect. Therefore, HFNC flow should be considered based on the need for the washout effect or PEEP.

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Section: Discussionmentioning

confidence: 99%

A high-flow nasal cannula system with relatively low flow effectively washes out CO2 from the anatomical dead space in a sophisticated respiratory model made by a 3D printer

Onodera

Akimoto

Suzuki

et al. 2018

ICMx

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“…What is surprising is that insufflation via the bronchoscope is not an integral part of the conversation in the literature about sedation-induced hypoxia; we were able to find one report of the efficacy of bronchoscopic insufflation during intubation over a bronchoscope, 9 and two case reports of insufflation via the bronchoscope causing pneumothoraces due to obstructed airways, the one contraindication identified in this study. 10 , 11 The literature on insufflation does not discuss insufflation via a bronchoscope for treatment of hypoxia, 12 – 14 and a recent review of management of oxygenation during bronchoscopy did not even mention insufflation. 15 Insufflation for re-expansion of atelectasis has been reported.…”

Section: Discussionmentioning

confidence: 99%

Oxygen insufflation through the bronchoscope channel for sedation-induced hypoxia: safe and effective

Abouzgheib

Miller

Bartter

2023

Ther Adv Respir Dis

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Objectives: To evaluate both efficacy and safety parameters for insufflation through the bronchoscope as a method of recovery from sedation-induced hypoxia. To explore parameters applicable to use in human beings using an animal model. Materials and methods: Two adult pigs were sedated enough to depress respiratory drive. The effects of insufflation at 15 l/min (the upper limits of flow that might be used clinically) were then evaluated. Pressure and volume responses to bronchoscopy during intubation and without an endotracheal tube in place were recorded. Several assays were performed for each scenario, with each animal acting as its own control. Recovery from hypoxemia using insufflation was compared with recovery using mechanical ventilation. Results: Insufflation was effective, with rapid increases in fraction of inspired oxygen (FIO2), saturation, and partial pressure of arterial oxygen (PaO2). The rate of recovery using insufflation was faster than that from institution of mechanical ventilation. Insufflation in an intubated animal with cuff inflated led to a rapid and dangerous rise in pressure. With balloon deflated, there were no adverse pressure consequences from insufflation via the endotracheal tube at a rate of 15 l/min. Conclusion: Insufflation through the bronchoscope for episodes of sedation-induced hypoxia should be safe and effective as long as not delivered within a closed system.

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“…Furthermore, by insufflating oxygen near the carina, the anatomic dead space is decreased, which increases alveolar ventilation and thereby decreases work of breathing. [ 9 ] Eventually patients are less homebound as they can be away from home longer with decreased oxygen flow rates. The later should impact quality of life.…”

Section: Discussion and Review Of The Literaturementioning

confidence: 99%

Three decades of transtracheal oxygen therapy: A review of the associated complications with an illustrative case presentation

Siddiqui

Campbell

et al. 2017

Lung India

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Untitled

Cited by 19 publications

References 39 publications

A high-flow nasal cannula system with relatively low flow effectively washes out CO2 from the anatomical dead space in a sophisticated respiratory model made by a 3D printer

A high-flow nasal cannula system with relatively low flow effectively washes out CO2 from the anatomical dead space in a sophisticated respiratory model made by a 3D printer

Oxygen insufflation through the bronchoscope channel for sedation-induced hypoxia: safe and effective

Three decades of transtracheal oxygen therapy: A review of the associated complications with an illustrative case presentation

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