A Preliminary Randomized Controlled Trial to Assess Effectiveness of Nasal High-Flow Oxygen in Intensive Care Patients

Abstract

OBJECTIVE:In a cardiothoracic and vascular intensive care unit, to compare nasal high-flow (NHF) oxygen therapy and standard high-flow face mask (HFFM) oxygen therapy in patients with mild to moderate hypoxemic respiratory failure. METHODS: In a prospective randomized comparative study, 60 patients with mild to moderate hypoxemic respiratory failure were randomized to receive NHF or HFFM. We analyzed the success of allocated therapy, noninvasive ventilation rate, and oxygenation. RESULTS: Significantly more NHF patients succeeded with their allocated therapy (P ‫؍‬ .006). The rate of noninvasive ventilation in the NHF group was 3/29 (10%), compared with 8/27 (30%) in the HFFM group (P ‫؍‬ .10). The NHF patients also had significantly fewer desaturations (P ‫؍‬ .009). CONCLUSIONS: NHF oxygen therapy may be more effective than HFFM in treating mild to moderate hypoxemic respiratory failure.

High flow oxygen cannula: the other side of the moon

“…The study showed that compared to standard oxygen therapy, HFNC did not improve atelectasis, oxygenation, respiratory rate, or dyspnea, nor did it reduce rates of failure of allocated therapy. Although these results are in accordance with previous ones [15], they are in contradiction with the recent study by Maggiore et al that showed that HFNC improved oxygenation, comfort, and reintubation rate in the post-extubation setting [7]. However, this study was conducted in patients with acute respiratory failure from pneumonia and trauma, which are quite different from obese patients extubated right after cardiac surgery.…”

Nasal high flow therapy: a novel treatment rather than a more expensive oxygen device

“…These encouraging results were further confirmed by the same group of authors 1 year later in a prospective observational study on patients with ARF caused by community-acquired pneumonia and sepsis [24]. Moreover, NHF may be more effective in treating mild to moderate hypoxaemic ARF compared to oxygen delivered through a face mask, with fewer desaturations and less need for NIV, as reported in a prospective randomised study by PARKE et al [25].…”

“…Patients on NHF had significantly fewer desaturations and succeeded more in their allocated therapy, with less need for NIV or intubation, although respiratory (SpO 2 , respiratory rate and forced expiratory volume in 1 s) and cardiovascular (systolic and diastolic arterial pressure and heart rate) variables did not differ between groups. Positive airway pressure, enabling the recruitment of atelectatic lung areas, along with facilitation of mucociliary clearance by the heated and humidified gas administered by NHF, were the possible key features that improved overall treatment effectiveness in both studies [25,45], given that atelectasis is the more common respiratory complication after surgery, presenting in 90% of patients undergoing general anaesthesia [42]. The specific mechanisms of benefits of NHF on post-surgical respiratory complications were studied further by CORLEY et al [5] and it was found that NHF compared to low-flow oxygen on post-cardiac surgery patients significantly increased mean airway pressure by 3.0 cmH 2 O, tidal volume by 10.5% and EELV by 25.6%, regardless of whether they breathed with the mouth open or closed.…”

“…Traditionally, low-and high-flow oxygen systems have been used to reverse post-surgical respiratory complications. NHF might be superior in post-cardiac and thoracic surgery patients, since it can provide a high flow of heated and hydrated oxygen while the positive airway pressure created by the high gas flow can recruit alveoli and increase the EELV [5,6,25,44,45]. In two studies conducted by the same authors [25,45], NHF was compared with SOT after extubation in patients undergoing cardiovascular surgery.…”

“…NHF might be superior in post-cardiac and thoracic surgery patients, since it can provide a high flow of heated and hydrated oxygen while the positive airway pressure created by the high gas flow can recruit alveoli and increase the EELV [5,6,25,44,45]. In two studies conducted by the same authors [25,45], NHF was compared with SOT after extubation in patients undergoing cardiovascular surgery. Patients on NHF had significantly fewer desaturations and succeeded more in their allocated therapy, with less need for NIV or intubation, although respiratory (SpO 2 , respiratory rate and forced expiratory volume in 1 s) and cardiovascular (systolic and diastolic arterial pressure and heart rate) variables did not differ between groups.…”