A Review of High Flow Nasal Cannula Oxygen Therapy in Human and Veterinary Medicine

Krawec, Philip; Marshall, Kristen; Odunayo, Adesola

doi:10.1016/j.tcam.2021.100596

Cited by 8 publications

(27 citation statements)

References 101 publications

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“…The cartridges used in this case series allowed flow rates from 5 to 40 L/min, hence the lower weight limit of 5 kg for inclusion. The fraction of inspired oxygen (FiO 2 ) can be independently adjusted on some HFNOT devices from 21 to 100% although the FiO 2 delivered to the alveoli is lower than the HFNOT machine setting ( 1 , 3 , 18 ). One experimental model showed that a machine set to deliver 100% FiO 2 only achieved a true FiO 2 delivery of 78.67 and 76.67% at 300 and 500 mL tidal volumes, respectively ( 18 ).…”

Section: Discussionmentioning

confidence: 99%

“…However, another study reported higher FiO 2 values ranging from 86 to 97% at HFNOT settings of 100% FiO 2 with flow rates ≥1 L/kg/min ( 6 ). The physiological effects of HFNOT are thought to include improvement of mucociliary function, enhanced secretion clearance and reduction in ventilation/perfusion mismatch (V/Q mismatch) ( 1 , 19 ). The use of warm, humidified gas reduces bronchoconstriction in people ( 20 ).…”

Section: Discussionmentioning

confidence: 99%

“…The flow-dependent continuous positive airway pressure (CPAP) may reduce atelectasia, improve functional residual capacity and prevent lung de-recruitment. HFNOT decreases anatomical dead space through nasopharyngeal “purging” of CO 2 and net positive pharyngeal pressure, leading to reduction of CO 2 rebreathing and thus improving ventilation and avoiding increased diaphragm activation during bronchoscopy and BAL ( 1 , 13 , 21 – 23 ). The reduction of resistance in the upper airways improves respiratory dynamics and reduces the minute ventilation necessary to provide appropriate alveolar ventilation.…”

Section: Discussionmentioning

confidence: 99%

“…High-Flow Nasal Oxygen Therapy (HFNOT) is an increasingly available method in veterinary medicine to deliver warmed, humidified, blended air-oxygen, at 95%-100% relative humidity and at high flow rates to patients through a nasal cannula using a specialized, commercially available machine ( 1 , 2 ). The fraction of inspired oxygen (FiO 2 ) can be independently adjusted on some HFNOT devices from 21 to 100% ( 1 – 3 ). HFNOT has shown to be a well-tolerated, safe and effective method for oxygen delivery to healthy and hypoxemic dogs ( 2 – 8 ).…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

The use of High-Flow Nasal Oxygen Therapy in 4 dogs undergoing bronchoscopy

Tesas

Matson

Tappin³

et al. 2023

Front. Vet. Sci.

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IntroductionHigh-Flow Nasal Oxygen Therapy is a method to deliver warmed, humidified air-oxygen blended at high flow rates to patients through a nasal cannula using a specialized, commercially available machine. This is a well-tolerated, safe and effective method for oxygen delivery to healthy and hypoxemic dogs. Patients undergoing bronchoscopic procedures frequently develop hypoxemia. Human trials have shown a reduction in incidents of hypoxemic events and higher pulse oximeter oxygen saturation during bronchoscopies in patients on High-Flow Nasal Oxygen.Materials and methodsThis is a single-centre, prospective case series. All dogs weighing between 5 and 15 kg and undergoing bronchoscopy during the study period (03/07/2022-01/10/2022) were eligible.ResultsTwelve patients were eligible for inclusion of which four were enrolled. No clinically significant complications related to the use of High-Flow Nasal Oxygen Therapy were recorded. Two of the patients were re-intubated post bronchoscopy due to clinician preference for recovery. One of the patients had a self-limiting period of severe hypoxemia with a pulse oximeter oxygen saturation of 84% for < 1 min during bronchoalveolar lavage, and whilst undergoing High-Flow Nasal Oxygen administration. Another patient had a self-limiting episode of mild hypoxemia (SpO2 of 94% lasting < 1 min) 5 min after completion of bronchoalveolar lavage.ConclusionNo clinically relevant complications relating to High-Flow Nasal Oxygen Therapy were recorded in this case series, although further studies are required to confirm this conclusion. This initial data suggests that the use of High-Flow Nasal Oxygen therapy during bronchoscopy is feasible and potentially safe, although it may not prevent hypoxemia in these patients. The use of High-Flow Nasal Oxygen Therapy during bronchoscopy in small patients carries multiple potential benefits and further studies to compare its efficacy against other traditional oxygen delivery systems are warranted in this patient population.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

The use of High-Flow Nasal Oxygen Therapy in 4 dogs undergoing bronchoscopy

Tesas

Matson

Tappin³

et al. 2023

Front. Vet. Sci.

View full text Add to dashboard Cite

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“…Many studies have reported the use of sedation to facilitate initiation and/or maintenance of HFNOT in veterinary patients, although this is not required in all patients ( 25 , 26 , 28 , 30 , 147 ). Sedation protocols should be based on individual patient factors and assessment, however, the use of butorphanol and/or α 2 -agonists is often reported ( 150 , 151 ).…”

Section: Clinical Application Of High Flow Nasal Oxygen Therapymentioning

confidence: 99%

Clinical review of high-flow nasal oxygen therapy in human and veterinary patients

Whitney¹,

Keir²

2023

Front. Vet. Sci.

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Oxygen therapy is the first-line treatment for hypoxemic acute respiratory failure. In veterinary medicine this has traditionally been provided via mask, low-flow nasal oxygen cannulas, oxygen cages and invasive positive pressure ventilation. Traditional non-invasive modalities are limited by the maximum flow rate and fraction of inspired oxygen (FiO2) that can be delivered, variability in oxygen delivery and patient compliance. The invasive techniques are able to provide higher FiO2 in a more predictable manner but are limited by sedation/anesthesia requirements, potential complications and cost. High-flow nasal oxygen therapy (HFNOT) represents an alternative to conventional oxygen therapy. This modality delivers heated and humidified medical gas at adjustable flow rates, up to 60 L/min, and FiO2, up to 100%, via nasal cannulas. It has been proposed that HFNOT improves pulmonary mechanics and reduces respiratory fatigue via reduction of anatomical dead space, provision of low-level positive end-expiratory pressure (PEEP), provision of constant FiO2 at rates corresponding to patient requirements and through improved patient tolerance. Investigations into the use of HFNOT in veterinary patients have increased in frequency since its clinical use was first reported in dogs with acute respiratory failure in 2016. Current indications in dogs include acute respiratory failure associated with pulmonary parenchymal disease, upper airway obstruction and carbon monoxide intoxication. The use of HFNOT has also been advocated in certain conditions in cats and foals. HFNOT is also being used with increasing frequency in the treatment of a widening range of conditions in humans. Although there remains conflict regarding its use and efficacy in some patient groups, overall these reports indicate that HFNOT decreases breathing frequency and work of breathing and reduces the need for escalation of respiratory support. In addition, they provide insight into potential future veterinary applications. Complications of HFNOT have been rarely reported in humans and animals. These are usually self-limiting and typically result in lower morbidity and mortality than those associated with invasive ventilation techniques.

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Retrospective evaluation of the respiratory rate–oxygenation index to predict the outcome of high‐flow nasal cannula oxygen therapy in dogs (2018–2021): 81 cases

Eicher,

Young,

Hoover

et al. 2024

J Vet Emergen Crit Care

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ObjectiveTo evaluate the respiratory rate–oxygenation index (ROX), modified ROX index (ROX‐HR), and the ratio of pulse oximetry saturation (Spo2) to Fio2 (SF) to determine if these indices over time are predictive of outcome in dogs treated with high‐flow nasal cannula oxygen therapy (HFNC).DesignRetrospective study.SettingTwo university teaching hospitals.AnimalsEighty‐one client‐owned dogs treated with HFNC for hypoxemic respiratory failure.InterventionsNone.Measurements and Main ResultsThe ROX was defined as the SF divided by the respiratory rate (RR), and the ROX‐HR was defined as the ROX divided by the heart rate multiplied by 100. The overall success rate of HFNC was 44% (n = 36/81). Dogs weaned from HFNC had a significantly higher ROX (P < 0.0001) at 1–3, 5–10, 12, and 15 hours than dogs that failed HFNC. Both the ROX and SF showed excellent discriminatory power in predicting HFNC failure at 6 hours, with an area under receiver operating curve of 0.85 (95% confidence interval: 0.72–0.99; P < 0.002) and 0.86 (95% confidence interval: 0.73–0.99; P < 0.001), respectively. The optimal cutoff values for predicting HFNC failure at 6 hours were a ROX ≤3.68 (sensitivity 72%, specificity 92%) and an SF ≤143 (sensitivity 79%, specificity 93%).ConclusionsThese results suggest that similar to people, the ROX and SF are useful predictors of HFNC failure. These indices are easy to measure at the bedside and may have clinical use. Future prospective studies are warranted to confirm the findings and to optimize cutoff values in a larger population of dogs undergoing HFNC.

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A Review of High Flow Nasal Cannula Oxygen Therapy in Human and Veterinary Medicine

Cited by 8 publications

References 101 publications

The use of High-Flow Nasal Oxygen Therapy in 4 dogs undergoing bronchoscopy

The use of High-Flow Nasal Oxygen Therapy in 4 dogs undergoing bronchoscopy

Clinical review of high-flow nasal oxygen therapy in human and veterinary patients

Retrospective evaluation of the respiratory rate–oxygenation index to predict the outcome of high‐flow nasal cannula oxygen therapy in dogs (2018–2021): 81 cases

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