Effects of High-Flow Nasal Cannula on the Work of Breathing in Patients Recovering From Acute Respiratory Failure*

Delorme, Mathieu; Bouchard, Pierre-Alexandre; Simon, Mathieu; Simard, Serge; Lellouche, François

doi:10.1097/ccm.0000000000002693

Cited by 123 publications

(122 citation statements)

References 43 publications

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“…This is in contrast to a report of 14 stable chronically hypercapnic COPD patients in which both HFNT and NIV significantly reduced PTPdi (diaphragmatic work) [8]. Furthermore, in a more recent study including 5 hypercapnic patients recovering from acute respiratory failure, esophageal pressure swings, PTP and work of breathing (markers of respiratory effort) were significantly reduced with HFNT at 60 L/min [33]. This difference, however, may also stem from inherent differences in the structure and function of the diaphragm between COPD and CF patients [34].…”

Section: Discussioncontrasting

confidence: 82%

“…In contrast to previous physiological studies on HFNT [8, 33, 37] that used esophageal balloon catheters, we chose to utilize diaphragm ultrasonography as our primary means of estimating patient work of breathing as previously demonstrated [24]. Although our approach makes direct comparison with these previous studies more difficult, we feel that diaphragm ultrasound has become a well-studied modality, with described reproducibility, applied noninvasively and relatively easily learned [43].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

High-flow nasal oxygen versus noninvasive ventilation in adult patients with cystic fibrosis: a randomized crossover physiological study

Sklar

Dres

Rittayamai

et al. 2018

Ann. Intensive Care

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BackgroundNoninvasive ventilation (NIV) is the first-line treatment of adult patients with exacerbations of cystic fibrosis (CF). High-flow nasal oxygen therapy (HFNT) might benefit patients with hypoxemia and can reduce physiological dead space. We hypothesized that HFNT and NIV would similarly reduce work of breathing and improving breathing pattern in CF patients. Our objective was to compare the effects of HFNT versus NIV in terms of work of breathing, assessed noninvasively by the thickening fraction of the diaphragm (TFdi, measured with ultrasound), breathing pattern, transcutaneous CO2 (PtcCO2), hemodynamics, dyspnea and comfort.MethodsAdult CF patients who had been stabilized after requiring ventilatory support for a few days were enrolled and ventilated with HFNT and NIV for 30 min in crossover random order.ResultsFifteen patients were enrolled. Compared to baseline, HFNT, but not NIV, reduced respiratory rate (by 3 breaths/min, p = 0.01) and minute ventilation (by 2 L/min, p = 0.01). Patients also took slightly larger tidal volumes with HFNT compared to NIV (p = 0.02). TFdi per breath was similar under the two techniques and did not change from baseline. MAP increased from baseline with NIV and compared to HFNT (p ≤ 0.01). Comfort was poorer with the application of both HFNT and NIV than baseline. No differences were found for heart rate, SpO2, PtcCO2 or dyspnea.ConclusionsIn adult CF patients stabilized after indication for ventilatory support, HFNT and NIV have similar effects on diaphragmatic work per breath, but high-flow therapy confers additional physiological benefits by decreasing respiratory rate and minute ventilation.Clinical trial registrationEthics Committee of St. Michael’s Hospital (REB #14-338) and clinicaltrial.gov (NCT02262871).Electronic supplementary materialThe online version of this article (10.1186/s13613-018-0432-4) contains supplementary material, which is available to authorized users.

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Section: Discussioncontrasting

confidence: 82%

Section: Discussionmentioning

confidence: 99%

High-flow nasal oxygen versus noninvasive ventilation in adult patients with cystic fibrosis: a randomized crossover physiological study

Sklar

Dres

Rittayamai

et al. 2018

Ann. Intensive Care

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“…HFNT provides warmed humidified air administered through slightly enlarged nasal prongs. HFNT reduces the minute volume, lowers the respiratory rate, and decreases the work of breathing [21,43], and it leads to a flow-dependent reduction in PaCO 2 [21]. When we analyzed data on arterial blood gases (pH, PaO 2 , PaCO 2 , and HCO 3− ), our results of reduced PaCO 2 levels were similar within each group, but did not significantly differ between the two groups at the end of the PR program.…”

Section: Discussionmentioning

confidence: 68%

Effect of high-flow nasal therapy during early pulmonary rehabilitation in patients with severe AECOPD: a randomized controlled study

et al. 2020

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Background: Chronic obstructive pulmonary disease (COPD) is airway inflammation characterized and low daily physical activity. Most pulmonary rehabilitation (PR) programs are often provided to stable patients, but fewer training programs are specific for hospitalized patients with acute exacerbation (AE). Patients with AECOPD experience increased dyspnea sensations and systemic inflammation during exercise training. High-flow nasal therapy (HFNT) reduces the minute volume, lowers the respiratory rate, and decreases the work of breathing. However, it is not clear whether HFNT is efficient during exercise training. In this study, we investigated the effects of HFNT during exercise training in an early PR program among hospitalized patients with severe AECOPD. Methods: We enrolled COPD patients hospitalized due to AE. They were randomized into two groups according to their status into HFNT PR and non-HFNT PR groups. This study collected basic data, and also assessed a pulmonary function test, 6-min walking test, blood inflammatory biomarkers, and arterial gas analysis at the baseline, and at 4 and 12 weeks of the intervention. Data were analyzed using SPSS statistical software.Result: We recruited 44 AECOPD patients who completed the 12-week PR program. The HFNT PR program produced significant improvements in exercise tolerance as assessed by the 6-min walking distance (6MWD), reduced dyspnea sensations in the modified Medical Research Council (mMRC), and decreased systemic inflammation as evidenced by the a lower C-reactive protein (CRP) level. A reduction in the length of hospitalization was achieved with PR in the 1-year follow-up in the two groups. The HFNT PR group showed better trends of reduced air trapping in the delta inspiration capacity (IC) and an increased quality of life according to the COPD assessment test (CAT) than did the non-HFNT PR group.Conclusions: HFNT during exercise training in early PR increases exercise tolerance and reduces systemic inflammation in hospitalized patients with severe AECOPD.

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“…Warming and humidification can improve the comfort of patients with non-invasive ventilation (1). Patients undergoing nasal oxygen therapy retain the warming and humidifying function in the upper respiratory tract, however, the generation of condensed water in the pipeline can reduce patient comfort and compliance, which means respiratory humidification therapy devices are preferred in patients who use nasal high-flow humidification oxygen therapy (10)(11)(12)(13) and are mainly used in patients with acute heart failure and hypoxemic respiratory failure (14,15). In order to prevent the formation of condensed water, the pipeline and the extension pipe joints use water-permeable and airtight technology, which reduces the relative humidity of the delivered gas but improves the comfort and compliance of patients with nasal high flow oxygen therapy.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the effect of two active warming and humidifying high‑flow oxygen therapy systems in patients with tracheotomy

Yang

Song

et al. 2019

biom rep

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The present study evaluated the effect of two active warming and humidifying high-flow oxygen therapy systems in patients with tracheotomy, in order to provide a basis for selecting the method of humidification oxygen therapy for tracheotomy. A total of 78 patients with tracheotomy, who underwent surgery between July 2017 and December 2017, were randomly divided into an observation group (39 patients) and a control group (39 patients). Patients in the observation group were treated with artificial airway high-flow humidification oxygen therapy in a closed suction system. Patients in the control group were treated using a respiratory humidification therapy device. Changes of sputum viscosity, pulmonary infection, arterial oxygen partial pressure (PaO 2 ), arterial blood carbon dioxide partial pressure (PaCO 2 ) and arterial oxygen saturation (SaO 2 ) were observed at 0, 48 and 96 h, and 7 days following oxygen therapy. The sputum viscosity and lung infection in the observation group were lower than those in the control group at 48, 96 h and 7 days following oxygen therapy, and the PaO 2 and SaO 2 were higher in the observation group than in the control group, which was statistically significant (P<0.05). However, there was no statistically significant difference (P>0.05) in PaCO 2 between the two groups. In conclusion, the artificial airway high-flow humidification oxygen therapy closed suction system was considered more suitable for long-term oxygen therapy of tracheotomy patients than the respiratory humidification therapy device. It can improve airway humidification and oxygen levels at lower equipment and consumable costs. The effects of treatment aim to reduce lung infections, which have clinical implications to a certain extent.

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Effects of High-Flow Nasal Cannula on the Work of Breathing in Patients Recovering From Acute Respiratory Failure*

Abstract: High-flow nasal cannula, when set at 60 L/min, significantly reduces the indexes of respiratory effort in adult patients recovering from acute respiratory failure. This effect is associated with an improvement in respiratory mechanics.

Cited by 123 publications

References 43 publications

High-flow nasal oxygen versus noninvasive ventilation in adult patients with cystic fibrosis: a randomized crossover physiological study

High-flow nasal oxygen versus noninvasive ventilation in adult patients with cystic fibrosis: a randomized crossover physiological study

Effect of high-flow nasal therapy during early pulmonary rehabilitation in patients with severe AECOPD: a randomized controlled study

Evaluation of the effect of two active warming and humidifying high‑flow oxygen therapy systems in patients with tracheotomy

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