High-flow nasal oxygen therapy

Ashraf-Kashani, Nina; Kumar, Ram

doi:10.1093/bjaed/mkw041

Cited by 48 publications

(50 citation statements)

References 19 publications

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“…In the last 20 years, HFNO was presented as a therapy for neonatal care with a facemask interface (16,17). More recently, HFNO has become a modality of oxygen administration in adult patients with type 1 respiratory failure (18). The device consists of a gas source (air/O 2 ), humidifier, various sizes of circuit tubing, and nasal cannula.…”

Section: Systematic Review Registrationmentioning

confidence: 99%

High Flow Nasal Oxygen for Acute Type 2 Respiratory Failure: A Systematic Review and Meta-Analysis Protocol

Alnajada¹,

Blackwood²,

Almobrad³

et al. 2020

Preprint

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BackgroundAcute Type 2 respiratory failure (AT2RF) is defined by hypercapnia (>6kPa) and these patients require ventilatory support in a significant proportion of cases. Non-invasive ventilation (NIV) is effective in preventing escalation to invasive mechanical ventilation (IMV) but has a high failure rate. High flow nasal oxygen (HFNO) is a novel device that integrates humidified air with oxygen at flow rates of up to 60 L/min. Various additional benefits including carbon-di-oxide (CO2) clearance have been attributed to HFNO. This systematic review aims to determine whether the use of HFNO for patients with AT2RF 1) improves arterial CO2 (PaCO2), 2) improves other clinical and patient-centred outcomes and 3) assess any potential harms.MethodSearches for relevant studies will be conducted in MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials, with no language restrictions. In addition, we will search Google Scholar and the references of all articles for any pertinent studies not found in our initial search. With the assistance of a professional librarian, we will develop a systematic search strategy using appropriate keywords and MeSH terms. We will identify trials that examined the efficacy of HFNO in adult AT2RF patients. We will include randomised trials and observational studies that compared two or more modalities of oxygen delivery that includes high flow nasal oxygen as one of the modes with the comparator being low flow oxygen and/or non-invasive ventilation. The primary outcome is change in PaCO2 level while other clinical and patient centred outcomes will be collected. Two reviewers will independently assess studies for eligibility, data extraction and quality appraisal. We will conduct a meta-analysis and/or a narrative summary as appropriate.DiscussionHFNO is utilised extensively in clinical practice with widening indications of use. The effects of HFNO includes CO2 clearance and PEEP benefits that may be beneficial to patients with AT2RF. While current publications indicate a beneficial role, no systematic review has attempted to summarise the evidence for this indication. The results of the proposed systematic review will summarise the current evidence to guide practice, guideline development and the design of future trials.Systematic review registrationPROSPERO CRD42019148748. (https://www.crd.york.ac.uk/prospero/)

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Section: Systematic Review Registrationmentioning

confidence: 99%

High Flow Nasal Oxygen for Acute Type 2 Respiratory Failure: A Systematic Review and Meta-Analysis Protocol

Alnajada¹,

Blackwood²,

Almobrad³

et al. 2020

Preprint

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“…However, with the advent of high-flow oxygenation, this apnoeic period has been shown to be significantly extended. 14,15 Limitation in application includes patient groups with high metabolic states, such as the morbidly obese, in whom the apnoeic window is limited. Maintenance of even minimal spontaneous effort can abate small airways collapse in these patients, mitigate hypercarbia and, importantly, allow for early detection of upper airway obstruction.…”

Section: Apnoeic Oxygenationmentioning

confidence: 99%

“…High-flow nasal cannula allow for effective oxygenation as part of a tubeless technique, avoiding the risks associated with jet ventilation and providing superior gas exchange to low-flow techniques. 14,15 This is particularly important for prolonged cases and high-risk patients. Ensuring unobstructed gas flow from the nasal passages to the glottis is key and upper airway patency should be continuously assessed and maintained throughout.…”

Section: High-flow Oxygen Deliverymentioning

confidence: 99%

Anaesthesia for laryngo-tracheal surgery, including tubeless field techniques

Pearson

McGuire

2017

BJA Education

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Laryngo-tracheal surgery presents the anaesthetist with numerous challenges including a shared airway with potential for airway compromise pre-, intra-or postoperatively. Surgical desire for a tubeless field in patients with acute or chronic laryngeal or tracheal pathology can be a daunting prospect for anaesthetists unfamiliar with these techniques. With careful preoperative planning and multidisciplinary communication, the most appropriate strategy for oxygenation and anaesthesia can be agreed. Although frequently the domain of the 'head and neck' specialist, all grades of anaesthetist may be faced with these challenging cases, particularly urgent scenarios, out of hours and in non-tertiary centres. Furthermore, proficiency in techniques such as airway topicalization, high-flow nasal oxygenation, and jet ventilation are beneficial in other areas of clinical practice. Lessons learned NAP4 The 2011 4th National Audit Project (NAP4) of the Royal College of Anaesthetists and the Difficult Airway Society investigated major complications of airway management in the United Kingdom. More than one-third of cases detailed in NAP4 involved an airway problem in association with an acute or chronic disease process in the head, neck, or trachea. 1 Approximately 70% of these patients presented with airway obstruction, with the majority requiring either anaesthesia for diagnostic and resective surgery or intervention to maintain airway patency. Expert reviewers considered airway management to have been poor in many of these reported cases, with inadequate patient assessment, planning, and team communication repeatedly cited failings. Recurring themes included airway deterioration following inhalational induction and repeated failure in direct laryngoscopy attempts. Major complications of high-pressure source ventilation A 2008 national survey exploring major complications during anaesthesia for elective laryngeal surgery in the United Kingdom found that this type of surgery was being performed in 62% of responding hospitals. 2 Across these sites, 67% were using high-pressure source ventilation (HPSV) with supraglottic, subglottic, and transtracheal routes being chosen by 86, 50, and Key points • Providing anaesthesia for surgery to the larynx and trachea is associated with a higher risk of airway complications and a need for skills in a variety of specialist techniques.

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“…Non-invaziv mekanik ventilasyon yöntemleri, invaziv yöntemlere göre daha az komplikasyon riski taşımaktadır (1). Günümüzde, yeni bir oksijen verme yöntemi olarak tasarlanan ancak oksijen vermek dışında birçok ek özelliği nedeniyle, noninvaziv ventilasyon yöntemi olarak da değerlendirilebilen "Yüksek akımlı nazal kanül oksijenizasyon" (YANKO) tedavisinin kullanıma girmesi ile YANKO tedavisinin akut solunum desteğinde etkinliğini araştıran çalışmalar yapılmaya başlanmıştır (2,3 Yenidoğan dönemi dışında çocuk hastalarda YANKO tedavilerini destekleyen verilerin çoğu bronşiolit üzerine yapılmış çalışmalar sonucunda elde edilmiştir. Bronşiolit dışında, çocuk hastalarda YANKO kullanımını destekleyen sınırlı veri vardır.…”

Section: Introductionunclassified

Evaluation of Patients Receiving High-flow Nasal Cannula Oxygenation Therapy in a Pediatric Intensive Care Unit

Vural¹,

Tolunay²,

Tolunay³

2022

tybd

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Objective: Patients hospitalized in pediatric intensive care units require various rates of respiratory and oxygen support therapies. Invasive and non-invasive treatment methods are used as respiratory support treatment, and new technologies are being used in oxygen delivery systems. This study aimed to investigate the success and complication rates of high flow nasal cannula oxygen (HFNCO) therapy in the pediatric intensive care unit. Materials and Methods: In this study, demographic characteristics, treatment processes and success/complication rates of the patients treated with HFNCO between 01.02.2018 and 01.02.2019 in the pediatric intensive care unit of Pediatric Clinic of Adana City Training and Research Hospital were evaluated retrospectively. Results: The mean age of 131 patients included in the study was 41.82 ± 46.88 months. The indications for hospitalization of the patients to pediatric intensive care unit or the reasons for starting HFNCO treatment were as follows: pneumonia in 59.5%, asthma/bronchiolitis in 14.5%, sepsis in 6.9%, post-extubation stridor / respiratory distress in 16.8% and other causes in 2.3%. HFNCO treatment was evaluated as successful in 90.8% of the patients and unsuccessful in 9%. Complications were seen in five patients (3.8%), pneumothorax in four patients, and abdominal distension in one patient. Conclusion: Studies on HFNCO therapy in terms of therapeutic efficacy, safety, and indications for use are not yet sufficient in quantity and terms of scientific evidence. To evaluate the efficacy and complications of HFNCO treatment, multicenter randomized controlled trials are needed in different patient groups.

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High-flow nasal oxygen therapy

Abstract: • High-flow nasal oxygen therapy (HFNOT) provides a valuable triad of humidity, high FI O2 , and improved patient compliance.

Cited by 48 publications

References 19 publications

High Flow Nasal Oxygen for Acute Type 2 Respiratory Failure: A Systematic Review and Meta-Analysis Protocol

High Flow Nasal Oxygen for Acute Type 2 Respiratory Failure: A Systematic Review and Meta-Analysis Protocol

Anaesthesia for laryngo-tracheal surgery, including tubeless field techniques

Evaluation of Patients Receiving High-flow Nasal Cannula Oxygenation Therapy in a Pediatric Intensive Care Unit

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