High-flow oxygen therapy and other inhaled therapies in intensive care units

Levy, Susan R.; Alladina, Jehan; Hibbert, Kathryn A.; Harris, R. Scott; Bajwa, Ednan K.; Hess, Dean

doi:10.1016/s0140-6736(16)30245-8

Cited by 52 publications

(30 citation statements)

References 96 publications

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“…Increased end-expiratory lung volume caused by positive end expiratory pressure could decrease CO 2 clearance [15]. However, the airway gas washout effect of HFNC therapy may improve PaCO 2 [16, 17]. These opposite effects may be the reason for no significant difference in PaCO 2 .…”

Section: Discussionmentioning

confidence: 99%

Physiological impact of high-flow nasal cannula therapy on postextubation acute respiratory failure after pediatric cardiac surgery: a prospective observational study

et al. 2017

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BackgroundReintubation after pediatric cardiac surgery is associated with a high rate of mortality. Therefore, adequate respiratory support for postextubation acute respiratory failure (ARF) is important. However, little is known about the physiological impact of high-flow nasal cannula (HFNC) therapy on ARF after pediatric cardiac surgery. Our working hypothesis was that HFNC therapy for postextubation ARF after pediatric cardiac surgery improves hemodynamic and respiratory parameters.MethodsThis was a prospective observational study conducted at a single university hospital. Children less than 48 months of age who had postextubation ARF after cardiac surgery were included in this study. HFNC therapy was started immediately after diagnosis of postextubation ARF.Data obtained just before starting HFNC therapy were used for pre-HFNC analysis, and data obtained 1 h after starting HFNC therapy were used for post-HFNC analysis. We compared hemodynamic and respiratory parameters between pre-HFNC and post-HFNC periods. The Wilcoxon signed-rank test was used to analyze these indices.ResultsTwenty children were included in this study. The median age and body weight were 4.5 (2.3–14.0) months and 4.3 (3.1–7.1) kg, respectively. Respiratory rate (RR) significantly decreased from 43.5 (32.0–54.8) to 28.5 (21.0–40.5) breaths per minute (p = 0.0008) 1 h after the start of HFNC therapy. Systolic blood pressure also decreased from 87.5 (77.8–103.5) to 76.0 (70.3–85.0) mmHg (p = 0.003). Oxygen saturation, partial pressure of arterial carbon dioxide, heart rate, and lactate showed no remarkable changes. There was no adverse event caused by HFNC therapy.ConclusionsHFNC therapy improves the RR of patients who have postextubation ARF after pediatric cardiac surgery without any adverse events.

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Section: Discussionmentioning

confidence: 99%

Physiological impact of high-flow nasal cannula therapy on postextubation acute respiratory failure after pediatric cardiac surgery: a prospective observational study

et al. 2017

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“…Millions of divers, as well as cancer and diabetes patients, receive oxygen therapy for wound-healing [1,2]. It is, therefore, important to understand and characterize the neurobiological effects of this hyperoxia-induced oxidative stress on brain function, even in the absence of clinical symptoms (e.g., seizure).…”

Section: Discussionmentioning

confidence: 99%

“…Due to the relative convenience and low-cost to modulate O 2 levels, manipulation of its concentration in the body via control of inspired air has generated opportunities for clinical evaluation and interventions. Oxygen therapy has been widely used in wound-healing from radiation injury and diabetes [1,2], and every day, thousands of people receive oxygen treatment in major medical centers and private practice facilities. However, despite the increasing use of oxygen as a treatment, the effect of O 2 gas modulation on the brain is poorly understood.…”

Section: Introductionmentioning

confidence: 99%

The impact of hyperoxia on brain activity: A resting-state and task-evoked electroencephalography (EEG) study

et al. 2017

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A better understanding of the effect of oxygen on brain electrophysiological activity may provide a more mechanistic insight into clinical studies that use oxygen treatment in pathological conditions, as well as in studies that use oxygen to calibrate functional magnetic resonance imaging (fMRI) signals. This study applied electroencephalography (EEG) in healthy subjects and investigated how high a concentration of oxygen in inhaled air (i.e., normobaric hyperoxia) alters brain activity under resting-state and task-evoked conditions. Study 1 investigated its impact on resting EEG and revealed that hyperoxia suppressed α (8-13Hz) and β (14-35Hz) band power (by 15.6±2.3% and 14.1±3.1%, respectively), but did not change the δ (1-3Hz), θ (4-7Hz), and γ (36-75Hz) bands. Sham control experiments did not result in such changes. Study 2 reproduced these findings, and, furthermore, examined the effect of hyperoxia on visual stimulation event-related potentials (ERP). It was found that the main peaks of visual ERP, specifically N1 and P2, were both delayed during hyperoxia compared to normoxia (P = 0.04 and 0.02, respectively). In contrast, the amplitude of the peaks did not show a change. Our results suggest that hyperoxia has a pronounced effect on brain neural activity, for both resting-state and task-evoked potentials.

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“…Data from the SARS [23] and MERS [24] outbreaks cautioned against the use of high-flow nasal oxygen or non-invasive ventilation, although this has recently been countered by data demonstrating no increased dissemination of bacteria with high-flow nasal oxygen, yet viral spread remains unexplored [25]. As well as the potential risk of viral aerosolisation and the need for careful isolation precautions, non-invasive ventilation may also be insufficient to manage COVID-19-induced respiratory failure, and preliminary observations from the current Italian outbreak suggest there may be a poor response to non-invasive ventilation [3,23,[25][26][27].…”

Section: Oxygen Administrationmentioning

confidence: 99%

The Italian coronavirus disease 2019 outbreak: recommendations from clinical practice

et al. 2020

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Summary Novel coronavirus 2019 is a single‐stranded, ribonucleic acid virus that has led to an international pandemic of coronavirus disease 2019. Clinical data from the Chinese outbreak have been reported, but experiences and recommendations from clinical practice during the Italian outbreak have not. We report the impact of the coronavirus disease 2019 outbreak on regional and national healthcare infrastructure. We also report on recommendations based on clinical experiences of managing patients throughout Italy. In particular, we describe key elements of clinical management, including: safe oxygen therapy; airway management; personal protective equipment; and non‐technical aspects of caring for patients diagnosed with coronavirus disease 2019. Only through planning, training and team working will clinicians and healthcare systems be best placed to deal with the many complex implications of this new pandemic.

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High-flow oxygen therapy and other inhaled therapies in intensive care units

Cited by 52 publications

References 96 publications

Physiological impact of high-flow nasal cannula therapy on postextubation acute respiratory failure after pediatric cardiac surgery: a prospective observational study

Physiological impact of high-flow nasal cannula therapy on postextubation acute respiratory failure after pediatric cardiac surgery: a prospective observational study

The impact of hyperoxia on brain activity: A resting-state and task-evoked electroencephalography (EEG) study

The Italian coronavirus disease 2019 outbreak: recommendations from clinical practice

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