High-Velocity Nasal Insufflation in the Treatment of Respiratory Failure: A Randomized Clinical Trial

Doshi, Pratik; Whittle, Jessica S.; Bublewicz, Michael; Kearney, Joseph; Ashe, Terrell; Graham, Russell; Salazar, Suesann; Ellis, Terry W.; Maynard, Dianna; Dennis, Rose; Tillotson, April; Hill, Mandy J.; Granado, Misha; Gordon, Nicole; Dunlap, Charles L.; Spivey, Sheldon; Miller, Thomas L.

doi:10.1016/j.annemergmed.2017.12.006

Cited by 106 publications

(98 citation statements)

References 16 publications

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“…Patient comfort or tolerability plays an important role in the effects of NIV or HFNC. Doshi et al () found that intolerance resulted in 29% failure in the NIV group, compared to 4% in the HFNC group.…”

Section: Discussionmentioning

confidence: 99%

Comparison of high flow nasal cannula with noninvasive ventilation in chronic obstructive pulmonary disease patients with hypercapnia in preventing postextubation respiratory failure: A pilot randomized controlled trial

Jing

Dong

et al. 2019

Research in Nursing & Health

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High flow nasal cannula (HFNC) has been shown to improve extubation outcomes in patients with hypoxemia, but the role of HFNC in weaning patients with chronic obstructive pulmonary disease (COPD) with hypercapnia from invasive ventilation is unclear. We compared the effects of HFNC to noninvasive ventilation (NIV) on postextubation vital signs and arterial blood gases (ABGs) among patients with COPD. Other outcomes included comfort scores, need for bronchoscopy, use of pulmonary medications, and chest physiotherapy. Forty‐two COPD patients who had persistent hypercapnia at extubation were assigned randomly to receive HFNC (22) or NIV (20). Twenty patients in each group were enrolled for per‐protocol analysis with regard to primary outcomes. Vital signs and ABGs before extubation were similar between groups. At 3 hr after extubation, pH in the NIV group was lower than HFNC group (7.42 ± 0.06 vs. 7.45 ± 0.05, p = 0.01). At 24 hr after extubation, patients’ mean arterial pressure (82.97 ± 9.04 vs. 92.06 ± 11.11 mmHg, p = 0.05) and pH (7.42 ± 0.05 vs. 7.46 ± 0.03, p = 0.05) in the NIV group were lower than in the HFNC group. No significant differences were found at 48 hr after extubation. In the HFNC group, comfort scores were better (3.55 ± 2.01 vs. 5.15 ± 2.28, p = 0.02) and fewer patients needed bronchoscopy for secretion management within 48 hr after extubation (2/22 vs. 9/20, p = 0.03). HFNC is a potential alternative to NIV to wean hypercapnic COPD patients with regard to vital signs and ABGs, HFNC improved patients’ comfort and secretion clearance.

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Section: Discussionmentioning

confidence: 99%

Comparison of high flow nasal cannula with noninvasive ventilation in chronic obstructive pulmonary disease patients with hypercapnia in preventing postextubation respiratory failure: A pilot randomized controlled trial

Jing

Dong

et al. 2019

Research in Nursing & Health

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“…The most common condition treated was COPD (39% of patients). The primary outcome was treatment failure rate defined by the need for intubation and decision to apply alternate therapy within 72 h. The principal findings showed that HFOT was not inferior to NIV . Although the included patients did not meet specific criteria of COPD exacerbation with acute respiratory acidosis at baseline, they had hypercapnia and an indication (accepted by the investigators) to be treated by NIV.…”

Section: Niv As First‐line Treatment For Acute Respiratory Acidosis Dmentioning

confidence: 99%

“…Up until now, only a few smaller studies and case reports with hypercapnic patients have been published. However, studies conducted in emergency departments comparing HFOT with standard oxygen or NIV included larger samples of patients with ARF of various causes and, especially, COPD exacerbation . One RCT compared HFOT with NIV in 204 patients with respiratory failure admitted to emergency departments and requiring NIV .…”

Section: Niv As First‐line Treatment For Acute Respiratory Acidosis Dmentioning

confidence: 99%

“…However, studies conducted in emergency departments comparing HFOT with standard oxygen or NIV included larger samples of patients with ARF of various causes and, especially, COPD exacerbation . One RCT compared HFOT with NIV in 204 patients with respiratory failure admitted to emergency departments and requiring NIV . The most common condition treated was COPD (39% of patients).…”

Section: Niv As First‐line Treatment For Acute Respiratory Acidosis Dmentioning

confidence: 99%

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Non‐invasive ventilation or high‐flow oxygen therapy: When to choose one over the other?

2018

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It has been found that high-flow oxygen therapy (HFOT) can reduce mortality of patients admitted to intensive care unit (ICU) for de novo acute respiratory failure (ARF) as compared to non-invasive ventilation (NIV). HFOT might therefore be considered as a firstline strategy of oxygenation in these patients. The beneficial effects of HFOT may be explained by its good tolerance and by physiological characteristics including delivery of high FiO 2 , positive end expiratory pressure (PEEP) effect and continuous dead space washout contributing to decreased work of breathing. In contrast, NIV should be used cautiously in patients with de novo ARF due to high tidal volumes promoted by pressure support and that may potentially worsen pre-existing lung injury. Although recent studies have reported no benefit and even deleterious effects of NIV in immunocompromised patients with ARF, the experts have recommended its use as a first-line strategy. In patients with acute-on-chronic respiratory failure and respiratory acidosis, it has been clearly shown that NIV is the best strategy of oxygenation. However, HFOT seems able to reverse respiratory acidosis and further studies are needed to evaluate whether HFOT could represent an alternative to standard oxygen. Although NIV is recommended to treat ARF in postoperative patients or to prevent post-extubation respiratory failure in ICU, recent large-scale randomized studies suggest that HFOT could be equivalent to NIV. While recent recommendations have been established from studies comparing NIV with standard oxygen, new studies are needed to compare NIV versus HFOT in order to better define the appropriate indications for both treatments.

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“…More recently, there has been emerging interest in using HFNT to treat AHRF. 21 This article will examine the epidemiology, mechanisms of action, and clinical evidence for using NIV in patients with COPD exacerbations. The potential indications of HFNT in AHRF with the emerging evidence will be also reviewed.…”

Section: Introductionmentioning

confidence: 99%

Noninvasive Ventilation and High-Flow Nasal Therapy Administration in Chronic Obstructive Pulmonary Disease Exacerbations

Ferrer

Torres

2020

Semin Respir Crit Care Med

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Noninvasive ventilation (NIV) is considered to be the standard of care for the management of acute hypercapnic respiratory failure in patients with chronic obstructive pulmonary disease exacerbation. It can be delivered safely in any dedicated setting, from emergency rooms to high dependency or intensive care units and wards. NIV helps improving dyspnea and gas exchange, reduces the need for endotracheal intubation, and morbidity and mortality rates. It is therefore recognized as the gold standard in this condition. High-flow nasal therapy helps improving ventilatory efficiency and reducing the work of breathing in patients with severe chronic obstructive pulmonary disease. Early studies indicate that some patients with acute hypercapnic respiratory failure can be managed with high-flow nasal therapy, but more information is needed before specific recommendations for this therapy can be made. Therefore, high-flow nasal therapy use should be individualized in each particular situation and institution, taking into account resources, and local and personal experience with all respiratory support therapies.

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High-Velocity Nasal Insufflation in the Treatment of Respiratory Failure: A Randomized Clinical Trial

Cited by 106 publications

References 16 publications

Comparison of high flow nasal cannula with noninvasive ventilation in chronic obstructive pulmonary disease patients with hypercapnia in preventing postextubation respiratory failure: A pilot randomized controlled trial

Comparison of high flow nasal cannula with noninvasive ventilation in chronic obstructive pulmonary disease patients with hypercapnia in preventing postextubation respiratory failure: A pilot randomized controlled trial

Non‐invasive ventilation or high‐flow oxygen therapy: When to choose one over the other?

Noninvasive Ventilation and High-Flow Nasal Therapy Administration in Chronic Obstructive Pulmonary Disease Exacerbations

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