Nasal high–flow oxygen therapy in patients with hypoxic respiratory failure: effect on functional and subjective respiratory parameters compared to conventional oxygen therapy and non-invasive ventilation (NIV)

Abstract

BackgroundAim of the study was to compare the short-term effects of oxygen therapy via a high-flow nasal cannula (HFNC) on functional and subjective respiratory parameters in patients with acute hypoxic respiratory failure in comparison to non-invasive ventilation (NIV) and standard treatment via a Venturi mask.MethodsFourteen patients with acute hypoxic respiratory failure were treated with HFNC (FiO2 0.6, gas flow 55 l/min), NIV (FiO2 0.6, PEEP 5 cm H2O Hg, tidal volume 6–8 ml/kg ideal body weight,) and Venturi mask (FiO2 0.6, oxygen flow 15 l/min,) in a randomized order for 30 min each. Data collection included objective respiratory and circulatory parameters as well as a subjective rating of dyspnea and discomfort by the patients on a 10-point scale. In a final interview, all three methods were comparatively evaluated by each patient using a scale from 1 (=very good) to 6 (=failed) and the patients were asked to choose one method for further treatment.ResultsPaO2 was highest under NIV (129 ± 38 mmHg) compared to HFNC (101 ± 34 mmHg, p <0.01 vs. NIV) and VM (85 ± 21 mmHg, p <0.001 vs. NIV, p <0.01 vs. HFNC, ANOVA). All other functional parameters showed no relevant differences. In contrast, dyspnea was significantly better using a HFNC (2.9 ± 2.1, 10-point Borg scale) compared to NIV (5.0 ± 3.3, p <0.05), whereas dyspnea rating under HFNC and VM (3.3 ± 2.3) was not significantly different. A similar pattern was found when patients rated their overall discomfort on the 10 point scale: HFNC 2.7 ± 1.8, VM 3.1 ± 2.8 (ns vs. HFNC), NIV 5.4 ± 3.1 (p <0.05 vs. HFNC). In the final evaluation patients gave the best ratings to HFNC 2.3 ± 1.4, followed by VM 3.2 ± 1.7 (ns vs. HFNC) and NIV 4.5 ± 1.7 (p <0.01 vs. HFNC and p <0.05 vs. VM). For further treatment 10 patients chose HFNC, three VM and one NIV.ConclusionsIn hypoxic respiratory failure HFNC offers a good balance between oxygenation and comfort compared to NIV and Venturi mask and seems to be well tolerated by patients.Trial registrationGerman clinical trials register: DRKS00005132.

Effect of high-flow nasal cannula oxygen therapy in adults with acute hypoxemic respiratory failure: a meta-analysis of randomized controlled trials

“…32 An improvement in the Pao 2 :Fio 2 ratio was observed among patients receiving noninvasive ventilation compared with HFNC oxygen therapy, as has been reported previously. 38 This result may have been due to the higher positive end-expiratory pressure or higher mean airway pressure being applied during noninvasive ventilation. 39,40 We found no significant differences between HFNC oxygen therapy and the control groups in ICU mortality or length of ICU stay.…”

Use of High-Flow Nasal Cannula for Acute Dyspnea and Hypoxemia in the Emergency Department

“…An observational study by Lenglet et al 11 showed that HFNC decreased dyspnea scores compared with COT in subjects with acute respiratory failure presenting to an emergency department. Furthermore, Schwabbauer et al 12 found that HFNC significantly reduced dyspnea and improved comfort compared with noninvasive ventilation in subjects with hypoxemic respiratory failure. In addition, the subjects in the present study tolerated HFNC very well, and no serious adverse events occurred during the study period.…”

Seriously, Should We Be Treating Severe ARDS With High-Flow Nasal Cannula Oxygen?

“…7 In mild hypoxemic situations, although NIV produces better oxygenation, HFNC is subjectively better tolerated, and it can be considered as a reasonable alternative therapy. 8 However, we disagree with the use of HFNC in moderate or severe ARDS (P aO 2 / F IO 2 of Ͻ 200). ARDS is a clinical condition with high mortality.…”