Oxygen delivery through high-flow nasal cannulae increase end-expiratory lung volume and reduce respiratory rate in post-cardiac surgical patients

Corley, Amanda; Caruana, Lawrence R.; Barnett, Adrian; Tronstad, Oystein; Fraser, John F.

doi:10.1093/bja/aer265

Cited by 441 publications

(410 citation statements)

References 29 publications

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“…FiO 2 values administered via NHF are more stable and higher than those of standard oxygen delivery systems [1], because NHF can generate high flow rates up to 60 L·min −1 that can match or even exceed the patient's inspiratory flow demand, thus reducing entrainment of room air and dilution of administered oxygen [3,4]. In addition, these high flow rates create a positive airway pressure which linearly correlates with the administered flow rate [3][4][5][6][7][8]. For every 10 L·min −1 increase in gas flow, the mean airway pressure increases by ∼0.69 cmH 2 O in the mouth-closed position and by 0.35 cmH 2 O in the mouth-open position [8].…”

Section: Mechanisms Of Actionmentioning

confidence: 99%

“…Analysis of the pressure generated during different parts of the respiratory cycle demonstrated that higher pressures are obtained during expiration than inspiration, which are flow dependent [9]. This mechanism resembles the application of positive end-expiratory pressure (PEEP), and it results in recruitment of the atelectatic areas and thus increase of end-expiratory lung volume (EELV) by ∼25% [5]. This effect is more pronounced in subjects with higher body mass index (BMI), regardless of body position [5,10].…”

Section: Mechanisms Of Actionmentioning

confidence: 99%

“…This mechanism resembles the application of positive end-expiratory pressure (PEEP), and it results in recruitment of the atelectatic areas and thus increase of end-expiratory lung volume (EELV) by ∼25% [5]. This effect is more pronounced in subjects with higher body mass index (BMI), regardless of body position [5,10]. Furthermore, lung compliance increases and the patient breathes more slowly, with almost 10% higher tidal volumes [5].…”

Section: Mechanisms Of Actionmentioning

confidence: 99%

“…This effect is more pronounced in subjects with higher body mass index (BMI), regardless of body position [5,10]. Furthermore, lung compliance increases and the patient breathes more slowly, with almost 10% higher tidal volumes [5]. The imposed expiratory resistance to the patient's exhalation against the continuous high flow of incoming oxygen gas and the pressurisation of the upper airway above atmospheric pressure are the possible explanations for this mechanism [7,8].…”

Section: Mechanisms Of Actionmentioning

confidence: 99%

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Nasal high flow therapy: a novel treatment rather than a more expensive oxygen device

2017

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Nasal high flow is a promising novel oxygen delivery device, whose mechanisms of action offer some beneficial effects over conventional oxygen systems. The administration of a high flow of heated and humidified gas mixture promotes higher and more stable inspiratory oxygen fraction values, decreases anatomical dead space and generates a positive airway pressure that can reduce the work of breathing and enhance patient comfort and tolerance. Nasal high flow has been used as a prophylactic tool or as a treatment device mostly in patients with acute hypoxaemic respiratory failure, with the majority of studies showing positive results. Recently, its clinical indications have been expanded to post-extubated patients in intensive care or following surgery, for pre-and peri-oxygenation during intubation, during bronchoscopy, in immunocompromised patients and in patients with "do not intubate" status. In the present review, we differentiate studies that suggest an advantage (benefit) from other studies that do not suggest an advantage (no benefit) compared to conventional oxygen devices or noninvasive ventilation, and propose an algorithm in cases of nasal high flow application in patients with acute hypoxaemic respiratory failure of almost any cause.

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Section: Mechanisms Of Actionmentioning

confidence: 99%

Section: Mechanisms Of Actionmentioning

confidence: 99%

Section: Mechanisms Of Actionmentioning

confidence: 99%

Section: Mechanisms Of Actionmentioning

confidence: 99%

See 2 more Smart Citations

Nasal high flow therapy: a novel treatment rather than a more expensive oxygen device

2017

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“…Additionally, this technique allows for the titration of the fraction of inspired oxygen as well. [1][2][3] High-flow oxygen therapy has been shown to result in better comfort and oxygenation in patients with acute respiratory failure in previous studies. However, evidence for high-flow oxygen therapy on intubation rates and mortality is lacking.…”

Section: Division Of Pulmonology Chris Hani Baragwanath Academic Hosmentioning

confidence: 99%

The challenge of the Asthma-COPD overlap syndrome (ACOS)

Banda

2015

S Afr Res J

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In the past, asthma airway inflammation was believed to be predominantly characterised by eosinophilic inflammation and type 2 helper T (Th2) lymphocytes, unlike chronic obstructive pulmonary disease (COPD), where inflammation is characterised predominantly by neutrophilic inflammation and CD8 lymphocytes. This difference in the pattern of inflammation makes the clinical extremes of asthma and COPD easily distinguishable, with differences in clinical picture and age of the patients. However, over the years, it has been observed that in older patients the presentation of asthma and COPD may converge clinically and the conditions may mimic each other. Airway remodelling that develops over time in some asthma patients leads to irreversible airway obstruction resembling COPD. In contrast, reversible airway obstruction can occur in patients with COPD, with the result that these patients may resemble those with asthma. The condition in which a person has clinical features of both asthma and COPD is called the asthma-COPD overlap syndrome (ACOS). The prevalence of ACOS is estimated to be 15 -45% in people with obstructive airway disease and increases with age.In a recent review, Postma and Rabe [1] discuss studies that have shown the heterogeneity of pathophysiology of asthma and COPD. Therefore it may be difficult to distinguish asthma from COPD in patients who have pathophysiological and clinical features of both. The authors emphasised that there is still a paucity of data on how to diagnose and treat ACOS and answers to the primary review questions (i.e. how would one make appropriate ACOS diagnosis and what is the appropriate treatment for ACOS?) are not evidencebased. Nevertheless, the review highlighted important points on pathophysiology, clinical features, diagnosis and treatment of obstructive airway disease assuming that asthma and COPD are two extreme ends of the disease spectrum with ACOS in between.

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High-Flow Nasal Oxygen vs Noninvasive Positive Airway Pressure in Hypoxemic Patients After Cardiothoracic Surgery

Stéphan

Barrucand

Petit

et al. 2015

JAMA

470

370

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Oxygen delivery through high-flow nasal cannulae increase end-expiratory lung volume and reduce respiratory rate in post-cardiac surgical patients

Abstract: This study suggests that HFNCs reduce respiratory rate and improve oxygenation by increasing both EELV and tidal volume and are most beneficial in patients with higher BMIs.

Cited by 441 publications

References 29 publications

Nasal high flow therapy: a novel treatment rather than a more expensive oxygen device

Nasal high flow therapy: a novel treatment rather than a more expensive oxygen device

The challenge of the Asthma-COPD overlap syndrome (ACOS)

High-Flow Nasal Oxygen vs Noninvasive Positive Airway Pressure in Hypoxemic Patients After Cardiothoracic Surgery

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