Heated and Humidified Oxygen in Critical Care Transport: Evaluating the Use of Aerogen Pro-X Nebulizer as an Alternative to Traditional High-Flow Humidifiers

Forum: AAMS, AMPA, ASTNA, NEMSPA, NFPA

Analysis of High Flow Nasal Cannula Utilization During Pediatric Critical Care Transport

Controversies in airway management of COVID-19 patients: updated information and international expert consensus recommendations

Preoxygenation using the Optiflow™ system

Objective To study the clinical application effects of nasal high flow humidification oxygen therapy in patients with chronic obstructive pulmonary disease (COPD) . Methods A total of 98 COPD patients hospitalized in PLA 81 Hospital from January to December 2016 were included in the study using convenient sampling method. Patients were randomly divided into the observation group and the control group, 49 cases respectively. Patients in the observation group received nasal high flow humidification oxygen therapy, while patients in the control group used common humidification oxygen bottle. Respiratory function indexes and the mucus viscosity were measured and compared between two groups before and after the intervention. Results Before the intervention, there were no statistically significant differences in respiratory function indexes between two groups (P>0.05) . After the intervention, there were significant differences in the respiratory frequency, PaO2, PaCO2, SaO2, heart rate, Clinical Pulmonary Infection Score between two groups (P 0.05) ; at 24 h and 72 h after the intervention, significant difference in the mucus viscosity was observed between two groups (P<0.05) . Conclusions Nasal high flow humidification oxygen therapy can improve the respiratory function and airway humidification of COPD patients when compared to normal humidification oxygen therapy. Thus, it is worthy of clinical promoting. Key words: Pulmonary disease, chronic obstructive; High flow; Warming humidification; Oxygen therapy; Pulmonary function

To determine the effects of low-flow oxygen therapy with humidified or non-humidified oxygen in adult patients. Although non-humidified oxygen in low-flow oxygen therapy is recommended by many guidelines, humidifying oxygen regardless of oxygen flow has been routinely performed in China and Japan and further studies are needed to evaluate the evidence. A systematic review and meta-analysis that comply with the recommendations of the Cochrane Collaboration were conducted. Studies (1980-2016) were identified by searching PUBMED, EMBASE, Science Direct, Cochrane library, CNKI and Wanfang Database. We performed a comprehensive, systematic meta-analysis of randomized controlled trials on the efficacy of humidified and non-humidified low-flow oxygen therapy. Summary risk ratios or weighted mean differences with 95% confidence intervals were calculated using a fixed- or random-effects model. Twenty-seven randomized controlled trials with a total number of 8,876 patients were included. Non-humidified oxygen offers more benefits in reducing the bacterial contamination of humidifier bottles, as shown by the mean operating time for oxygen administration and the respiratory infections compared with humidified oxygen therapy. No significant differences were found in dry nose, dry nose and throat, nosebleed, chest discomfort, the smell of oxygen and SpO2 changes. The routine humidification of oxygen in low-flow oxygen therapy is not justifiable and non-humidified oxygen tends to be more beneficial. However, considering that the quality of most included studies is poor, rigorously designed, large-scale randomized controlled trials are still needed to identify the role of non-humidified oxygen therapy.

Objective To observe and analyze the clinical effect of humidified oxygen therapy through high flow nasal catheter in the treatment of elderly patients with severe refractory pneumonia complicating respiratory failure. Methods 120 middle-aged and elderly patients with severe intractable pneumonia treated at our hospital from February, 2016 to May, 2018 were selected, and were randomly divided into a control group and an experimental group, 60 cases for each group. The control group were treated with nasal continuous positive pressure ventilation, and the experimental group with humidified oxygen therapy through high flow nasal catheter. Results The total effective rate was 75.0% (45/60) in the control group, and was 95.0% (57/60) in the experimental group (P<0.05). The times for the disappearance of three concave sign, shortness of breath, lung rales, and cyanosis as well as hospitalization time were shorter in the experimental group than in the control group (all P<0.05). Conclusion Humidified oxygen therapy through high flow nasal catheter in the treatment of middle-aged and elderly patients with severe refractory pneumonia complicating respiratory failure is effective and can effectively alleviate their clinical symptoms and signs and promote the patients’ rehabilitation, so it has clinical application value. Key words: Humidified oxygen therapy through nasal high flow nasal catheter; The middle-aged and elderly; Severe refractory pneumonia; Respiratory failure

High-flow nasal cannula (HFNC) systems are increasingly used for patients with both acute and chronic respiratory failure because of the clinical effectiveness and patient comfort associated with their use. Recently, HFNC has been used not only as a respiratory support device, but also as a drug delivery system. HFNC is designed to administer heated and humidified inspiratory oxygen flows (100% relative humidity at 37°C). Therefore, HFNC can provide high flows (up to 60 L/min) without discomfort. Moreover, HFNC improves oxygenation by exerting physiologic effects such as (a) dead-space washout and (b) moderate positive airway pressure. These characteristics and physiologic effects of HFNC may permit administration of high-flow nitrous oxide sedation while ensuring patient comfort and adequate sedative effect.

Forum

High-flow nasal cannula (HFNC) is increasingly used to provide respiratory support in infants with bronchiolitis. The delivery of aerosol therapy through a jet nebulizer is widely indicated despite its controversial efficacy and poor tolerability. This randomized cross-over study aimed to evaluate the comfort and satisfaction of the delivery of aerosol therapy using a nebulization system integrated into HFNC compared with the standard practice of using a jet nebulizer with a face mask. The COMFORT-Behavior (COMFORT-B) scale, a visual analog scale, and a numeric rating scale were used by health professionals and caregivers to assess subjects' levels of comfort and satisfaction. A total of 113 nebulizations (64 via nebulizer with HFNC; 49 via jet nebulizer) were delivered to the 6 subjects included in the study. Use of the nebulizer with HFNC showed increased comfort and satisfaction during nebulization compared to use of the jet nebulizer, as measured by the COMFORT-B scale, the visual analog scale, and the numeric rating scale, with the following median (interquartile range) scores: 10.7 (7-16) versus 14.5 (10-20) (P = .006), 8.5 (6-10) versus 7 (4-9) (P = .02), and 3.84 (3.61-4.07) versus 1.83 (1.58-2.08) (P < .001), respectively. Correlation between the COMFORT-B scale and the visual analog scale using Spearman's rho was -0.757 (P < .001). The intraclass correlation coefficient for the COMFORT-B scale, visual analog scale, and numeric rating scale, as measured by 2 different nurses, was between 0.75 and 0.87. The use of a nebulizer incorporated into HFNC therapy results in an increased level of comfort and satisfaction compared to the use of a conventional jet nebulizer in subjects with bronchiolitis who required HFNC therapy. Further studies are needed to determine whether aerosol therapy delivered through HFNC improves the clinical course of this pathology.

Analysis of High Flow Nasal Cannula Utilization During Pediatric Critical Care Transport

Heated Humidified High-Flow Nasal Oxygen in Adults

To describe the changes to paediatric intensive care unit (PICU) admission patterns and ventilation requirements for children with bronchiolitis following the introduction of humidified high-flow nasal cannula oxygen outside the PICU. Retrospective study comparing patients <24 months of age with a discharge diagnosis of bronchiolitis admitted to the PICU. A comparison was made between those before humidified high-flow nasal cannula oxygen use (year 2008) to those immediately following the introduction of humidified high-flow nasal cannula oxygen use (year 2011) and those following further consolidation of humidified high-flow nasal cannula oxygen use outside the PICU (year 2013). Humidified high-flow nasal cannula oxygen use up to 1 L/kg/min in the hospital did not reduce PICU admission. Intubation rates were reduced from 22.2% in 2008 to 7.8% in 2013. There was a non-significant trend towards decreased length of stay in the PICU while hospital length of stay showed a significant decrease following the introduction of humidified high-flow nasal cannula oxygen. Age <6 months and respiratory syncytial virus bronchiolitis were associated with an increased chance of failing humidified high-flow nasal cannula oxygen therapy. Humidified high-flow nasal cannula oxygen utilised outside of the PICU in our institution for children with bronchiolitis did not reduce admission rates or length of stay to the PICU but was associated with a decreasing need for invasive ventilation and reduced hospital length of stay.

High-flow nasal cannula (HFNC) is a noninvasive oxygenation modality that delivers heated and humidified oxygen. It possesses several advantages due to the unique physiological effects on the lung and ventilation mechanics compared to other modes of oxygen therapy. The use of HFNC is tolerable, comfortable, and easy to set up. Current evidence indicates that the use of HFNC in critically ill patients with coronavirus disease 2019 (COVID-19)-acute hypoxemic respiratory failure (AHRF) is noninferior to noninvasive ventilation in the reduction of endotracheal intubation rate. Early identification of HFNC failure is vital to avoid delaying intubation. However, multiple knowledge gaps exist, and unpowered observational studies limit HFNC incorporation into strong recommendations. The low dispersion of particles demonstrates the feasibility of HFNC; yet, an appropriate setting and precautions should be maximized. Here, we review the recent evidence of HFNC implications in the management of patients with COVID-19-AHRF.

Hypercapnia respiratory failure is one of the common types of respiratory failure in clinical practice. Traditional oxygen therapy can improve oxygenation, but may inevitable cause some complications. In recent years, high-flow nasal humidified oxygen (HFNC) therapy has been widely used in clinical setting as a new effective method. It uses high speed of oxygen flow to reduce the anatomical dead space of the mouth, nose and pharynx, reduce CO2 re-inspiration, produce positive pressure at the end of exhalation, increase expiratory lung volume and become the ideal choice of patients with high carbonate type of respiratory failure. This paper reviews the application of HFNC therapy in hypercapnic respiratory failure in recent years. Key words: High-flow nasal humidified oxygen therapy; Respiratory failure; Hypercapnia