Interferon lambda 3 in the early phase of coronavirus disease-19 can predict oxygen requirement.

High-flow nasal cannula (HFNC) oxygen therapy is used to deliver warm and humidified gases to patients in respiratory failure. A purported advantage of HFNC oxygen therapy is that it can allow for oral feeding while on the device, although few data support this practice. The purpose of this study was to identify practices and opinions with regard to feeding practices during HFNC oxygen therapy. A survey related to the practice and opinions of feeding practices during HFNC oxygen therapy was developed and sent to respiratory therapists, speech-language pathologists, physicians, advanced practice providers, and registered dietitians. Respondents included 307 professionals from 14 different countries. Most respondents worked in an academic/teaching hospital (n = 174 [56.7%]) with patients ages ≥ 18 years (n = 282 [91.9%]). Most respondents stated that their institution did not have a specific feeding protocol for HFNC oxygen therapy (n = 246 [80.4%]) and felt that patients could have an oral diet during HFNC oxygen therapy if not in imminent danger of being intubated (n = 264 [86.3%]). Fewer than half of the respondents felt that patients should have a bedside/clinical swallow examination before eating and/or drinking during HFNC oxygen therapy (n = 143 [46.7%]). By profession, most physicians/advanced practice providers (n = 67 [59.3%]), respiratory therapists (n = 37 [62.7%]) and half of the registered dietitians (n = 16 [50%]) felt that bedside/clinical swallow examinations were unnecessary before eating and/or drinking with HFNC, but speech-language pathologists were in favor (n = 77 [75.5%]). Most facilities did not have a protocol to guide feeding practices when HFNC oxygen therapy is used. Most clinicians felt that an oral diet is safe for stable patients not in danger of being intubated. In general, speech-language pathologists felt that patients on HFNC oxygen therapy should undergo a bedside/clinical swallow examination before eating and/or drinking.

Hypoxemia is a common and serious complication occurring during deep sedation for prolonged upper gastrointestinal endoscopy (UGE). We evaluated and compared the efficacy of high-flow nasal cannula (HFNC) oxygen therapy vs conventional nasal cannula oxygen therapy (COT) in preventing hypoxemia in patients admitted to the intensive care unit (ICU) and who underwent prolonged (>15 minutes) UGE under deep sedation. Seventy patients aged 20-60 years with American Society of Anesthesia (ASA) I, II, or III who were admitted to the ICU and were scheduled for an anticipated prolonged UGE were included. They were randomly assigned to be administered either oxygen through a standard nasal cannula (COT group) or oxygen through an HFNC (HFNC group). The primary outcome was any occurrence of at least moderate hypoxemic episodes [oxygen saturation (SpO2) < 90%] of any duration. Regarding the occurrence of hypoxemic episodes, 18 patients (51.4%) in the COT group experienced hypoxemia with 11 (31.4%) experiencing mild hypoxemia, six (17.1%) experiencing moderate hypoxemia, and only one patient (2.9%) experienced severe hypoxemia, with a total of seven patients (20.0%) whose SpO2 was <90%. Conversely, only two patients (5.7%) in the HFNC group had mild hypoxemia, and no patients had SpO2 < 90%. Additionally, nine patients in the COT group experienced clinically significant hypoxemia, whereas no patients in the HFNC group (p = 0.001). High-flow nasal cannula (HFNC) oxygen therapy was safe, well tolerated, and significantly decreased the incidence of hypoxemic episodes, compared to COT, among high-risk ICU patients who underwent prolonged UGE under propofol deep sedation.(Registered at ClinicalTrials.gov with ID: NCT06350864). Mohamed AM, Selima WZ. HFNC Oxygen Therapy vs COT in Prolonged Upper Gastrointestinal Endoscopy Inside the ICU: A Prospective, Randomized, Controlled Clinical Study. Indian J Crit Care Med 2025;29(3):223-229.

High-flow nasal cannula (HFNC) oxygen therapy has been shown to reduce the need for mechanical ventilation and decrease the duration of hospital and intensive care unit (ICU) stays for patients with a severely compromised respiratory system. This study aims to observe the evolution of lung aeration via lung ultrasound score (LUS) in a chest-injured population who had been treated with HFNC oxygen therapy, and to assess the benefit of the HFNC oxygen therapy in trauma patients. A retrospective study examined trauma patients with moderate to severe thoracic injuries who were admitted to the ICU at a tertiary hospital between October 2015 and March 2017. The decision to initiate HFNC oxygen therapy was made at the discretion of the trauma surgeon and respiratory therapist when supplemental oxygen delivery was required. All of the patients were assessed by transthoracic lung ultrasound every day after being admitted into the ICU. We retrospectively analyzed 3 time points for this study: the initial emergency intensive care units presentation within 12 hours (T1), 24 to 48 hours after the treatment (T2), and 72 to 96 hours after the treatment (T3). Transthoracic lung ultrasound was performed by an experienced investigator with level 3 certification using a Mindray M9 echograph and a 2- to 4-MHz round-tipped probe. Primary outcomes were the need for intubation after HFNC oxygen therapy for respiratory failure during the treatment within 72 hours, the length of ICU stay, and mortality of 28 days. During the study period, 50 patients with blunt chest trauma were admitted to the study; 18 patients received HFNC therapy and 32 received conventional oxygen therapy (COT); there was no significant difference in the baseline clinical characteristics between the 2 groups. The length of ICU stay and intubation rate for respiratory failure within 72 hours were significantly different between the 2 groups (P < .05), but there was no difference in the 28-day mortality. The LUS of the COT group was not significantly different from T1 to T2 or from T2 to T3 (P > .05). However, the LUS decreased significantly-by 25% from T1 to T2 (P < .05) and by 31% from T1 to T3 (P < .05) in the HFNC therapy group. The LUS of the patients intubated for respiratory failure within 72 hours, in the COT group increased from T1 (17 ± 3) to T3 (21 ± 3), and the LUS (21 ± 3) was much higher than the patients who were not intubated (11 ± 3) at T3; the LUS of the HFNC group was all above 15, which was not significantly different from T1 to T2 or from T2 to T3 (P > .05). High-flow nasal cannula oxygen therapy may be considered as an initial respiratory therapy for trauma patients with blunt chest injury. High-flow nasal cannula therapy could improve lung aeration as noted by the transthoracic lung ultrasound assessment, and LUS may help the attending physicians identify the usefulness of HFNC therapy and decide whether to continue the use of HFNC therapy or intubate the patient.

To compare the clinical efficacy of high-flow nasal cannula (HFNC) oxygen therapy and conventional oxygen therapy (COT) in dogs with noncardiogenic pulmonary edema (NCPE), focusing on respiratory parameters and survival outcomes. This retrospective observational cohort study reviewed cases from a veterinary teaching hospital between September 2022 and September 2024. Dogs were identified through electronic medical records and included if they met clinical criteria for NCPE, excluding those with cardiac or aspiration-related causes. Patients were assigned to the COT or HFNC group on the basis of the treatment received. High-flow nasal cannula oxygen therapy was initiated in dogs with insufficient response to COT. Respiratory rate (RR), peripheral oxygen saturation of hemoglobin as measured by pulse oximetry (SpO2), and dyspnea scores were evaluated at baseline and 24 hours after treatment. The primary outcome was the change in respiratory parameters; secondary outcomes included survival to discharge and adverse events. Nonparametric statistical tests (Wilcoxon signed rank and Mann-Whitney U tests) were used (P < .05). 26 dogs met the inclusion criteria (COT, n = 13; HFNC, 13). High-flow nasal cannula oxygen therapy resulted in greater improvements in RR (median, 66 to 35 breaths/min) and SpO2 (median, 83% to 97%) compared to COT. Dyspnea scores significantly improved only in the HFNC group. Two HFNC dogs survived to discharge, while none survived in the COT group. Minor aerophagia occurred in 2 HFNC dogs and was medically managed. HFNC was associated with improved clinical signs including RR, SpO2, dyspnea scores, and survival in dogs with NCPE. HFNC may serve not only as an alternative but also as a more effective and well-tolerated option than COT for the management of dogs with presumed NCPE.

High-flow nasal cannula (HFNC) oxygen therapy is attracting increasing interest in acute medicine as an alternative to standard oxygen therapy; however, its use to prevent hypoxaemia after major abdominal surgery has not been evaluated. Our trial was designed to close this evidence gap. A multicentre randomised controlled trial was carried out at three university hospitals in France. Adult patients at moderate to high risk of postoperative pulmonary complications who had undergone major abdominal surgery using lung-protective ventilation were randomly assigned using a computer-generated sequence to receive either HFNC oxygen therapy or standard oxygen therapy (low-flow oxygen delivered via nasal prongs or facemask) directly after extubation. The primary endpoint was absolute risk reduction (ARR) for hypoxaemia at 1h after extubation and after treatment discontinuation. Secondary outcomes included occurrence of postoperative pulmonary complications within 7days after surgery, the duration of hospital stay, and in-hospital mortality. The analysis was performed on data from the modified intention-to-treat population. This trial was registered with ClinicalTrials.gov (NCT01887015). Between 6 November 2013 and 1 March 2015, 220 patients were randomly assigned to receive either HFNC (n=108) or standard oxygen therapy (n=112); all of these patients completed follow-up. The median duration of the allocated treatment was 16h (interquartile range 14-18h) with standard oxygen therapy and 15h (interquartile range 12-18) with HFNC therapy. Twenty-three (21%) of the 108 patients treated with HFNC 1h after extubation and 29 (27%) of the 108 patients after treatment discontinuation had postextubation hypoxaemia, compared with 27 (24%) and 34 (30%) of the 112 patients treated with standard oxygen (ARR 4, 95% CI -8 to 15%; p=0.57; adjusted relative risk [RR] 0.87, 95% CI 0.53-1.43; p=0.58). Over the 7-day postoperative follow-up period, there was no statistically significant difference between the groups in the proportion of patients who remained free of any pulmonary complication (ARR 7, 95% CI -6 to 20%; p=0.40). Other secondary outcomes also did not differ significantly between the two groups. Among patients undergoing major abdominal surgery, early preventive application of high-flow nasal cannula oxygen therapy after extubation did not result in improved pulmonary outcomes compared with standard oxygen therapy.

ObjectivesTo investigate the indications of high-flow nasal cannula (HFNC) oxygen therapy among patients with mild hypercapnia and to explore the predictors of intubation when HFNC fails.MethodsThis retrospective study was conducted based on the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. Adult patients with mild hypercapnia (45 < PaCO2 ≤ 60 mmHg) received either HFNC or non-invasive ventilation (NIV) oxygen therapy. Propensity score matching (PSM) was implemented to increase between-group comparability. The Kaplan–Meier method was used to estimate overall survival and cumulative intubation rates, while 28-day mortality and 48-h and 28-day intubation rates were compared using the Chi-squared test. The predictive performances of HR/SpO2 and the ROX index (the ratio of SpO2/FiO2 to respiratory rate) at 4 h were assessed regarding HFNC failure, which was determined if intubation was given within 48 h after the initiation of oxygen therapy. The area under the receiver operating characteristic curve (AUC) for HR/SpO2 and the ROX index were calculated and compared.ResultsA total of 524,520 inpatient hospitalization records were screened, 106 patients in HFNC group and 106 patients in NIV group were successfully matched. No significant difference in 48-h intubation rate between the HFNC group (the treatment group) and the NIV group (the control group) (14.2% vs. 8.5%, p = 0.278); patients receiving HFNC had higher 28-day intubation rate (26.4% vs. 14.2%, p = 0.029), higher 28-day mortality (17.9% vs. 8.5%, p = 0.043), and longer ICU length of stay (4.4 vs. 3.3 days, p = 0.019), compared to those of NIV group. The AUC of HR/SpO2 at 4 h after the initiation of HFNC yielded around 0.660 for predicting 48-h intubation, greater than that of the ROX index with an AUC of 0.589 (p < 0.01).ConclusionPatients with impending respiratory failure had lower intubation rate, shorter ICU length of stay, and lower mortality when treated mild hypercapnia with NIV over HFNC. As opposed to the ROX index, a modest, yet improved predictive performance is demonstrated using HR/SpO2 in predicting the failure of HFNC among these patients.

Objective To investigate the effect of high-flow nasal cannula (HFNC) oxygen therapy in sequential therapy in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods The AECOPD patients with invasive ventilator treatment in our department from January 2017 to April 2018 were observed. DRW (Disease Relieved Window) was defined as the time point when state of illness was under controlled. At DRW the patients were randomly divided into HFNC group and NIV group. We recored the re-intubation within 48 hours, ICU length of stay (LOS) and incidence of adverse events. Results 35 patients were enrolled with 18 patients in the HFNC group and 17 patients in the NIV group. In 48 hours, 3 patients (16.7%) in HFNC group and 2 patients (11.8%) in NIV group were re-intubated (P>0.05). ICU LOS of HFNC was significantly shorter than that in NIV group [(10.4±1.8) d vs (14.2±1.1) d, t=-2.549, P=0. 023]. There were 1 case (5.6%) of adverse events in HFNC group and 5 cases (29.4%) in NIV group (P<0.01). Conclusion High-flow nasal cannula is similar in efficacy to noninvasive in sequential ventilation, and it is associated with shorter ICU LOS and less adverse events. Key words: Chronic obstructive pulmonary disease; Acute exacerbation; Nasal high-flow oxygen therapy; Sequential therapy

Purpose: One of the respiratory supports in acute respiratory failure (ARF) is high-flow nasal cannula (HFNC) oxygen therapy, which is being increasingly used. In this study, we aimed to evaluate the patients with ARF who received HFNC oxygen therapy in pediatric intensive care unit (ICU). Material and Methods: The study was done retrospectively in 104 patients who were admitted to the pediatric ICU and received HFNC oxygen therapy between January 2015 and December 2017. Results: The median age of the patients participating in the study was 5 months. The most common cause of hospitalization was lower respiratory disease (97.1%) and 52.9% of the patients had type 1 respiratory failure. The median length of stay in the pediatric ICU was 7 days, while the median duration of HFNC oxygen therapy was 48 hours. Of the patients who received HFNC oxygen therapy, 28.8% were intubated. In patients who were intubated during HFNC oxygen therapy, the rates of having a chronic disease and chronic lung disease were significantly higher than those who were not intubated (p=0.001, p=0.033, respectively). In terms of complications, 8.7% of the patients had nasal skin damage caused by the cannula and pneumothorax developed in 1.9% of the patients. The rates of chronic diseases and congenital heart disease of the patients who were admitted to pediatric ICU and died after HFNC oxygen therapy were significantly higher than the survivors (p=0.043, p=0.003, respectively). Conclusion: The results of HFNC oxygen therapy, which is being increasingly used in the treatment of respiratory failure in children, are generally satisfactory. However, due to possible complications close monitoring is required during the application.

Rationale:Respiratory muscle paralysis due to low cervical spinal cord injury (CSCI) can lead to dysphagia. Noninvasive positive airway pressure (PAP) therapy can effectively treat this type of dysphagia. High-flow nasal cannula (HFNC) oxygen therapy can generate a low level of positive airway pressure resembling PAP therapy, it may improve the dysphagia.Patient concerns:The patient was an 87-year-old man without preexisting dysphagia. He suffered a CSCI due to a dislocated C5/6 fracture, without brain injury, and underwent emergency surgery. Postoperatively (day 2), he complained of dysphagia, and the intervention was initiated.Diagnosis:Based on clinical findings, dysphagia in this case, may have arisen due to impaired coordination between breathing and swallowing, which typically occurs in patients with CSCI who have reduced forced vital capacity.Interventions:HFNC oxygen therapy was started immediately after the surgery, and swallowing rehabilitation was started on Day 2. Indirect therapy (without food) and direct therapy (with food) were applied in stages. HFNC oxygen therapy appeared to be effective because swallowing function temporarily decreased when the HFNC oxygen therapy was changed to nasal canula oxygen therapy.Outcomes:Swallowing function of the patient improved and he did not develop aspiration pneumonia.Lessons:HFNC oxygen therapy improved swallowing function in a patient with dysphagia associated with respiratory-muscle paralysis following a CSCI. It may have prolonged the apnea tolerance time during swallowing and may have improved the timing of swallowing. HFNC oxygen therapy can facilitate both indirect and direct early swallowing therapy to restore both swallowing and respiratory function.

Patients undergoing thoracic surgery are at high risk for pulmonary and extra pulmonary complications, and may develop impairment of gas exchange during surgery and in the postoperative period. This review focuses on the potential benefits of high-flow nasal cannula (HFNC) oxygen therapy in those patients. HFNC oxygen therapy can be used pre, intra and postoperatively. However, evidence for the use of HFNC oxygen therapy is still limited. Most trials investigated the effects of HFNC oxygen therapy in the postoperative period only, with promising beneficial effects. Preoperative HFNC oxygen therapy might be an alternative to conventional techniques, and allows continuous oxygenation during the apneic time of laryngoscopy. In certain patients, thoracic surgery might be performed in awake and nonintubated patients who are breathing spontaneously. Under these conditions, HFNC oxygen therapy might be considered for respiratory support by experienced anesthesiologists. In the postoperative period, HFNC oxygen therapy can prevent escalation of respiratory management and has the potential to reduce the length of hospital stay. Throughout the perioperative period, close monitoring of patients receiving HFNC oxygen therapy is key, and intubation criteria to avoid delayed intubation should be defined a priori to prevent harm. HFNC oxygen therapy is a promising tool in the perioperative care of thoracic surgical patients, when properly set, performed by experienced staff and closely monitored.

Conflicting recommendations exist on whether high-flow nasal cannula (HFNC) oxygen therapy should be administered to adult patients in critical care with acute hypoxemic respiratory failure. We performed a meta-analysis of randomized controlled trials (RCTs) to evaluate its effect on intubation rates. We searched electronic databases from inception to April 2016. We included RCTs that compared HFNC oxygen therapy with usual care (conventional oxygen therapy or noninvasive ventilation) in adults with acute hypoxemic respiratory failure. Because of the different methodologies and variation in clinical outcomes, we conducted 2 subgroup analyses according to oxygen therapy used and disease severity. We pooled data using random-effects models. The primary outcome was the proportion of patients who required endotracheal intubation. We included 6 RCTs (n = 1892). Compared with conventional oxygen therapy, HFNC oxygen therapy was associated with a lower intubation rate (risk ratio [RR] 0.60, 95% confidence interval [CI] 0.38 to 0.94; I2 = 49%). We found no significant difference in the rate between HFNC oxygen therapy and noninvasive ventilation (RR 0.86, 95% CI 0.68 to 1.09; I2 = 2%). In the subgroup analysis by disease severity, no significant differences were found in the intubation rate between HFNC oxygen therapy and either conventional oxygen therapy or noninvasive ventilation (interaction p = 0.3 and 0.4, respectively). The intubation rate with HFNC oxygen therapy was lower than the rate with conventional oxygen therapy and similar to the rate with noninvasive ventilation among patients with acute hypoxemic respiratory failure. Larger, high-quality RCTs are needed to confirm these findings.

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

High-Flow Nasal Cannula (HFNC) oxygen therapy emerged as the therapy of choice in COVID-19-related pneumonia and moderate to severe acute hypoxemic respiratory failure (AHRF). HFNC oxygen therapy in COVID-19 has been recommended based its use to treat AHRF of other etiologies, and studies on assessing outcomes in COVID-19 patients are highly needed. This study aimed to examine outcomes in COVID-19 patients with pneumonia and severe AHRF treated with HFNC. The study included 235 COVID-19 patients with pneumonia treated with HFNC. Data extracted from medical records included demographic characteristics, comorbidities, laboratory parameters, clinical and oxygenation status, clinical complications, as well as the length of hospital stay. Patients were segregated into two groups based on their oxygen therapy needs: HDU group, those who exclusively required HFNC and ICU group, those whose oxygen therapy needed to be escalated at some point of hospital stay. The primary outcome was the need for respiratory support escalation (noninvasive or invasive mechanical ventilation) and the secondary outcome was the in-hospital all-cause mortality. The primary outcome was met in 113 (48%) of patients. The overall mortality was 70%, significantly higher in the ICU group [102 (90.2%) vs. 62 (50.1%), p < 0.001]. The rate of intrahospital infections was significantly higher in the ICU group while there were no significant differences in the length of hospital stay between the groups. The ICU group exhibited significant increases in D-dimer, NLR, and NEWS values, accompanied by a significant decrease in the SaO2/FiO2 ratio. The multivariable COX proportional regression analysis identified malignancy, higher levels of 4C Mortality Score and NEWS2 as significant predictors of mortality. High-Flow Nasal Cannula oxygen therapy is a safe type of respiratory support in patients with COVID-19 pneumonia and acute hypoxemic respiratory failure with significantly less possibility for emergence of intrahospital infections. In 52% of patients, HFNC was successful in treating AHRF in COVID-19 patients. Overall, mortality in COVID-19 pneumonia with AHRF is still very high, especially in patients treated with noninvasive/invasive mechanical ventilation.

Effects of high flow nasal cannula following minimally invasive esophagectomy in ICU patients: A prospective pre-post study

Since the cluster of the 2019 novel coronavirus (2019-nCoV) pneumonia, a large number of patients gathered, the mortality of critical patients has remained high and the treatment was unclear. In this outbreak, Hunan Changde region immediately set up a hospital and intensive care unit. The patients relieved through respiratory support, hemodynamics management, nutritional support, the application of antiviral drugs, analgesic and sedation. The treatment experience in severe cases of 2019-nCov pneumonia patients were summarized as follows: in terms of respiratory support, we needed to pay attention to the advantages of high-flow nasal cannula oxygen therapy (HFNC) and the intervention of mechanical ventilation, pay attention to the ventilator parameters, and adopt prone position timely. In the aspects of fluid resuscitation and volume management, we should pay attention to the characteristics of severe patients' volume status, perform early evaluation, and clinicians should focused on hemodynamic management beside the bed. In the aspect of nutritional support and evaluation and maintenance of intestinal function, early enteral nutrition should be adopted in time. However, the trade-off between the risk of intestinal function and nutritional support in patients with mechanical ventilation and the antiviral benefits of Kaletra needed to be reevaluated, the optimized way of analgesia and sedation was adopted, at the same time, the usage and side effects of antiviral drugs should be paid attention to. We should grasp the opportunity of transportation for severe patients. It is suggested that some warning scores should be used to facilitate early recognition of patients with severe infection and then they should be earlier transferred to the designated hospital for intensive care. Key words: 2019 Novel coronavirus pneumonia; Critical case; Treatment experience