Effect Of High-flow Oxygen Therapy Research Articles

The effects of high-flow oxygen therapy on mortality in patients with COVID-19.

High-flow oxygen therapy (HFOT) has been successful in treating acute hypoxic respiratory failure (AHRF) and acute respiratory distress syndrome (ARDS). Successful treatment with noninvasive ventilation and avoidance of mechanical ventilation (MV) has been associated with decreased mortality and positive patient outcomes. It is unclear whether the evidence supports the use of HFOT to treat coronavirus disease 2019 (COVID-19)-induced AHRF and ARDS. To determine whether the use of HFOT decreases the need for intubation or decreases mortality compared with MV in patients with AHRF due to COVID-19. A literature search was conducted in March 2022 using CINAHL, Embase, PubMed, and Scopus bibliographic databases. Ten studies comparing HFOT and MV in COVID-19 respiratory failure met inclusion criteria. Nine studies found a statistically significant reduction in the need for intubation; eight studies found significantly decreased morality in patients who received HFOT. Study design and methodologies limited the findings. Based on the available evidence, the use of HFOT positively affected mortality and incidence of the need for intubation and MV. Further research needs to be conducted before HFOT is adopted as the standard of care for COVID-19-induced AHRF and ARDS. Nurse practitioners should be informed regarding the various respiratory support modalities and evaluate risk versus benefit when caring for patients with COVID-19-induced AHRF and ARDS.

Retracted: The Clinical Effect of High-Flow Oxygen Therapy through the Nose on Patients with Acute Left Heart Failure and Hypoxemia.

[This retracts the article DOI: 10.1155/2022/7117508.].

Effectiveness of high-flow oxygen therapy in a second-level hospital in bronchiolitis

IntroductionTo estimate the impact of the incorporation of high-flow nasal cannule (HFNC) in patients admitted with acute bronchiolitis in a hospital without pediatric intensive care unit (PICU). Material and methodsCohort study with historical control of bronchiolitis in a second-level hospital, before (2009−2012) and after (2015−2020) the implementation of HFNC. The main outcome was the need for admission to the PICU. Results301 patients were included. Respiratory syncytial viruses were identified in 64.7% of them and influenza viruses in 0.3%. No differences in age nor comorbility between periods were observed. The average stay was 3.67 days (standard deviation [SE] 2.10) in the first period and 4.00 days (SE 2.35) in the second. Three patients were transferred to UCIP (2.6%) before the availability of HFCN and 13 patients (9.4%) after, which supposed an important increase of the risk (relative risk 3.58; confidence interval [CI] 95%: 1.04–12.27), although not significant in adjusted analyses (Odds ratio 3.48; IC95% 0.95–12.72). A significant increase in readmission risk was also observed (from 5.3%–13.7%) and a shortening of the time to transfer. ConclusionsThe incorporation of HFNC was not associated with a lower risk of transfer to PICU nor a shorter length of oxygen therapy. In the absence of evidence, that supports the effectiveness and efficiency of the HFNC and establishes its indications, we must reassess its use.

In severe COVID-19, high-flow vs. conventional oxygen therapy reduced intubation and time to clinical recovery at 28 d.

Ospina-Tascón GA, Calderón-Tapia LE, García AF, et al. Effect of high-flow oxygen therapy vs conventional oxygen therapy on invasive mechanical ventilation and clinical recovery in patients with severe COVID-19: a randomized clinical trial. JAMA. 2021;326:2161-71. 34874419.

The Clinical Effect of High-Flow Oxygen Therapy through the Nose on Patients with Acute Left Heart Failure and Hypoxemia.

Objective To evaluate the clinical efficacy of nasal high-flow oxygen therapy in patients with acute left heart failure and hypoxemia. Methods From July 2016 to November 2018, patients with acute left heart failure complicated with hypoxemia treated in the Department of Critical Medicine of Yantai Affiliated Hospital of Binzhou Medical University were retrospectively observed (a total of 140 cases met the inclusion criteria). They were randomly divided into two groups, with 70 cases in each group. Patients were given continuous ECG monitoring, improved blood gas analysis test, and recorded HR, RR, map, SaO2, pH, PaO2, PaCO2, and Lac, perfect examination and color Doppler echocardiography, and record NT-proBNP and EF before and 24 hours after treatment. The effective rates of the two groups before and after oxygen therapy were detected. Results There were 67 patients with high-flow oxygen therapy group improvement, 95.7% improvement rate, and 55 patients with general oxygen therapy group improvement rate. The treatment improvement rate was 78.6%. A total of 67 patients were treated with high-flow oxygen therapy. After high-flow oxygen therapy, HR (t = 18.8, P ≤ 0.05), RR (t = 19.7, P ≤ 0.05), MAP (t = 12.1, P ≤ 0.05), PaCO2 (t = 9.53, P ≤ 0.05), Lac (t = 8.69, P ≤ 0.05), and NT-proBNP (t = 7.03, P ≤ 0.05) were significantly lower than before. SaO2 (t = −12.4, P ≤ 0.05), pH (t = −12.2, P ≤ 0.05), PaO2 (t = −17.7, P ≤ 0.05), and EF (t = −13.4, P ≤ 0.05) were significantly higher than before. A total of 55 patients were in the general oxygen therapy group. After administration of ordinary oxygen therapy, HR (t = 18.2, P ≤ 0.05), RR (t = 10.8, P ≤ 0.05), MAP (t = 13.1, P ≤ 0.05), PaCO2 (t = 15.8, P ≤ 0.05), Lac (t = 7.1, P ≤ 0.05), and NT-proBNP (t = 10, P ≤ 0.05) were significantly lower than before. SaO2 (t = −15.5, P ≤ 0.05), pH (t = −4.5, P ≤ 0.05), PaO2 (t = −20, P ≤ 0.05), and EF value (t = −7.7, P ≤ 0.05) were significantly higher than before. Conclusion High-flow oxygen therapy and general oxygen therapy have an obvious curative effect on patients with acute left heart failure and hypoxemia. Compared with the two, high-flow oxygen therapy is more effective. After high-flow oxygen therapy and general oxygen therapy in patients with acute left heart failure and hypoxia, HR, RR, MAP, SaO2, pH, PaO2, PaCO2, Lac, EF, and NT-proBNP value all improved, and the improvement of high-flow oxygen therapy was greater.

Edge Detection Algorithm-Based Lung Ultrasound in Evaluation of Efficacy of High-Flow Oxygen Therapy on Critical Lung Injury.

The study focused on the therapeutic effects of high-flow oxygen therapy on patients with critical lung injury using edge detection-based ultrasound images. Firstly, the traditional Canny edge detection algorithm was improved, and the optimal threshold was obtained by optimizing the median filter and combining Otsu algorithm and threshold iteration method. Then, the optimized algorithm was compared with the traditional Canny edge detection algorithm and applied to process the lung ultrasound images of 120 cases of critical lung injury, to compare the efficacy of high-flow oxygen therapy and the traditional oxygen therapy. It was found that the peak signal-to-noise ratio (PSNR) (20.34~31.3), edge intensity value (17.89~27.34), and edge detection effect of the improved Canny algorithm were better than the traditional Canny algorithm (15.2~28.61, 9.44~18.56). The failure rate of extubation (4.1%), reintubation rate (0.8%), comfort (2.38 ± 0.15 points), dry humidity score (1.07 ± 0.21 points), antibiotic use (7.41 ± 0.74 days), and hospital stay (8.66 ± 1.02 days) in the experimental group were significantly lower than the corresponding indexes in the control group (11.7%, 5%, 4.25 ± 0.26 minutes, 4.94 ± 0.78 minutes, 19.29 ± 1.7 days, and 27.49 ± 2.22 days), and the difference was statistically significant (P < 0.05). In the experimental group, within 48 hours after extubation, the respiratory rate (RR), heart rate (HR), arterial partial pressure of carbon dioxide (PaCO2), and HCO3− were significantly lower than those of the control group; and the values of transcutaneous oxygen saturation (SpO2), mean arterial pressure (MAP), arterial partial pressure of oxygen (PaO2), and pH were significantly higher than the control group, and the difference was statistically significant (P < 0.05). In conclusion, the algorithm in this study is superior to the traditional Canny algorithm, and the high-flow oxygen therapy can reduce the failure rate of extubation, strengthen patient comfort, improve the degree of gas humidification, stabilize the respiratory function and circulatory system, and shorten the time of antibiotic use and hospital stay.

Predicting the effectiveness of high-flow oxygen therapy in COVID-19 patients: a single-centre observational study.

High-flow nasal cannula (HFNC) therapy is a helpful tool in the treatment of hypoxaemic respiratory failure. However, the clinical parameters predicting the effectiveness of HFNC in coronavirus-19 disease (COVID-19) patients remain unclear. Sixteen COVID-19 patients undergoing HFNC in the Asklepios Lung Clinic Munich-Gauting, Germany between 16 March and 3 June 2020 were retrospectively included into the study. Seven patients successfully recovered after HFNC (Group 1), while 9 patients required intubation upon HFNC failure (Group 2). Relevant predictors for an effective HFNC therapy were analysed on day 0 and 4 after HFNC initiation via receiver operating characteristics. The groups did not differ significantly in terms of age, sex, body mass index, and comorbidities. Five patients died in Group 2 upon disease progression and HFNC failure. Group 1 required a lower oxygen supplementation (FiO2 0.46 [0.31-0.54] vs. 0.72 [0.54-0.76], P = 0.022) and displayed a higher PaO2/FiO2 ratio (115 [111-201] vs. 93.3 [67.2-145], P = 0.042) on day 0. In Group 2, fever persisted on day 4 (38.5 [38.0-39.4]°C vs. 36.5 [31.1-37.1]°C, P = 0.010). Serum C-reactive protein (CRP) levels > 108 mg L-1 (day 0) and persistent oxygen saturation < 89% and PaO2/FiO2 ratio < 91 (day 4) were identified as significant predictors for HFNC failure (area under curve 0.929, 0.933, and 0.893). Elevated oxygen saturation, decreased FiO2 and reduced serum CRP on day 4 significantly predict HFNC effectiveness in COVID-19 patients. Based on these parameters, larger prospective studies are necessary to further investigate the effectiveness of HFNC in the treatment of COVID-19-associated hypoxaemic respiratory failure.

Effect of High-Flow Oxygen Therapy vs Conventional Oxygen Therapy on Invasive Mechanical Ventilation and Clinical Recovery in Patients With Severe COVID-19

The effect of high-flow oxygen therapy vs conventional oxygen therapy has not been established in the setting of severe COVID-19. To determine the effect of high-flow oxygen therapy through a nasal cannula compared with conventional oxygen therapy on need for endotracheal intubation and clinical recovery in severe COVID-19. Randomized, open-label clinical trial conducted in emergency and intensive care units in 3 hospitals in Colombia. A total of 220 adults with respiratory distress and a ratio of partial pressure of arterial oxygen to fraction of inspired oxygen of less than 200 due to COVID-19 were randomized from August 2020 to January 2021, with last follow-up on February 10, 2021. Patients were randomly assigned to receive high-flow oxygen through a nasal cannula (n = 109) or conventional oxygen therapy (n = 111). The co-primary outcomes were need for intubation and time to clinical recovery until day 28 as assessed by a 7-category ordinal scale (range, 1-7, with higher scores indicating a worse condition). Effects of treatments were calculated with a Cox proportional hazards model adjusted for hypoxemia severity, age, and comorbidities. Among 220 randomized patients, 199 were included in the analysis (median age, 60 years; n = 65 women [32.7%]). Intubation occurred in 34 (34.3%) randomized to high-flow oxygen therapy and in 51 (51.0%) randomized to conventional oxygen therapy (hazard ratio, 0.62; 95% CI, 0.39-0.96; P = .03). The median time to clinical recovery within 28 days was 11 (IQR, 9-14) days in patients randomized to high-flow oxygen therapy vs 14 (IQR, 11-19) days in those randomized to conventional oxygen therapy (hazard ratio, 1.39; 95% CI, 1.00-1.92; P = .047). Suspected bacterial pneumonia occurred in 13 patients (13.1%) randomized to high-flow oxygen and in 17 (17.0%) of those randomized to conventional oxygen therapy, while bacteremia was detected in 7 (7.1%) vs 11 (11.0%), respectively. Among patients with severe COVID-19, use of high-flow oxygen through a nasal cannula significantly decreased need for mechanical ventilation support and time to clinical recovery compared with conventional low-flow oxygen therapy. ClinicalTrials.gov Identifier: NCT04609462.

Неинвазивная вентиляция легких (лекция)

В лекции освещены вопросы step by step респираторной терапии у больных с острой дыхательной дисфункцией (ОДД). Первым шагом в лечении больных с ОДД (при отсутствии показаний к инвазивной механической вентиляции легких) является использование высокопоточной оксигенации (ВПО) и неинвазивной вентиляции легких (НИВЛ). По сравнению с инвазивной механической вентиляцией легких эти технологии имеют определенные преимущества. Они не приводят к вентилятор-ассоциированному повреждению легких, вентилятор-ассоциированной диафрагмальной дисфункции и не вызывают вентилятор-ассоциированной пневмонии. НИВЛ обеспечивает определенная концентрация кислорода на вдохе (FiO2) в сочетании с умеренным давлением в конце выдоха (РЕЕР)/постоянным положительным давлением в дыхательных путях (СРАР) и инспираторным давлением. В отличие от оксигенации через лицевую маску или носовые канюли она уменьшает возможность экспираторного закрытия мелких дыхательных путей, предупреждает коллапс альвеол и возможность возникновения ателектазов. Преимуществом НИВЛ в сравнении со стандартной оксигенотерапией через лицевую маску/носовые канюли можно считать то, что она обеспечивает умеренный уровень РЕЕР/СРАР, который уменьшает пред- и постнагрузку левого желудочка. Это имеет особенное значение у больных с острой левожелудочковой недостаточностью или отеком легких. Главным условием успешного проведения НИВЛ является наличие адекватного сознания у больного. В основе клинической эффективности ВПО лежит возможность создания большой скорости потока газа (до 60 л/мин). Такая скорость потока (которая равна или даже больше скорости потока при вдохе больного) минимизирует «примешивание» комнатного воздуха и разрешает поддерживать на вдохе высокую FiO2. Принципиально важно наличие возможности методом step by step регулировать скорость потока и температуры, точное измерение FiO2. Современные системы ВПО имеют специальные контуры из полупроницаемых материалов, которые не допускают образования конденсата и имеют оригинальные носовые или трахеостомические канюли.

High Flow Oxygen Therapy in Patients with Burn Injury

Some patients with severe burn injury have a high risk of developing acute respiratory failure, the cause of which may be interstitial pulmonary edema caused by inadequate infusion therapy.The objective: to evaluate the effectiveness of high-flow oxygen therapy (HFOT) in acute parenchymatous respiratory failure in burn patients.Subjects and methods. The prospective analysis included 74 patients with ARF in the stage of burn toxemia, without inhalation trauma, with PaO2/FiO2 below 300. In Main Group (37 patients), HFOT was used, while in Control Group patients received oxygenation through nasal cannula with the rate up to 15 l/min. Parameters of respiratory rate, PaO2/FiO2, PaCO2, MAP, heart rate, the number of intubations, respiratory comfort were recorded within 48 hours.Results. Main Group had higher values of oxygenation index in 48 hours of the trial (342 vs. 305.5, p = 0.02), faster normalization of blood gas composition compared to Control Group. HFOT was associated with greater respiratory comfort (8.4 vs. 5.3 VAS scores, p = 0.03), lower need in mechanical ventilation (4 vs. 11, p = 0.04).Conclusion: HFOT is an effective method for the treatment of respiratory failure in inpatients with burns. The need for intubation decreases, it is more comfortable to be tolerated than standard methods of oxygen therapy.

Effects of Oxygen via High-Flow Nasal Cannula on Adult Oropharyngeal Swallowing: A Literature Review

Purpose The use of high-flow oxygen via nasal cannula has become increasingly more common in various patient populations given the multiple benefits for treating respiratory distress and failure. There is emerging, though varying research on the impact high-flow oxygen delivery may have on adult oropharyngeal swallowing function. The purpose of this literature review is to outline available research and examine study design, populations investigated, findings, and clinical considerations of these findings. Method After an extensive online database search, we found five available peer-reviewed research articles specifically investigating oropharyngeal swallowing function in adults receiving high-flow nasal cannula (HFNC) therapy. Each article was reviewed and summarized in detail with close attention paid to results and clinical implications. Limitations, indirectness, and/or methodologic flaws are highlighted for the readers' consideration. Conclusions Four prospective design studies and one retrospective data analysis collection have been published evaluating the effects of high-flow oxygen therapy on adult oropharyngeal swallowing. Three of the prospective design studies evaluated healthy adults; one prospective design and the retrospective analysis data collection investigated acute care patients requiring HFNC. Study findings varied greatly likely due to variability of each study's subject population, design, and methods. Variability of results may make it challenging for speech pathologists attempting to use evidence-based decision making in clinical practice. Additional studies investigating nonhealthy subjects undergoing instrumental swallow studies while on HFNC are warranted.

Effects of high-flow oxygen therapy on patients with hypoxemia after extubation and predictors of reintubation: a retrospective study based on the MIMIC-IV database

BackgroundTo investigate the indications for high-flow nasal cannula oxygen (HFNC) therapy in patients with hypoxemia during ventilator weaning and to explore the predictors of reintubation when treatment fails.MethodsAdult patients with hypoxemia weaning from mechanical ventilation were identified from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. The patients were assigned to the treatment group or control group according to whether they were receiving HFNC or non-invasive ventilation (NIV) after extubation. The 28-day mortality and 28-day reintubation rates were compared between the two groups after Propensity score matching (PSM). The predictor for reintubation was formulated according to the risk factors with the XGBoost algorithm. The areas under the receiver operating characteristic curve (AUC) was calculated for reintubation prediction according to values at 4 h after extubation, which was compared with the ratio of SpO2/FiO2 to respiratory rate (ROX index).ResultsA total of 524,520 medical records were screened, and 801 patients with moderate or severe hypoxemia when undergoing mechanical ventilation weaning were included (100 < PaO2/FiO2 ≤ 300 mmHg), including 358 patients who received HFNC therapy after extubation in the treatment group. There were 315 patients with severe hypoxemia (100 < PaO2/FiO2 ≤ 200 mmHg) before extubation, and 190 patients remained in the treatment group with median oxygenation index 166[157,180] mmHg after PSM. There were no significant differences in the 28-day reintubation rate or 28-day mortality between the two groups with moderate or severe hypoxemia (all P > 0.05). Then HR/SpO2 was formulated as a predictor for 48-h reintubation according to the important features predicting weaning failure. According to values at 4 h after extubation, the AUC of HR/SpO2 was 0.657, which was larger than that of ROX index (0.583). When the HR/SpO2 reached 1.2 at 4 h after extubation, the specificity for 48-h reintubation prediction was 93%.ConclusionsThe treatment effect of HFNC therapy is not inferior to that of NIV, even on patients with oxygenation index from 160 to 180 mmHg when weaning from ventilator. HR/SpO2 is more early and accurate in predicting HFNC failure than ROX index.

Autonomic and Cognitive Function Response to Normobaric Hyperoxia Exposure in Healthy Subjects. Preliminary Study.

Background and objective: This is the first study to investigate the effect of high-flow oxygen therapy, using a normobaric chamber on cognitive, biochemical (oxidative stress parameters and the level of neurotrophins), cardiovascular and autonomic functioning. Materials and methods: 17 healthy volunteers, eight males and nine females, with a mean age of 37.5 years, were examined. The experimental study involved ten two-hour exposures in a normobaric chamber with a total pressure of 1500 hPa, in air adjusted to 37% oxygen, 1.079% carbon dioxide and 0.44% hydrogen. Cognitive function was assessed by using Trail Making Test parts A, B and difference in results of these tests (TMT A, TMT B and TMT B-A); California Verbal Learning Test (CVLT); Digit symbol substitution test (DSST); and Digit Span (DS). Fatigue (Fatigue Severity Scale (FSS)), cardiovascular, autonomic and baroreceptor functioning (Task Force Monitor) and biochemical parameters were measured before and after intervention. Results: After 10 sessions in the normobaric chamber, significant decreases in weight, caused mainly by body fat % decrease (24.86 vs. 23.93%, p = 0.04 were observed. TMT part A and B results improved (p = 0.0007 and p = 0.001, respectively). In contrast, there was no statistically significant influence on TMT B-A. Moreover, decrease in the number of symbols left after a one-minute test in DSST was noted (p = 0.0001). The mean number of words correctly recalled in the CVLT Long Delay Free Recall test improved (p = 0.002), and a reduction in fatigue was observed (p = 0.001). Biochemical tests showed a reduction in levels of malondialdehyde (p < 0.001), with increased levels of Cu Zn superoxide dismutase (p < 0.001), Neurotrophin 4 (p = 0.0001) and brain-derived neurotrophic factor (p = 0.001). A significant increase in nitric oxide synthase 2 (Z = 2.29, p = 0.02) and Club cell secretory protein (p = 0.015) was also noted. Baroreceptor function was significantly improved after normobaric exposures (p = 0.003). Significant effect of normobaric exposures and BDNF in CVLT Long Delay Free Recall was noted. Conclusions: This study demonstrates that 10 exposures in a normobaric chamber have a positive impact on visual information and set-shifting processing speed and increase auditory-verbal short-term memory, neurotrophic levels and baroreceptor function. A response of the respiratory tract to oxidative stress was also noted. There is a need to rigorously examine the safety of normobaric therapy. Further studies should be carried out with physician examination, both pre and post treatment.

Comparative analysis of the use of high-flow and traditional oxygen therapy in patients with severe community-acquired pneumonia. An experimental and clinical study

Introduction. In patients with spontaneous breathing and respiratory failure, various methods of delivering the gas mixture to the respiratory tract have been developed. The use of high-flow oxygen therapy is alternative standard oxygen therapy. Objectives. Experimental study of the effects of high-flow oxygen therapy and evaluation of its clinical effectiveness in comparison with traditional oxygen therapy in patients with severe community-acquired pneumonia. Materials and Methods. During the experimental stage of the study, the level of mean airway pressure was determined depending on the flow of the gas mixture using a lung model with parameters of biomechanics of respiration. During the clinical stage, a comparative analysis of the effectiveness of respiratory support in groups of patients with severe community-acquired pneumonia using high-flow and traditional oxygen therapy was carried out. Results. During experimental study, flow of gas mixture 30 l/min was determined, at which mean airway pressure registered on models of healthy lungs and lungs with modified respiratory biomechanics significantly increases. During the clinical phase of the study, a statistically significant decrease in the frequency of initiation of artificial (invasive and non-invasive) lung ventilation, an increase in oxygenation (saturation hemoglobin with oxygen, partial pressure oxygen in arterial blood) and partial pressure carbon dioxide with simultaneous decrease in respiratory rate. Conclusion. The value of gas flow over 30 l/min has significant effect on the recorded mean airway pressure calculated using models of lungs in experiment. However, clinical significance of this indicator is not clinically significant. The use of high-flow oxygen therapy in patients with severe community-acquired pneumonia in comparison with standard method reduces the frequency use of ventilation (invasive and non-invasive) with a significant increase in oxygenation indicators. This reduces hyperventilation, which is confirmed by a significant increase in partial pressure carbon dioxide and a decrease in respiratory rate.

High-flow oxygen therapy in tracheostomized patients at high risk of weaning failure

PurposeHigh-flow oxygen therapy delivered through nasal cannulae improves oxygenation and decreases work of breathing in critically ill patients. Little is known of the physiological effects of high-flow oxygen therapy applied to the tracheostomy cannula (T-HF). In this study, we compared the effects of T-HF or conventional low-flow oxygen therapy (conventional O2) on neuro-ventilatory drive, work of breathing, respiratory rate (RR) and gas exchange, in a mixed population of tracheostomized patients at high risk of weaning failure.MethodsThis was a single-center, unblinded, cross-over study on fourteen patients. After disconnection from the ventilator, each patient received two 1-h periods of T-HF (T-HF1 and T-HF2) alternated with 1 h of conventional O2. The inspiratory oxygen fraction was titrated to achieve an arterial O2 saturation target of 94–98% (88–92% in COPD patients). We recorded neuro-ventilatory drive (electrical diaphragmatic activity, EAdi), work of breathing (inspiratory muscular pressure–time product per breath and per minute, PTPmusc/b and PTPmusc/min, respectively) respiratory rate and arterial blood gases.ResultsThe EAdipeak remained unchanged (mean ± SD) in the T-HF1, conventional O2 and T-HF2 study periods (8.8 ± 4.3 μV vs 8.9 ± 4.8 μV vs 9.0 ± 4.1 μV, respectively, p = 0.99). Similarly, PTPmusc/b and PTPmusc/min, RR and gas exchange remained unchanged.ConclusionsIn tracheostomized patients at high risk of weaning failure from mechanical ventilation, T-HF did not improve neuro-ventilatory drive, work of breathing, respiratory rate and gas exchange compared with conventional O2 after disconnection from the ventilator. The present findings might suggest that physiological effects of high-flow therapy through tracheostomy substantially differ from nasal high flow.

The Effectiveness of High-Flow Oxygen Therapy and the Fascinating Song of the Sirens

This Viewpoint describes the evidence supporting the use of high-flow oxygen therapy in pediatric patients with bronchiolitis, with remarks associating this unproven therapy with characters from the Odyssey, by Homer.