High-flow Humidified Oxygen Research Articles

High-flow humidified oxygen as an early intervention in children with acute severe asthma: a feasibility randomised controlled trial.

Treating children with acute severe asthma (ASA) who fail to respond to first-line inhaled bronchodilators is problematic: use of intravenous agents is inconsistent and side-effects are common. High-flow humidified oxygen (HiFlo) has shown promise in other respiratory conditions and is increasingly used in ASA, but with little evidence. We conducted a feasibility randomised controlled trial with deferred consent to assess early HiFlo in children aged 2-11 years with ASA not responding to "burst" therapy (high-dose inhaled salbutamol ± ipratropium). Children with Paediatric Respiratory Assessment Measure (PRAM) score 5+ after "burst" were randomised to commence HiFlo or follow standard care. Candidate primary outcomes assessed were treatment failure requiring escalation, and time to meeting hospital discharge criteria. The target was met despite coronavirus disease 2019 pandemic disruption: 56 children were randomised across four sites, with deferred consent received in 50 out of 56 (89%), and mean recruitment rate 1.1 per site per month. 28 were allocated early HiFlo and 22 standard care. Data collection was complete for both candidate primary outcomes. Treatment failure requiring escalation occurred in 18 of 28 children (64%) in the HiFlo arm and in 19 of 22 (86%) in the standard care arm. Median (interquartile range) time from randomisation to meeting discharge criteria was 29.3 h (21.8-43.7 h) in the HiFlo arm and 36.8 h (24.1-46.3 h) in the standard care arm. HiFlo in childhood ASA is a potentially promising intervention whose use is increasing despite lack of evidence. A definitive randomised controlled trial to assess its effectiveness is required and appears to be feasible.

High-Flow Humidified Oxygen as an Early Intervention in Children With Acute Severe Asthma: Protocol for a Feasibility Randomized Controlled Trial.

Acute severe asthma (ASA) is a leading cause of hospital attendance in children. Standard first-line therapy consists of high-dose inhaled bronchodilators plus oral corticosteroids. Treatment for children who fail to respond to first-line therapy is problematic: the use of intravenous agents is inconsistent, and side effects are frequent. High-flow humidified oxygen (HiFlo) is widely used in respiratory conditions and is increasingly being used in ASA, but with little evidence for its effectiveness. A well-designed, adequately powered randomized controlled trial (RCT) of HiFlo therapy in ASA is urgently needed, and feasibility data are required to plan such an RCT. In this study, we describe the protocol for a feasibility study designed to fill this knowledge gap. This study aims to establish whether a full RCT of early HiFlo therapy in children with ASA can be conducted successfully and safely, to establish whether recruitment using deferred consent is practicable, and to define appropriate outcome measures and sample sizes for a definitive RCT. The underlying hypothesis is that early HiFlo therapy in ASA will reduce the need for more invasive treatments, allow faster recovery and discharge from hospital, and in both these ways reduce distress to children and their families. We conducted a feasibility RCT with deferred consent to assess the use of early HiFlo therapy in children aged 2 to 11 years with acute severe wheeze not responding to burst therapy (ie, high-dose inhaled salbutamol with or without ipratropium). Children with a Preschool Respiratory Assessment Measure score ≥5 after burst therapy were randomized to commence HiFlo therapy or follow standard care. The candidate primary outcomes assessed were treatment failure requiring escalation and time to meet hospital discharge criteria. Patient and parent experiences were also assessed using questionnaires and telephone interviews. The trial was opened to recruitment in February 2020 but was paused for 15 months owing to the COVID-19 pandemic. The trial was reopened at the lead site in July 2021 and opened at the other 3 sites from August to December 2022. Recruitment was completed in June 2023. This feasibility RCT of early HiFlo therapy in children with ASA recruited to the target despite major disturbances owing to the COVID-19 pandemic. The data are currently being analyzed and will be published separately. International Standard Randomised Controlled Trial Number Registry ISRCTN78297040; https://www.isrctn.com/ISRCTN78297040. DERR1-10.2196/54081.

Effect of nasal high-flow oxygen humidification on patients after cardiac surgery

BackgroundAlthough high-flow humidified oxygen therapy (HFNC) has emerged as an important treatment for respiratory failure, few studies have reported on whether HFNC is appropriate for patients with hypoxemia after cardiac surgery, and the clinical efficacy of HFNC in patients undergoing cardiac surgery is unclear. ObjectiveTo investigate the clinical effect of HFNC after cardiac surgery. MethodsConvenience sampling was used to select 76 patients who underwent invasive mechanical ventilation and oxygen therapy after valve replacement or coronary artery bypass grafting from July 2019 to June 2021. The patients were divided into the routine group and the HFNC group according to the oxygen therapy provided after the operation. The patients in the routine group (N = 38) were treated with oxygen inhalation by face mask after the operation, while those in the HFNC group (N = 38) were treated with HFNC via nasal cavity. The arterial partial pressure of oxygen (PaO2), the arterial partial pressure of carbon dioxide (PaCO2) and the oxygenation index (OI) were observed and compared between the two groups at 6 h, 12 h and 24 h after treatment. The sputum viscosity, incidence of second intubation and the intensive care unit (ICU) stay time were evaluated. ResultsThe difference in PaCO2 between the two groups was statistically significant at 24 h after treatment (p < 0.05). The PaO2 in the HFNC group was significantly higher than in the routine group at 24 h after treatment, and the OI of the routine group was lower than in the HFNC group at 6 h, 12 h and 24 h after treatment (p < 0.05). The sputum viscosity in the HFNC group was better than in the routine group at 12 h and 24 h after treatment. The second intubation rate and ICU stay time in the HFNC group were lower than in the routine group (p < 0.05). ConclusionCompared with conventional mask oxygen inhalation, HFNC can effectively reduce sputum viscosity, improve oxygenation, reduce the incidence of repeated intubation and meet patients’ comfort needs. It is an advantageous respiratory support strategy for patients after cardiac surgery compared with invasive mechanical ventilation to oxygen therapy and is beneficial to the recovery of cardiopulmonary function.

Analysis of the Efficacy of Humidified High-Flow Nasal Oxygen Therapy Combined with Alveolar Lavage in the Treatment of Patients with Severe Pneumonia Complicated with Respiratory Failure

Objective: To analyze the curative effect of humidified high-flow nasal oxygen therapy combined with alveolar lavage in patients with severe pneumonia and respiratory failure. Methods: 120 patients with severe pneumonia complicated with respiratory failure admitted to the Third People’s Hospital of Xining from July 2021 to December 2022 were randomly divided into two groups: group A and group B. The patients in group A were given humidified high-flow nasal oxygen therapy combined with alveolar lavage, whereas those in group B were given humidified high-flow nasal oxygen therapy. The treatment efficacy, blood gas analysis results, and differences in inflammatory mediators were compared between the two groups. Results: The curative effect in group A (96.67%) was significantly higher than that in group B (81.67%), P &lt; 0.05; the partial pressure of carbon dioxide (PaCO2), partial pressure of oxygen (PaO2 ), oxygen saturation (SpO2 ), and Horowitz index (P/F) of group A were significantly better than group B, P &lt; 0.05; the interleukin 6 (IL-6), tumor necrosis factor alpha (TNF-α), and C-reactive protein (CRP) levels, white blood cell (WBC) count, serum procalcitonin (PCT), and neutrophil (N) percentage of group A were significantly lower than those of group B, P &lt; 0.05. Conclusion: For patients with severe pneumonia complicated with respiratory failure, alveolar lavage, on the basis of humidified high-flow oxygen therapy, can inhibit local inflammation, improve blood gas analysis results, promote disease recovery, and improve the clinical treatment effect.

Comparative evaluation of high flow oxygen therapy versus low flow oxygen therapy in the management of acute moderate bronchiolitis

Background: Acute bronchiolitis is the most common respiratory tract infection in young children. Despite the high prevalence, no consensus exists on management. Hence the present study was conducted to find out the efficacy of high flow oxygen therapy (HFNC) versus low flow oxygen therapy in the management of acute moderate bronchiolitis. Methods: Prospective randomized controlled study of 100 children aged between 2 months to 24 months with signs and symptoms of acute moderate bronchiolitis were admitted to Indira Gandhi Institute of Child Health, Bangalore from January 2018 to June 2019 formed the study group, they were randomised into 2 groups, group A received high flow oxygen therapy and group B received low flow oxygen therapy. Results: Out of 100 children enrolled in the study, 50 children (group A) received high flow oxygen therapy and 50 children (group B) received low flow oxygen therapy. At 24 hours the mean severity score for group A was 0.46±077 and group B was 1.86±0.86 (p&lt;0.001). Maximum improvement in O2 saturation was observed in group A compared to group B. The duration of hospital stay was shorter (2-3 days) in group A with a mean of 2.20 days and was longer (4-5 days) in group B with a mean value of 3.84 days which was statistically significant (p&lt;0.001). Conclusions: Children with acute bronchiolitis treated with heated humidified high flow oxygen (HFNC) had early improvement in the clinical severity score, reduced duration of oxygen requirement and decrease in the length of hospital stay. Hence heated humidified high flow oxygen (HFNC) is an effective and safe modality of treatment for children with acute moderate bronchiolitis compared to low flow oxygen therapy (p&lt;0.0001).

THRIVE to the rescue.

Dear Editor, “Transnasal humidified rapid insufflation ventilator exchange (THRIVE)” works on the principle of ventilation without ventilator movements. With THRIVE, ventilation occurs with a noninvasive nasal cannula, with high flow humidified oxygen at 30–60 L/min. These high flows create a distending alveolar pressure or positive end-expiratory pressure (PEEP) up to 7 cm of water, which prevents airway collapse and atelectasis.[1,2] We describe two cases in which the use of THRIVE helped prevent reintubation postoperatively. Case 1: A 61-year-old male was operated for robotic radical cystectomy under general anesthesia in lithotomy and Trendelenburg position for 8 h. After extubation within a few minutes, he started to desaturate. Blood gas showed pH-7.33/pCO2-46.5/pO2-47.2/sat-76.4%. Bilateral lung basal atelectasis secondary to the position during the procedure was the probable diagnosis. In view of persistent hypoxia and the possibility of worsening oxygenation, the choice was noninvasive ventilation (NIV) or reintubation. However, NIV was logistically not possible in the OT. THRIVE (OptiFlow THRIVE system by Fisher and Paykel Healthcare Ltd, Auckland, New Zealand), was started at 30 L/min. Within few minutes, the saturation picked to 100%. Blood gas done after 30 min of THRIVE showed pH-7.38, pCO2-35, pO2-107.9, satulation-97.5%. As the patient was breathing comfortably and hemodynamically stable, he was shifted to the intensive care unit (ICU) with facemask oxygen for transfer. THRIVE was continued in the ICU for another 2 h and finally weaned off to a nasal cannula of 2 L/min. Case 2: A 61-year-old lady was operated for breast microdocectomy under general anesthesia, post-operatively the patient was extubated after which her respiratory rate was 36–38 per min with oxygen saturation of 88%–90% on 10 L oxygen non rebreathing mask and blood pressure of 213/102 mm Hg. Chest auscultation revealed bilateral crepts. Suspecting it to be pulmonary edema, injection furosemide IV was administered, and nitroglycerine (NTG) infusion was started. Her blood gas showed pH- 6.99, pCO2- 116, pO2- 85, pHCO3- 19, oxygen saturation-90%. After the initiation of THRIVE at 40 L/min over the next 10 min, her saturation started picking up to 97%–98%, and her respiratory rate settled to 18–20 per mi. Eventually her THRIVE flow was reduced to 20 L/min. Her blood gas was pH- 7.32, pCO2- 50.6, PO2 -140, HCO3-26 and was shifted to the ICU. After 2 h of THRIVE in the ICU, her blood gas was pH-7.3, pCO2- 41, pO2- 138, pHCO3- 25. Thrive delivers gases at a flow rate that exceeds the patient’s peak inspiratory flow rate.[3] It helps to recruit the lungs. It washes out the upper airway dead space, creating an oxygen reservoir and increasing the tidal volume, probably explaining the mechanism for decreasing the PCO2.[4] By increasing the end-inspiratory lung volume, it decreases the work of breathing.[5] The warm and humidified inspired gases decrease airway inflammation and improve drainage of respiratory secretions.[4] THRIVE can be an important additional tool to provide oxygen in the post-operative period to prevent reintubation. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Retracted: Application Evaluation of High-Flow Humidified Oxygen in Patients with Respiratory Failure after General Anesthesia Extubation for Multiple Injuries.

[This retracts the article DOI: 10.1155/2021/1387129.].

Apnoeic oxygenation during paediatric intubation: A systematic review.

This review assesses the effect of apnoeic oxygenation during paediatric intubation on rates of hypoxaemia, successful intubation on the first attempt and other adverse events. The databases searched included PubMed, Medline, CINAHL, EMBASE and The Cochrane Library. An electronic search for unpublished studies was also performed. We screened studies that include children undergoing intubation, studies that evaluate the use of apnoeic oxygenation by any method or device with outcomes of hypoxaemia, intubation outcome and adverse events were eligible for inclusion. Screening, risk of bias, quality of evidence and data extraction was performed by two independent reviewers, with conflicts resolved by a third reviewer where consensus could not be reached. From 362 screened studies, fourteen studies (N = 2442) met the eligibility criteria. Randomised controlled trials (N = 482) and studies performed in the operating theatre (N = 835) favoured the use of apnoeic oxygenation with a reduced incidence of hypoxaemia (RR: 0.34, 95% CI: 0.24 to 0.47, p < 0.001, I 2 = 0% and RR: 0.27, 95% CI: 0.11 to 0.68, p = 0.005, I 2 = 68% respectively). Studies in the ED and PICU were of lower methodological quality, displaying heterogeneity in their results and were unsuitable for meta-analysis. Among the studies reporting first attempt intubation success, there were inconsistent effects reported and data were not suitable for meta-analysis. There is a growing body of evidence to support the use of apnoeic oxygenation during the intubation of children. Further research is required to determine optimal flow rates and delivery technique. The use of humidified high-flow oxygen shows promise as an effective technique based on data in the operating theatre, however its efficacy has not been shown to be superior to low flow oxygen in either the elective anesthetic or emergency intubation situations Systematic Review Registration: This review was prospectively registered in the PROSPERO international register of systematic reviews (Reference: CRD42020170884, registered April 28, 2020).

Analysis of the Effect of Cluster Nursing on the Efficacy of Nasal High-Flow Humidified Oxygen Therapy in Patients with Hypoxemia in ICU

Analysis of the Effect of Cluster Nursing on the Efficacy of Nasal High-Flow Humidified Oxygen Therapy in Patients with Hypoxemia in ICU

Improved nutritional outcomes with neurally adjusted ventilatory assist (NAVA) in premature infants: a single tertiary neonatal unit\u2019s experience

During neurally adjusted ventilatory assist (NAVA)/non-invasive (NIV) NAVA, a modified nasogastric feeding tube with electrodes, monitors the electrical activity of the diaphragm (Edi). The Edi waveform determines the delivered pressure from the ventilator. Infant breathing is in synchrony with the ventilator and therefore is more comfortable with less work of breathing. Our aim was to determine if infants on NAVA had improved nutritional outcomes compared to infants managed on conventional respiratory support. A retrospective study was undertaken. Infants on NAVA were matched with two conventionally ventilated controls by gestational age, birth weight, sex, antenatal steroid exposure, and whether inborn or transferred ex utero. NAVA/NIV-NAVA was delivered by the SERVO-n® Maquet Getinge group ventilator. Conventional ventilation included pressure and volume control ventilation, and non-invasive ventilation included nasal intermittent positive pressure ventilation, triggered biphasic positive airway pressure, continuous positive airway pressure and heated humidified high flow oxygen. The measured outcome was discharge weight z scores. Eighteen “NAVA” infants with median gestational age (GA) of 25.3 (23.6–27.1) weeks and birth weight (BW) of 765 (580–1060) grams were compared with 36 controls with GA 25.2 (23.4–28) weeks (p = 0.727) and BW 743 (560–1050) grams (p = 0.727). There was no significant difference in the rates of postnatal steroids (61% versus 36% p = 0.093), necrotising enterocolitis (22% versus 11% p = 0.279) in the NAVA/NIV NAVA compared to the control group. There were slightly more infants who were breastfed at discharge in the NAVA/NIV NAVA group compared to controls: breast feeds (77.8% versus 58.3%), formula feeds (11.1% versus 30.6%), and mixed feeds (11.1% versus 11.1%), but this difference was not significant (p = 0.275). There was no significant difference in the birth z scores 0.235 (−1.56 to 1.71) versus −0.05 (−1.51 to −1.02) (p = 0.248) between the groups. However, the discharge z score was significantly in favour of the NAVA/NIV-NAVA group: −1.22 (−2.66 to −0.12) versus −2.17 (−3.79 to −0.24) in the control group (p = 0.033).Conclusion: The combination of NAVA/NIV-NAVA compared to conventional invasive and non-invasive modes may contribute to improved nutritional outcomes in premature infants.What is known about this topic:• Neurally adjusted ventilatory assist (NAVA) ventilation enables synchronisation of both the start and end of an inflation breath and allows the neonate to initiate their own breath and regulate.What this study adds: • NAVA when offered to extremely premature infants may have additional benefit of improved nutritional outcomes.

Risk of airway fire with the use of KTP laser and high flow humidified oxygen delivery in a laryngeal surgery model

Airway surgery presents a unique environment for operating room fire to occur. This study aims to explore the factors of combustion when using KTP laser with high flow oxygen in an ex-vivo model. The variables tested were varying tissue type, tissue condition, oxygen concentration, laser setting, and smoke evacuation in a stainless-steel model. Outcome measures were time of lasing to the first spark and/or flame. A multivariate Cox proportional hazard model was used to determine the risk of spark and flame across the different risk factors. For every 10% increase in oxygen concentration above 60% the risk of flame increased by a factor of 2.3. Continuous laser setting at 2.6 W increased the risk by a factor of 72.8. The risk of lasing adipose tissue is 7.3 times higher than that of muscle. Charred tissue increases the risk of flame by a factor of 92.8. Flame occurred without a preceding spark 93.6% of the time. Using KTP laser in the pulsed mode with low wattages, minimising lasing time, reducing the oxygen concentration and avoiding lasing adipose or charred tissue produce a relatively low estimated risk of spark or flame.

Sixteen cases of severe pneumonia caused by Chlamydia psittaci in South China investigated via metagenomic next-generation sequencing.

Introduction. Chlamydia psittaci is an important cause of community-acquired pneumonia (CAP). The spectrum of CAP due to Chlamydia psittaci ranges from mild, self-limited to acute respiratory failure and the early identification of this disease can be challenging. Metagenomic next-generation sequencing (mNGS) of bronchoalveolar lavage fluid has the potential to improve the pathogen identification in severe CAP.Hypothesis/Gap Statement. Metagenomic next-generation sequencing (mNGS) of bronchoalveolar lavage fluid has the potential to rapidly identify pathogens in severe CAP. The early identification and appropriate use of antibiotics can improve the prognosis of severe CAP caused by Chlamydia psittaci.Aim. The aim of the study is to describe the clinical spectrum of severe psittacosis pneumonia to provide a better understanding of this disease and to demonstrate that mNGS is an effective method for pathogen detection.Methodology. Retrospective case analysis from November 2019 to November 2020 was performed. Sixteen cases of severe psittacosis pneumonia were diagnosed through mNGS. Clinical features, laboratory findings, imaging features, treatment and outcome were summarized.Results. Frequent symptoms included fever (16/16, 100%), dyspnoea (16/16, 100%), cough (12/16, 75%), sputum (11/16, 69%) and headache (9/16, 56%). The median leukocytosis was within the normal range, while C-reactive proteins, CK, LDH, AST, D-Dimer were significantly elevated. The feature of computed tomography included ground-glass opacity with consolidation and multiple lobar distributions. The total number of sequences of Chlamydia psittaci identified from bronchoalveolar lavage by mNGS varied from 58 to 57115. Five patients underwent noninvasive mechanical ventilation, four patients underwent high flow humidified oxygen therapy and one patient underwent invasive mechanical ventilation. Two patients had septic shock needing vasoactive medications. All of the sixteen patients experienced full recoveries.Conclusion. The symptoms of severe CAP caused by Chlamydia psittaci were not typical while laboratory results may have some clues. The mNGS technology can early detect of psittacosis, reduce unnecessary use of antibiotics and short the course of the disease.

Application of high-flow humidified oxygen therapy in patients with tracheotomy and non-mechanical ventilation

To observe the effect of tracheotomy high-flow oxygen therapy (THFO) on the clinical efficacy of non-mechanically ventilated patients undergoing a tracheotomy. Sixty adult patients with tracheotomy and non-mechanical ventilation who were diagnosed and treated from January 2019 to December 2020 in Fenyang Hospital of Shanxi Province were enrolled. According to the random number table, the patients were divided into Venturi oxygen therapy group and THFO group, 30 cases in each group. The THFO group was given oxygen therapy with THFO; the Venturi group (without mask) was given Venturi connected the MR850 base and the ventilator tube. Observe the changes of two groups at 7 AM within 5 days, including body temperature which was 1 centigrade higher than the baseline, white blood cell count (WBC) which was 2×109/L higher than baseline, oxygenation index (PaO2/FiO2) < 300 mmHg (1 mmHg = 0.133 kPa), the occurrence of lower respiratory tract infections (based on radiography), and changes in sputum indexing and sputum formation. Compared with the Venturi oxygen therapy group, the body temperature increased > 1 centigrade, WBC increased by 2×109/L, PaO2/FiO2 < 300 mmHg, and the proportion of lower respiratory tract infection in THFO group decreased significantly [body temperature increased > 1 centigrade: 10.0% (3/30) vs. 13.3% (4/30), WBC increased by 2×109/L: 10.0% (3/30) vs. 30.0% (9/30), PaO2/FiO2 < 300 mmHg: 3.3% (1/30) vs. 10.0% (3/30), the proportion of lower respiratory tract infection: 6.7% (2/30) vs. 13.3% (4/30), all P < 0.05]. The proportion of patients with sputum scab formation and sputum viscosity of I degree were significantly increased [sputum scab formation: 16.7% (5/30) vs. 6.7% (2/30), sputum viscosity of I degree: 30.0% (9/30) vs. 20.0% (6/30), both P < 0.05]. THFO during non-mechanical ventilation of adult patients with tracheotomy can maintain a higher oxygen partial pressure and ideally control the temperature and humidity of the inhaled gas, promote the discharge of sputum with degree I and II viscosity, thereby reducing the tracheotomy complications such as lower respiratory tract infections.

Application Evaluation of High-Flow Humidified Oxygen in Patients with Respiratory Failure after General Anesthesia Extubation for Multiple Injuries.

Objective To explore the effect of high-flow humidified oxygen therapy (HFNC) on patients with respiratory failure after general anesthesia extubation for multiple injuries. Methods 214 patients with multiple injuries in our hospital who underwent general anesthesia and suffered respiratory failure after weaning extubation and received sequential treatment were included. And, they were divided into control group (HFNC group) and observation group (NIMV group) according to the random number table method. Patients in the control group (125 cases) used high-flow nasal cannula (HFNC) after general anesthesia extubation, while patients in the observation group (89 cases) used NIMV. The respiratory rate, heart rate, finger pulse oxygen, oxygenation index (PaO2/FiO2), and re-tracheal intubation rate in the two groups were compared at 2, 8, and 24 hours after sequential treatment, and the mortality rate and hospital stay of ICU time were whole-course observation. And, the effect of conventional oxygen inhalation or HFNC on oxygenation and prognosis was analyzed. Then, SPSS21.0 software was applied for statistical analysis. To analyze the effect of conventional oxygen inhalation or HFNC on the improvement of oxygenation and prognosis, the receiver operating characteristic (ROC) curve can be used to evaluate the feasibility and treatment effect of high-flow nasal oxygen therapy (HFNC) for patients with respiratory failure after general anesthesia extubation for multiple injuries. Results Compared with the NIMV group, the respiratory frequency and heart rate of the HFNC group were significantly improved after 2 h, 8 h, and 24 h. At the same time, the finger pulse oxygen and oxygenation index increased significantly and returned to normal levels. HFNC can significantly reduce the reintubation rate, ICU hospital stay, and mortality rate. The area under the ROC curve was 0.9102, with 95% CI (0.8256, 0.9949) and P < 0.0001. Conclusion For patients with multiple injuries undergoing general anesthesia and respiratory failure after weaning and extubation, the application of HFNC can moderate patients' heart rate and respiratory rate faster, increase oxygenation index and finger pulse oxygen, and reduce the reintubation rate, mortality rate, and ICU stay. At the same time, it can effectively improve the respiratory failure of patients after extubation and reduce the occurrence of complications.

The effect of heated humidified nasal high flow oxygen supply on exercise tolerance in patients with interstitial lung disease: A pilot study

Background and objectivesPatients with interstitial lung disease (ILD) experience early symptoms of dyspnoea and leg fatigue during exercise together with severe and rapid oxygen desaturation. Heated and humidified nasal high flow oxygen (NHF) has been proven to enhance exercise endurance and physiological parameters in COPD patients. This study aims to evaluate the effect of NHF on exercise tolerance in ILD patients. MethodsTwenty-five patients (10 female) with severe ILD performed three constant-load (70% maximal workload) cycling tests to exhaustion under different breathing conditions: room air, oxygen supplementation (4 L min−1 O2) and NHF (inspiratory O2 fraction 0.5, 30–50 L min−1, heated 34 °C and humidified). ResultsEndurance time was significantly longer with NHF (618 ± 297 s) compared to O2 (369 ± 217 s, p < 0.001) and room air (171 ± 76 s, p < 0.001). Kinetics of oxygen desaturation, chronotropic response, dyspnoea and leg fatigue sensations were delayed with NHF. At exhaustion with NHF, compared to the two other conditions, oxygen desaturation was less severe while heart rate, dyspnoea and leg fatigue were similar. ConclusionNHF significantly improved endurance time, physiological parameters and sensations during exercise in severe ILD patients. NHF may be useful to improve functional capacities and facilitate pulmonary rehabilitation in ILD.

Comparison of High-Flow Humidified Oxygen With Conventional Continuous Positive Airway Pressure in Nonventilated Lungs During Thoracic Surgery: A Randomized Cross-Over Study

This study assessed the efficacy of high-flow humidified oxygen (HFHO) as an alternative to continuous positive airway pressure (CPAP) for improving oxygenation while preserving nonventilated lung collapse during one-lung ventilation. A prospective randomized cross-over trial. A tertiary medical center. The study comprised 28 patients undergoing elective thoracotomy with one-lung ventilation using a double-lumen endobronchial tube placement. The patients received prophylactic CPAP or HFHO to the nonventilated lung for 20 minutes and were then crossedover to the other oxygenation modality for 20 minutes, with a 20-minute recovery interval between the two modalities. Changes in respiratory parameters and lung deflation quality were recorded. Both CPAP and HFHO increased the partial pressure of arterial oxygen in either sequence in both groups, ranging from 31.8-to-66.0 mmHg. However, the increments from these two interventions were not statistically significant (95% confidence interval -12.84 to 21.87; p = 0.597). There were no differences in other parameters. Half the patients receiving CPAP experienced worsening of the surgical condition, whereas the HFHO patients experienced no change or reported a better lung deflation (p < 0.001). HFHO could be an alternative method to CPAP for improving arterial oxygenation while preserving lung deflation during one-lung ventilation. However, additional studies are warranted in regard to its cost-effectiveness and establishment as a routine treatment.

High-flow oxygen therapy v. standard care in infants with viral bronchiolitis.

Background High-flow humidified oxygen (HFHO) therapy has demonstrated benefit in infants with bronchiolitis. Objectives To investigate the efficacy of HFHO in infants with moderate to severe viral bronchiolitis, when used outside the paediatric intensive care unit (PICU), in a hospital with limited PICU resources. Methods A randomised controlled trial, which enrolled 28 infants between 1 month and 2 years of age, with a clinical diagnosis of acute viral bronchiolitis and moderate to severe respiratory distress. Participants were randomised to receive HFHO 2L/kg/min or oxygen by nasal cannula/ face mask. Respiratory rate, heart rate, oxygen saturations, and modified TAL (M-TAL) score were measured at baseline, 60 - 90 minutes after starting therapy and at 6- and 12-hourly intervals. The primary outcome evaluated was the improvement in respiratory distress (M-TAL score). The secondary outcome assessed was the need for intubation and ventilation. Results There was a significant improvement in respiratory distress (M-TAL score), in infants who received HFHO therapy. Additionally, there was also a reduction in heart rate in the HFHO group as well as a trend to lower intubation rates. Conclusion HFHO is a beneficial therapy for infants with moderate-severe viral bronchiolitis. It can be safely used outside the PICU and could potentially reduce the need for intubation and admission to PICU in resource-limited settings. Contributions of the study High-flow humidified oxygen (HFHO) is effective in infants with moderate to severe bronchiolitis, and not only in those with milder forms of the disease. It can be safely used outside the paediatric intensive care unit, where adequate respiratory monitoring is available. This is important in low-resource areas where there may be insufficient critical care resources to manage these patients.

A nationwide survey on the use of heated humidified high flow oxygen therapy on the paediatric wards in the UK: current practice and research priorities

BackgroundHeated Humidified High Flow Nasal Cannula Oxygen Therapy (HHFNC) is increasingly used on the paediatric wards and High Dependency Units (HDU) for different types of pathologies and different age groups. We aimed to describe current practice related to the use of HHFNC on the paediatric wards and HDUs, weaning practices and preferred outcome measures for future research.MethodsWe carried out a cross-sectional online survey of UK paediatric consultants or their delegates working on the paediatric wards. Descriptive analysis of their geographical, and organizational characteristics, their specialties, and their level of experience was investigated. Reasons for HHFNC initiation, weaning criteria, patients’ characteristics and their primary pathologies were also analysed.ResultsParticipation of 218 paediatricians from 81 hospitals (Median: 2.7, Range: 1–11) was registered. HHFNC was provided in most of the surveyed hospitals (93%, 75/81). A High Dependency Unit (HDU) was available in 47 hospitals (58%); less than a third of those have a dedicated paediatrician. Decisions around HHFNC were made solely by paediatricians in (75%) of the cases, mostly at hospitals with no HDU compared to those with dedicated HDUs (70.3% VS 36.6, 95%CI:22.6–50.4%, P < .001). HHFNC was reported by nearly two-thirds (68%) of the practitioners who used it on the wards to be as effective or superior to CPAP (Continuous Positive Airway Pressure) with fewer complications. Failure rate while on HHFNC was identified as the most important outcome measure in any future research followed by the length of need for HHFNC support (37.1, and 28% respectively).ConclusionThis survey showed support for developing paediatric-specific national guidance on the use of HHFNC on the wards. Our list of defined research priorities may help guide further collaborative research efforts in this field.

A review of the use of transnasal humidified rapid insufflation ventilatory exchange for patients undergoing surgery in the shared airway setting.

Transnasal humidified rapid insufflation ventilatory exchange (THRIVE) is a recent technique that delivers warm humidified high flow oxygen to patients, allowing for prolonged apneic oxygenation. A review of current literature was performed to determine the use of THRIVE in apneic patients undergoing surgery in a shared airway setting. An initial free hand search was done to identify keywords followed by a systematic search of major databases with no date or language restrictions. Inclusion criteria include all apneic patients who receive THRIVE for any operative procedure. Fifteen studies fulfilled the inclusion criteria. There were ten case series, two case reports, two review articles and one randomized controlled trial. All of the studies discussed the use of THRIVE during laryngopharyngeal surgeries. The median apnea time reported ranged between 13 and 27min. There were no significant complications reported as a result of using THRIVE. Most studies identified in this review were observational in nature involving laryngopharyngeal procedures. They have demonstrated THRIVE to be effective in providing apneic oxygenation during short procedures in adult patients. Further studies are required to determine the limitations of safe use in specific populations and when THRIVE is combined with diathermy or laser use.

Respiratory Support in Bronchiolitis: Trial Evidence.

Acute viral lower respiratory tract infection is frequently associated with hypoxemia and respiratory distress, sometimes progressing to hypercarbia and respiratory failure. In recent years, trials have assessed the effects of oxygen supplementation and respiratory support with high-flow oxygen therapy. An oxygen saturation target of 90% is as safe and clinically effective as 94% in infants with bronchiolitis. Trials of high-flow humidified oxygen have demonstrated safety, but as yet poorly demarcated an appropriate place for use within the clinical course of the disease. Effective trials of continuous positive airway pressure are lacking and urgently required. The trials reported to date have highlighted the need for common outcomes in relation to treatment failure.