High-flow Nasal Cannula Research Articles

Cost-effectiveness and clinical outcomes comparison between noninvasive ventilation and high-flow nasal cannula use in patients with multiple rib fractures.

Patients with multiple rib fractures often require advanced respiratory support to prevent intubation and associated morbidity. Noninvasive ventilation (NIV) and high-flow nasal cannula (HFNC) are commonly used, but direct comparisons of clinical outcomes and cost-effectiveness remain limited. This study aimed to compare NIV versus HFNC using a large, nationwide US database. This retrospective cohort study used the 2020-2021 National Inpatient Sample database to identify adult trauma patients (18-89 years) with two or more rib fractures who received either NIV or HFNC without prior intubation. To focus on isolated thoracic injuries, patients with significant injuries elsewhere (Abbreviated Injury Scale score ≥3) or who died within 24 hours were excluded. Inverse probability of treatment of weighting was used to balance patient characteristics, including demographics, comorbidities, and injury severity. Primary outcomes included mortality, tracheostomy, pulmonary complications, and intubation rates. Hospital length of stay and total costs were also assessed. Cost-effectiveness analyses were conducted with intubation avoidance as the effectiveness measure, and a willingness-to-pay threshold of US $50,000 per effectiveness unit was used. After adjustment, the NIV group demonstrated significantly better outcomes compared with HFNC, including lower mortality (11.4% vs. 17.0%, p = 0.007) and tracheostomy (1.2% vs. 3.1%, p = 0.006), and fewer pulmonary complications. Although intubation rates were not statistically different (12.0% vs. 15.6%, p = 0.085), the HFNC group had longer length of stay (13 vs. 10 days, p < 0.001) and incurred higher costs (US $42,505 vs. US $32,024, p < 0.001). Cost-effectiveness analysis revealed that NIV dominated HFNC, yielding better outcomes at lower costs. Among patients with multiple rib fractures, NIV yielded superior clinical outcomes, shortened hospital stays, and reduced costs compared with HFNC. These findings suggest that NIV may be a more cost-effective and clinically advantageous choice. Therapeutic/Care Management; Level III.

Dyspnea Among Mechanically Ventilated Patients: A Systematic Review.

Dyspnea is a common and distressing symptom; yet, how frequently and intensely mechanically ventilated patients experience dyspnea remains unclear. We performed a systematic review to identify the prevalence and severity of dyspnea in communicative, mechanically ventilated critically ill adults. We also identified factors associated with dyspnea in the short-term and long-term and potential management strategies. We performed a systematic search of the following databases: MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Web of Science Core Collection, PsycInfo, and CINAHL. Our search strategy used variations of these terms: dyspnea, mechanical ventilation, and critical care. We included prospective observational studies and randomized controlled trials. Two independent reviewers screened citations and extracted data using a predrafted report form to examine dyspnea prevalence and severity, association with short-term and long-term outcomes, and interventions to mitigate dyspnea. Of 6290 records screened, we included 21 observational studies and 3 randomized controlled trials. We calculated percentages and 95% CIs for prevalence using Stata 17 se. Dyspnea was present in 475 of 1169 communicative, mechanically ventilated patients (40.6%, 95% CI, 37.8-43.5) and was found to be moderate to severe. In the lone study to examine long-term outcomes, dyspnea was associated with posttraumatic stress disorder (PTSD) at 90 days. Interventions to reduce dyspnea included: mechanical threshold inspiratory muscle training, ventilation adjustments, supplemental high-flow nasal cannula, opioids, hyperoxemia, and nonpharmacologic interventions, including music and fan therapy. In this systematic review, we found that dyspnea among mechanically ventilated patients is common and moderate to severe in its intensity. Dyspnea is associated with adverse long-term outcomes, including probable PTSD. Strategies to manage, or palliate, dyspnea were identified. Future study is warranted to examine how this information can be incorporated into clinical practice to improve short-term and long-term outcomes.

Oxygen supplementation in pediatric sedation-prospective, multicenter, randomized controlled trial.

Children undergoing moderate to deep sedation for diagnostic and therapeutic procedures are susceptible to hypoxemia because of their anatomical and physiological features. However, optimal oxygen administration methods are unclear. This study aimed to evaluate the efficacy of oxygen supplementation during sedation using either low-flow or high-flow nasal cannula (HFNC). This prospective, multicenter randomized controlled trial included children (<18 years) undergoing moderate to deep sedation. The participants were randomly assigned to three groups as follows: (1) control (no oxygen), (2) low-flow (LF) (2-6 L/min oxygen via nasal cannula), and (3) high-flow (HF) (oxygen administration via HFNC with a flow rate of 2 L/kg and 50% fraction of inspired oxygen). The primary outcome was hypoxemia incidence (saturation of peripheral oxygen, SpO2 ≤95% for more than 5 s). Secondary outcomes included SpO2 <90%, rescue interventions, and sedation-related complications. Between-group differences were compared using a logistic regression model. A total of 253 participants were randomized, with 250 completing the study. Hypoxemia occurred in 27.6% of participants in the Control group, 7.2% in the LF group, and 1.2% in the HF group (p<0.001). The odds of hypoxemia in the LF and HF groups were lower than that in the Control group [odds ratio, OR=0.184 (95% CI, 0.067 - 0.503), p=0.001 for LF; OR=0.026 (95% CI, 0.003 - 0.207), p<0.001 for HF]. However, hypoxemia incidence of the HF group was not statistically lower than the LF group (OR 0.143 (95% CI, 0.017- 1.245), p=0.078). Rescue interventions were conducted more frequently in the Control group (52.9%) than in the LF (10.8%) and HF (3.6%) groups (p<0.001). Sedation-related complications such as desaturation and apnea were lower in the LF and HF groups than in the Control group (p<0.001). Routine oxygen supplementation prevents hypoxemia during pediatric moderate and deep sedation. Low-flow oxygen can be a reasonable choice as it effectively reduces hypoxemia while being more cost-effective and widely accessible than high-flow oxygen.

Modern Approach to the Treatment of Acute Respiratory Failure – from nasal cannula to ECMO

Introduction Respiratory failure is a major healthcare issue, significantly threatening patient life. Early diagnosis and appropriate oxygen therapy are critical for improving prognosis. This article aims to summarize and compare current oxygen therapy methods and their clinical indications. Material and Methods Oxygen therapy methods were discussed in the context of acute respiratory failure in the emergency department. The therapies reviewed included conventional oxygen therapy (COT), high-flow nasal oxygen therapy (HFNOT), noninvasive ventilation (NIV), invasive ventilation, and extracorporeal membrane oxygenation (ECMO). Indications were based on the latest guidelines from the European Respiratory Society, American Thoracic Society, and other medical organizations. Results High-flow nasal oxygen therapy (HFNOT) is superior to conventional oxygen therapy in treating acute hypoxemic respiratory failure, reducing the need for therapy escalation. Noninvasive ventilation (NIV) is effective for patients with respiratory acidosis and COPD exacerbations. ECMO is a life-saving option when other treatments fail, but its use is limited to patients with reversible causes of respiratory failure. Conclusions The choice of oxygen therapy depends on the patient's clinical condition. Modern approaches, such as HFNOT and NIV, offer advantages in reducing mortality and the need for invasive ventilation in acute respiratory failure, compared to traditional therapies. ECMO remains effective in severe cases but is reserved for specific indications. Further research is needed to optimize oxygen therapy use, focusing on reducing mortality and complications.

Successful nasotracheal intubation with surgical incision and video laryngoscope in a patient with anticipated difficult intubation due to limited mouth opening: A case report.

Difficult ventilation and intubation in anaesthesia are highly complex and challenging for the anaesthetist. We aim to present a case of successful nasotracheal intubation with surgical incision and video laryngoscope in a patient with anticipated difficult ventilation and intubation due to a limited mouth opening. A patient was an 81-year-old female scheduled for oral surgery for lip cancer. The patient's American Society of Anesthesiologists (ASA) physical classification was class III, and the oral airway was assessed as a Mallampati Class IV. A comprehensive preoperative evaluation of the patient revealed limited mouth opening (distance between incisors 1cm) and multiple decayed and broken teeth. A 2cm surgical incision of the skin was performed by plastic surgery under local anaesthesia and sedation without general anaesthesia. A high-flow nasal cannula (HFNO) was used for preoxygenation and to prevent desaturation during a difficult intubation. The oral cavity was topicalised with 2% lidocaine, and after the topical nasal vasoconstrictor to the nasal cavity, we selected a 7.0mm nasal flexible endotracheal tube (ETT). We inserted it into the right nostril with a video laryngoscope under local anaesthesia and sedation without general anaesthesia, and then, the patient's nasotracheal intubation was successfully performed. A multidisciplinary team approach to airway management should include all participants in planned patient care in the operating room, intensive care unit (ICU), post-anaesthesia care unit, or ward.

A Comparative Study of the Effectiveness of Surfactant Administration by a Less Invasive Surfactant Administration With Intubation-Surfactant-Extubation Method in Premature Infants With RDS: A Clinical Trial Study.

Conventional surfactant administration via tracheal tube involves short periods of positive pressure ventilation, which carries the risk of lung injury. The aim of this study was to investigate the feasibility and potential benefits of the less invasive surfactant administration (LISA) method in premature infants compared to the usual intubation-surfactant-extubation (INSURE). This randomized clinical trial was performed in Yazd between 2021 and 2023. One hundred twenty neonates with RDS were included in the study. The INSURE group (n=60) was injected with surfactant in the usual way inside the tracheal tube, and the LISA group was injected using nasal continuous positive airway pressure (CPAP) with a thin surfactant catheter. Duration of need for respiratory support by nasal CPAP (nCPAP) and high-flow nasal cannula was significantly more in the LISA group (P value = .00). Primary and secondary outcomes during surfactant injection in 2 groups were not statistically significant. In our study, there was no significant difference between the primary and secondary outcomes between LISA and INSURE groups. Therefore, more studies are needed in this field.

Ventilator Settings in Critically Ill Pediatric Patients (VESPer)—insights from a European Registry

AimTo explore ventilator settings, ventilation variables and parameters in critically ill pediatric patients across European Centers.MethodsInternational, multicenter, prospective observational study, collecting ventilation data for 7 days from patients aged ≤ 12 years, requiring ventilatory support for ≥ 12 h. Primary endpoint was a set of key ventilator settings, including tidal volume (VT), respiratory rate (RR), peak and mean airway pressure (Ppeak and Pmean), positive end–expiratory pressure (PEEP), and the fraction of inspired oxygen (FiO2). Ventilator settings were compared across neonates (aged < 1 month), infants (1 to 12 months), toddlers (1 to 3 years) and children (4 to 12 years), and between patients with and without pediatric acute respiratory distress syndrome (PARDS).ResultsPatients enrolment occurred in 43 centers in 11 countries, with a total of 166 patients—mostly infants—included in this analysis. The majority began with invasive ventilation, while one–third started with noninvasive ventilation (NIV) or high–flow nasal oxygen (HFNO). Patients on invasive ventilation, NIV and HFNO were weaned within a median of 3 [2–6], 3 [2–4] and 3 [2–4] days, respectively. In 22% of patients, NIV or HFNO was used following invasive ventilation. VT, RR and FiO2 varied across age groups, and airway pressures were higher in PARDS patients.ConclusionsIn this cohort, ventilator settings, and ventilation variables and parameters, varied between individual patients and across patient groups. Larger studies are needed to confirm this variability, explore associations between ventilation practices and clinical outcomes, and assess temporal and geo–economic differences.

Liberalizing Maximum High-Flow Nasal Cannula Flow Rates in the General Inpatient Ward Is Associated With Decreased Intensive Care Admissions for Infants With Bronchiolitis

Objective: To compare the use of intensive care for infants with bronchiolitis following a policy change increasing the rate maximums for high-flow oxygen given by nasal cannula [high-flow nasal cannula (HFNC)] allowable in the inpatient (IP) ward setting. Methods: This was a retrospective pre-post cohort study at an urban, tertiary care children’s hospital. Infants without complex chronic conditions presenting to the emergency department with bronchiolitis from December 2018 to March 2019 and December 2019 to March 2020 were included in the study. In December 2019, our institution increased the allowable HFNC flow rate on IP to 2 liters per minute/kilogram. The primary outcome was patient disposition from the emergency department. Secondary outcomes were the need for IP to pediatric intensive care unit (PICU) transfer, the need for care escalation to positive airway pressure or invasive mechanical ventilation, and hospital length of stay. Results: In total, 1043 and 1104 patients were included in the 2018 to 2019 and 2019 to 2020 cohorts, respectively. Infants in the second cohort were more likely to be admitted, though this association was not significant after adjusting for patient age and triage acuity. Infants in the second cohort had a lower risk of admission to the PICU, before and after adjusting for age and triage acuity. The risk of IP-to-PICU transfer, risk of care escalation, and length of stay did not increase. Conclusions: Increasing HFNC flow rates up to 2 liters per minute/kilogram on IP wards was associated with a reduction in intensive care admission and appears safe by balancing measures of care escalation.

Comparative Efficacy of Continuous Positive Airway Pressure Versus High-Flow Nasal Cannula Therapy in Children With Acute Bronchiolitis: A Systematic Review and Meta-Analysis

Comparative Efficacy of Continuous Positive Airway Pressure Versus High-Flow Nasal Cannula Therapy in Children With Acute Bronchiolitis: A Systematic Review and Meta-Analysis

The role of high-flow nasal cannula in pediatric respiratory distress

Recently, high-flow nasal cannula (HFNC) oxygen therapy has been introduced as a non-invasive ventilation therapy in pediatric populations. It has shown great efficacy in managing respiratory distress in adult ’populations, and it has been associated with promising outcomes in pediatrics through the last two decades. HFNC provides heated and humidified air mixed with oxygen through a nasal cannula, resulting in better oxygenation and reduced respiratory distress. Additionally, it has a basic principle, which is setting oxygen flow higher than inspiratory demand flow based on the clinical situation. HFNC was originally used in pediatric intensive care units; however, its use has expanded to various pediatric settings and different respiratory conditions, such as bronchiolitis and asthma. Although evidence exploring the effectiveness of HFNC in managing respiratory distress in pediatrics has steadily grown, it is still limited compared to evidence on adults. This review explores the effectiveness of HFNC in pediatric respiratory distress, highlighting its implications and adverse effects. Current evidence shows that HFNC efficacy is comparable to other non-invasive ventilation modalities or higher in some cases. It is also considered generally safe, as it is associated with fewer adverse events and is easier to use. These results encourage further research focusing on the use of HFNC in more uncommon and severe respiratory distress conditions in pediatrics.

Research hotspots and publication trends of high flow nasal oxygen: a bibliometric analysis from 2004 to 2023

BackgroundHigh-flow nasal oxygen (HFNO) has become an essential respiratory support modality in anesthesia, intensive care, and emergency medicine. This bibliometric analysis systematically evaluates the research landscape and technological developments in HFNO monitoring and management.MethodsRelevant publications were retrieved from the Web of Science Core Collection database using a comprehensive search strategy. Bibliometric analysis and visualization of countries, institutions, authors, journals, and keywords were performed using CiteSpace, VOSviewer, and Scimago Graphica. The analysis covered publications from 2004 to 2023.ResultsA total of 2782 publications on HFNO were identified. The United States was the leading country in terms of research output, while the University of Toronto was the most productive institution. Jie Li was the most prolific author, and Respiratory Care was the journal with the highest number of publications. The most common keywords included “COVID-19”, “noninvasive ventilation”, “high-flow nasal cannula”, “therapy”, and “ventilation”. Keyword emergence testing revealed that Transnasal Humidified Rapid-Insufflation Ventilatory Exchange (THRIVE) is a recent research hotspot.ConclusionThe study reveals a significant increase in HFNO research publications worldwide, a trend that is expected to continue. Future research should focus on exploring HFNO applications in diverse clinical settings, optimizing personalized treatment strategies, and integrating other respiratory support techniques to enhance its efficacy and safety.

Clinical Profile and Outcome of High Flow Nasal Cannula Therapy in Children with Acute Respiratory Distress: A Single Centre Retrospective Cohort Study from Southern India

Introduction: High Flow Nasal Cannula (HFNC) therapy is being widely used as a treatment option for acute respiratory support prior to tracheal intubation or invasive ventilation. HFNC is a form of therapy in which high concentrations of oxygen, with adequate humidity and temperature, are administered non invasively via a nasal cannula. This approach has been shown to reduce airway resistance and improve lung compliance. While there are studies in Western literature regarding the efficacy of HFNC therapy in children in developed countries, there is still a paucity of data on the outcomes and efficacy of HFNC therapy in children in developing countries. Aim: To describe the clinical profile and outcomes of HFNC therapy in children admitted to a Paediatric Intensive Care Unit (PICU) with acute respiratory distress, as well as to identify the risk factors for failure of HFNC therapy in these children. Materials and Methods: This was a retrospective cohort study conducted by analysing the case records of children admitted with severe respiratory distress to the PICU of a tertiary care hospital in Southern India during the period from January 1, 2023, to December 31, 2023. The results were analysed over a threemonth period from January 1, 2024, to March 31, 2024. In this study, 55 children aged between one month and 18 years were included if they had received HFNC therapy for acute respiratory distress during the study period. Clinical and demographic data were collected and analysed with regard to the aetiology of acute respiratory distress, the indication for HFNC therapy, and the outcome. Results: During the study period, 55 (23.6%) of the 233 children admitted to the PICU required HFNC oxygen therapy for acute distress. Of these, 24 (43.6%) were children less than one year of age. The most common indication for HFNC therapy was bronchiolitis in acute respiratory distress (58.2%). In this study, 43 (78.2%) of the 55 children improved with HFNC; however, 12 children (21.8%) required escalation to invasive mechanical ventilation, which was considered a treatment failure. The reasons for treatment failures were analysed and found to include desaturation with worsening of the primary pathology and discontinuation of HFNC due to nasal discomfort, particularly in older children. Conclusion: This study concluded that HFNC therapy is beneficial, offering favourable outcomes and alleviating the need for more invasive forms of ventilation.

Outcomes of high-flow versus conventional oxygen therapy in adult medical and post-surgical oncology patients: A systematic review and meta-analysis.

Outcomes of high-flow versus conventional oxygen therapy in adult medical and post-surgical oncology patients: A systematic review and meta-analysis.

Identifying risk factors and developing a nomogram for High Flow Nasal Cannula failure in patients with hypercapnic acute respiratory failure.

Identifying risk factors and developing a nomogram for High Flow Nasal Cannula failure in patients with hypercapnic acute respiratory failure.

Airway fires during use of high-flow nasal oxygen: a cause for concern.

Airway fires during use of high-flow nasal oxygen: a cause for concern.

Physiological effects and clinical evidence of high-flow nasal cannula during acute exacerbation in COPD patients: A narrative review.

Physiological effects and clinical evidence of high-flow nasal cannula during acute exacerbation in COPD patients: A narrative review.

Efficacy and Safety of Remdesivir for the Treatment of Patients with COVID-19: A Systematic Review

Abstract Remdesivir was widely used in India during the peak of the COVID-19 pandemic, and several guidelines recommended it for hospitalized hypoxic adult and pediatric patients. However, well-designed studies reported inconsistent results, and many international guidelines changed their recommendations with each emerging COVID-19 variant. This rapid review was done as part of living evidence synthesis (previous versions available in https://indicovidguidelines.org) to assess the effectiveness of various interventions in COVID-19 infection contextualizing to the current Indian context. We conducted a systematic review of randomized controlled trials (RCTs) evaluating remdesivir in COVID-19 infection (current to September 29, 2023). Two reviewers independently evaluated the eligibility of search results and extracted data for predefined outcomes. The risk of bias (RoB) was assessed using the Cochrane RoB v2.0 tool and meta-analysis using RevMan 5.4. We used hazard ratios for continuous outcomes, risk ratios (RRs) for dichotomous outcomes, and Grading of Recommendations, Assessment, Development, and Evaluation methodology to determine the certainty of evidence, which was then documented in the “ Table 2. summary of findings using GRADEpro Guideline Development Tool. In total, nine RCTs with 12,984 COVID-19 patients were included. Low certainty of evidence revealed that remdesivir when compared to standard care/placebo may reduce progression to noninvasive ventilation or high-flow nasal oxygen (RR = 0.70; 95% confidence interval [CI] = 0.51–0.98) but makes little to no difference on all-cause mortality at 28–30 days (RR = 0.92; 95% CI = 0.84–1.01) and progression to oxygen therapy (RR = 0.81; 95% CI = 0.54–1.22). The effect of remdesivir on progression to invasive mechanical ventilation (RR = 0.73; 95% CI = 0.51–1.06), adverse effects requiring interruption of therapy (RR = 1.18; 95% CI = 0.41–3.21), and hospitalization (RR = 0.14; 95% CI = 0.03–0.59) was unclear due to the very low certainty of evidence. This review suggests that remdesivir has an unclear benefit in the current context of COVID-19 variants which have a low propensity for severe disease, as well as widespread immunization in the country.

Efficacy of a standardized regional palivizumab administration protocol based on epidemic prediction for the following season.

Efficacy of a standardized regional palivizumab administration protocol based on epidemic prediction for the following season.

Delphi Consensus on the Management of Patients With Advanced COPD: COPD-Avanz Working Group.

Delphi Consensus on the Management of Patients With Advanced COPD: COPD-Avanz Working Group.

Predictors of Severity and Management of Severe Leptospirosis Patients in Intensive Care Unit

Background: Severe leptospirosis or Weil's syndrome occurs in 10% of leptospirosis cases, with a mortality rate of 5-40%. Misdiagnosis of leptospirosis often occurs due to nonspecific symptoms. Discussion of risk factors, causative agents, pathogenesis, clinical manifestations, diagnostic techniques, and predictors of disease severity are crucial for successful management.Cases: We report 3 cases of leptospirosis with various clinical manifestations and management. In these 3 cases, older age was associated with severe leptospirosis and poor outcomes. The SPiRO score can identify patients with severe leptospirosis requiring intensive care. All three cases of leptospirosis were severe with complications in the kidneys, lungs, and hematological system requiring intensive care in the intensive care unit (ICU).Discussion: Early and appropriate management can reduce patient mortality rates. ICU management of leptospirosis includes antibiotics, fluid balance, and support for affected organs. Patients with respiratory failure are given oxygenation using high-flow nasal cannula (HFNC), non-invasive ventilation (NIV), or invasive mechanical ventilation with endotracheal intubation (ETT). Acute kidney failure in leptospirosis can be managed with hemodialysis as indicated or may improve with conservative therapy. Corticosteroids may be administered for thrombocytopenia associated with leptospirosis.Conclusion: The three cases of leptospirosis were severe with complications in the kidneys, lungs, and hematological system requiring intensive care in the ICU. Early and appropriate management can reduce patient mortality rates. In these 3 cases, older age, mechanical ventilation, acute kidney failure, septic shock, thrombocytopenia, and elevated transaminase enzymes were associated with severe leptospirosis and poor outcomes.