High-flow Nasal Cannula Research Articles

Efficacy of High Flow Nasal Cannula in the Treatment of Patients with COVID-19 with Acute Respiratory Distress Syndrome: Results of Single Centre Study in Vietnam.

Most hospitalized patients required invasive or non-invasive ventilation and High Flow Nasal Cannula (HFNC). Therefore, this study was conducted to describe the characteristics of patients with severe Coronavirus Disease-2019 (COVID-19) treated by HFNC and its effectiveness for reducing the rate of intubated-mechanical ventilation in the Intensive Care Unit (ICU) of Phu Chanh COVID-19 Department-Binh Duong General Hospital. It was a cross-sectional and descriptive study. All severe patients with COVID-19 with acute respiratory failure eligible for the study were included. Patient characteristics, clinical symptoms, laboratory results, and treatment methods were collected for analysis; parameters and data related to HFNC treatment and follow-up were analysed. 80 patients, aged of 49.7 ± 16.6years, were treated with HFNC at admission in ICU. 14 patients had type 2 diabetes (17.5%), 3 patients had chronic respiratory disease (3.8%), 19 patients had high blood pressure (23.8%), and 5 patients with other comorbidities (7.4%). The majority of patients with severe COVID-19 had typical symptoms of COVID-19 such as shortness of breath (97.5%), intensive tired (81.3%), cough (73.7%), anosmia (48.3%), ageusia (41.3%), and fever (26.3%). The results of arterial blood gases demonstrated severe hypoxia under optimal conventional oxygen therapy (PaO2 = 52.5 ± 17.4mmHg). Respiratory rate, SpO2, PaO2 were significantly improved after using HFNC at 1st day, 3rd day and 7th day (P < 0.05; P < 0.05; P < 0.01; respectively). Receiver operating characteristics (ROC) index was significantly increased after treating with HFNC vs before HFNC treatment (4.79 ± 1.86, 5.53 ± 2.39, and 7.41 ± 4.24 vs 2.97 ± 0.39; P < 0.05, P < 0.05 and P < 0.01, respectively). 54 (67.5%) patients were success with HFNC treatment and 26 (32.5%) patients with HFNC failure needed to treat with Continuous Positive Airway Pressure (CPAP) (13 patients; 50%) or intubated ventilation (13 patients; 50%). HFNC therapy could be considered as a useful and effective alternative treatment for patients with acute respiratory failure. HFNC might help to delay the intubated ventilation for patients with respiratory failure and to minimise the risk of invasive ventilation complications and mortality. However, it is crucial to closely monitor the evolution of patient's respiratory status and responsiveness of HFNC treatment to avoid unintended delay of intubation-mechanical ventilation. An independent ethics committee approved the study (The Ethics Committee of Binh Duong General Hospital; No. HDDD-BVDK BINH DUONG 9.2021), which was performed in accordance with the Declaration of Helsinki, Guidelines for Good Clinical Practice.

Long-Term High-Flow Nasal Therapy in Patients with Bronchiectasis of Different Severity: A Retrospective Cohort Study.

Background/Objectives: High-flow nasal therapy (HFNT) has been shown to reduce exacerbations of COPD and some evidence displays benefits in non-cystic fibrosis bronchiectasis (NCFB) patients. The present study aimed to compare the effectiveness of 12 months of home HFNT on the annual exacerbation rate between mild/moderate and severe NCFB patients, classified by the bronchiectasis severity index (BSI). Secondary outcomes were the evaluation of the dyspnea, pulmonary function, and sputum cultures in both groups. Methods: The study population included NCFB adult patients, with at least one severe exacerbation in the previous year on optimized therapy. NCFB exacerbations, dyspnea (mMRC score), pulmonary function test, and sputum cultures were assessed at baseline and after 12 months of HFNT. Results: A total of 86 NCFB patients were enrolled: 36 in the mild/moderate (BSI < 9) and 50 in the severe (BSI ≥ 9) group. A significant improvement in the annual exacerbation rate was found in both BSI ≥ 9 (p < 0.0001) and BSI < 9 cohorts (p < 0.0001), with a between-group difference of -1 (95% CI: -2 to 0) exacerbations per year (p = 0.0209). The change in the annual exacerbation rate was significantly correlated with BSI (ρ = -0.26, p = 0.0151) and with HFNT daily use (ρ = -0.22, p = 0.0460). The mMRC score significantly improved by -2 points (95% CI: -2 to -1) after treatment in both groups (p < 0.0001). The percentage of patients with P. aeruginosa colonization decreased from 34.9% to 27.9%. Conclusions: Long-term HFNT reduces the annual exacerbation rate in NCFB patients and its effectiveness increases alongside disease severity and daily use of HFNT.

Features of children with critical asthma hospitalized in a pediatric intensive care unit: Results from the ICU-3A study.

Despite improvements in long-term asthma treatment, an increasing number of children are being hospitalized in pediatric intensive care units (PICU) for asthma. The main objective of this study was to describe a recent cohort of children hospitalized in PICU for asthma to identify risk factors associated with a need for respiratory support, and multiple PICU stays. We conducted a retrospective cohort study in three PICUs in Paris (intensive care units 3A Study), using medical files of children hospitalized for asthma between February 2019 and October 2020. Need for respiratory support was defined by the need for high-flow nasal cannula or mechanical ventilation (MV) (either noninvasive [NIV] or invasive [IMV]). During the study period, 252 stays corresponding to 234 patients were analyzed. MV was required in 17.5% of stays, for significantly younger patients (2.37 vs. 4.18 years, p = 0.002). On multivariate analysis, a higher risk of progression to a need for respiratory support was found for children requiring magnesium sulfate or oxygen therapy ≥6 L/mn before PICU admission (RR 4.48; CI95% [1.85-10.89]; p = 0.001, and RR 2.86; CI95% [1.13-7.22]; p = 0.03, respectively), and those with atelectasis detected on chest radiography (RR 3.38; CI95% [1.43-8.00]; p < 0.01). Multiple PICU stays were associated with greater social deprivation (RR for French Deprivation Index 1.25; CI95% [1.03-1.51]; p = 0.03). Children experiencing social deprivation are at greater risk of multiple PICU stays for severe asthma. After transfer to PICU, children with chest radiograph detected atelectasis on admission are at higher risk of needing respiratory support.

Assitenza ventilatoria non invasiva: dalla teoria alla pratica

Noninvasive respiratory assistance strategies are becoming part of everyday life for paediatricians, both in hospitals and territorial settings. In the acute condition, a timely and correct use of noninvasive respiratory support can improve the outcome of acute respiratory failure, decreasing the need for invasive mechanical ventilation. An increasing number of chronic patients can benefit from appropriate treatment with home ventilators. Respiratory assistance may be performed using High Flow Nasal Cannula (HFNC), Continuous Positive Airway Pressure (CPAP) or NonInvasive Ventilation (NIV), depending on the primary cause of respiratory failure. Understanding the working mechanisms of the different techniques and the golden rules to use them is crucial for a satisfying outcome.

Outcomes of severe lower respiratory tract infection in Mexican children with cancer

Abstract Background Lower respiratory tract infections (LRTI) are a very serious complication in children with cancer, with high morbidity and mortality, due to viral infections, followed by bacterial and fungal organisms. These patients with cancer are undergoing chemotherapy that damages their mucosal barrier and respiratory epithelium, and course with profound or severe neutropenia. Thus, they are high-risk to develop severe respiratory infections acquired from the community. However, the clinical characteristics, etiological agents, finding on computed tomography (CT) and outcomes of the LRTI in immunocompromised patients are not well known, these are necessary in order to start adequate management including empirical antimicrobial therapy and supplementary oxygen therapy. Methods Children with cancer who were attended in the pediatric emergency room due to fever (&amp;gt;38°C) and presence of respiratory symptoms such as increased breath rate, cough, O2Sat &amp;lt;93%, and needed to supplementary oxygen were included. To analyze the cases of children with cancer and LRTI we documented the data regarding to clinical presentation, detection of respiratory virus and findings in the CT. Data such age, sex, oncological diagnosis, absolute neutrophil count. The detection of nucleic acid of respiratory virus was performed by qPCR, whereas the identification galactomannan in serum was done for fungal diagnosis, and clinical presentation was initial used for diagnosis of bacterial LRTI. The findings on TC were included to integrate all the LRTI etiological diagnosis. The outcomes recorded were to need supplementary oxygen therapy (nasal cannula, high-flow nasal cannula or mechanical ventilation), ICU admission, and mortality on the follow for all patient included in the study. A descriptive statistical analysis was performed to estimate frequency of the etiological agents, outcomes, and mortality rate. Results A total of 10 children with cancer and severe LRTI were followed up, 60% female sex, age 5.5 years (range, 1-16 &amp;lt;); 80% had acute leukemias and 20% lymphoma. Seven (70%) children were diagnosed with bacterial LRTI, whereas two (20%) and one (10%) were viral LRTI-diagnosed. The finding in the CT were the follow: bilateral patchy consolidation and ill-defined small nodules for viral infection, centrilobular nodules and bronchial wall thickening for bacterial infection and scattered nodules or patchy focus for fungal infection. In respect to clinical presentation 90% had fever, 100% had cough, and 100% had O2Sat &amp;lt;93%. Of these patients 60% were presented with profound and 20% with severe neutropenia (p&amp;lt;0.05); 30% had required high-flow oxygen and 10% mechanical ventilation; and three (30%) patients required care in ICU. The mortality rate for severe LRTI was 30%. Conclusion Children with cancer and profound or severe neutropenia are in high-risk to develop severe LRTI and they have high mortality. The finding on the CT can help to start on adequate management for LRTI in immunosuppressed pediatric patients.

Laryngeal mask airway or high flow nasal cannulaversusnasal cannula for advanced bronchoscopy – a randomized controlled trial

Research QuestionAdvanced bronchoscopic procedures became a widely prevalent evaluation and treatment modality. These procedures require appropriate sedation and respiratory support. This study directly compares three respiratory support methods during advanced bronchoscopy.MethodsThis 3-arm, prospective, block randomized trial included 60 consenting adult patients that were referred for advanced bronchoscopy involving endobronchial ultrasound with transbronchial needle aspiration (EBUS – TBNA) and met inclusion / exclusion criteria. Patients were randomized to undergo a bronchoscopy through a laryngeal mask airway (LMA), or with a high-flow nasal cannula (HFNC) or low flow nasal cannula (NC), with bronchoscopy performed through a bite block. Demographic, procedural and clinical parameters were compared between the 3 groups, including complications, oxygenation, ventilation and need for intervention.ResultsAnalysis according to intention to treat was made for the 20 patients in each arm. There were no significant differences in demographic parameters, pre-morbidities, and procedure type and duration between groups. Hypoxia was significantly more common in the NC group (90%) compared with the LMA (45%) and HFNC (26%) groups (p&lt;0.01). Need for interventions and their number was also lower in the LMA (40%) and HFNC (52.6%) groups compared to the NC group (90%, p&lt; 0.01). A multivariate analysis confirmed both HFNC and LMA as independent predictors of lower rate of recurrent desaturation events and fewer complications in general compared to NC.

Lemierre’s syndrome associated-diabetic ketoacidosis in an elderly female: a case report

BackgroundThe co-occurrence of Lemierre’s syndrome, primarily triggered by Fusobacterium necrophorum following oropharyngeal infection, with diabetic ketoacidosis (DKA) in diabetes mellitus (DM) patients, underscores a rare but life-threatening clinical scenario. Lemierre’s syndrome induced DKA is extremely rare, with only one case report in adult and no case yet reported in elderly.Case PresentationWe reported a case of a 69-year-old female who presented with DKA triggered by deep neck space infection (DNSI), leading to rapid clinical deterioration within 6 h that necessitated high flow nasal cannula (HFNC) and antibiotic administration. Laboratory findings included leukocytosis, elevated serum C-reactive protein, hyperglycemia, ketonemia, and severe metabolic acidosis. Culture of the fluid from a neck mass puncture drainage and blood were positive for Klebsiella pneumoniae. The patient was further complicated by thrombosis of the left internal jugular vein with extension to the sigmoid and a neck abscess surrounding the carotid artery sheath, consistent with Lemierre’s syndrome. This condition was managed aggressively with fluid resuscitation, insulin therapy, surgical drainage, antibiotics, and anticoagulation led to a significant improvement in her condition. Following a 13-day hospitalization, there was significant clinical improvement, culminating in the patient’s discharge.ConclusionsThe case highlights the need for greater awareness and understanding of the interrelated and mutually promoting conditions of DKA and Lemierre’s syndrome among clinicians. Early recognition and treatment are crucial to prevent mortality in such complex cases.

Effects of Combined Respiratory Physiotherapy with High-Flow Nasal Cannula and Venturi Mask in Spinal Cord Injury: A Single-Subject Research Study and Literature Review.

The level of spinal cord injury affects the severity of respiratory impairment and the alteration of respiratory pattern and gas exchanges. Lesions at the C3-C5 level (phrenic nerve nucleus) cause disruption of descending input with paralysis of the main inspiratory muscle, often requiring tracheostomy and prolonged mechanical ventilation. Oxygen therapy is essential to switch from ventilatory support to removal of the endotracheal tube to correct residual difficulties in oxygenation management. A 58-year-old man had tracheostomy and tetraparesis as complication of tonsillectomy and adenoidectomy treatment for a history of obstructive sleep apnea. A respiratory rehabilitation program with protocol of oxygen therapy with high flow cannula alternated with a low-flow system by Venturi mask during daytime hours only was started. The patient was constantly monitored with capillary partial oxygen saturation to obtain adequate oxygenation (≥ 94%) and registered every 15 minutes in the clinical chart. There was gradual improvement of respiratory function. Oxygen by Venturi mask was gradually reduced due to improvement of partial pressure oxygen values. Over the course of days, the optimal results of respiratory parameters led to a gradual weaning from the Venturi mask until the complete discontinuation of the low-flow system during daytime and decreased of the high-flow fraction of inspired oxygen to the maximal tolerated level during nighttime. Implementing a combined protocol of nighttime oxygen with high flow cannula and daytime Venturi mask improves intensive motor training of patients by promoting the acquisition of ability to perform chair/bed transitions and to be able to achieve standing and begin gait training. More research is needed whether or noted to determine the role of this promising approach in patients with severe SCI and in other critically ill patients. This is a presentation of a new respiratory training protocol of combined oxygen therapy by high flow cannula and Venturi mask in a patient with cervical spinal cord injury and respiratory failure.Due to this new respiratory training, from the weaning of ventilation devices the patient had greater independence and improved quality of life, with more intensive motor training in the gym, improvement of the motor program and the patient tolerance to training.Oxygen therapy with high flow cannula and Venturi mask could be valid and reliable combined respiratory training to improve the respiratory pattern in severely hypoxemic and hypercapnic patients, without adverse events.

High Flow Nasal Cannula versus Non -Invasive Ventilation in Hypercapnic acute exacerbation of COPD.

High Flow Nasal Cannula versus Non -Invasive Ventilation in Hypercapnic acute exacerbation of COPD.

Impact of high-flow nasal oxygen therapy on postoperative atelectasis and reintubation rate after paediatric cardiac surgery.

Airway problems emerging after congenital cardiac surgery operations may have an impact on mortality and morbidity. Recently, to improve alveolar gas exchange and reduce respiratory effort, high-flow nasal cannula (HFNC) has started to be used in paediatric cases. This study aimed to evaluate the potential effects of high-flow nasal oxygen therapy on postoperative atelectasis development and reintubation rate in paediatric cardiac surgery patients. This study was conducted retrospectively in term newborns and infants younger than six months of age who underwent congenital cardiac surgery operation from 1 November 2022 to 1 November 2023 and were followed in the paediatric cardiac ICU. Patients who were receiving mechanical ventilator support at least 12 hours postoperatively were evaluated for the development of postoperative atelectasis and reintubation in the first 3 days of extubation. The patients were grouped as HFNC and non-HFNC users. Demographic characteristics, surgery type, and ICU clinical follow-up data were obtained from medical records. The results were statistically evaluated. A total of 40 patients who did not use HFNC in the early postoperative period and 40 patients with HFNC in the late period during the study period were included in the study. The median age was 1 month (IQR 15 days-2 months) with equal gender distribution. Among patients, 70% of them were in the neonatal age group. Reintubation rates in the first 72 hours in HFNC users and non-HFNC users were 2.5% and 12.5%, respectively (p < 0.05). The median postoperative atelectasis scores at 24, 48, and 72 hours of extubation were 2 versus 2.5 (p > 0.05), 1.5 versus 3.5 (p < 0.05), and 1 versus 3 (p < 0.05) in HFNC users and non-HFNC users, respectively. HFNC therapy may have a positive effect on preventing atelectasis and reducing the reintubation rate in the early postoperative period.

Noninvasive Respiratory Support for Pediatric Critical Asthma.

Pediatric asthma is a significant cause of emergency department visits and hospital admissions. While most patients respond well to standard pharmacologic treatments, those with more severe disease frequently require noninvasive respiratory support (NRS) and adjunct therapies, or admission to an intensive care unit-a condition termed critical asthma. NRS modalities include high-flow nasal cannula (HFNC), continuous positive airway pressure (CPAP), and noninvasive ventilation (NIV) to deliver standard air-oxygen mixtures or helium-oxygen (heliox). Each NRS modality offers distinct physiological benefits, primarily aimed at reducing work of breathing, enhancing gas exchange, and optimizing aerosol delivery. Despite the growing use of NRS, robust evidence supporting its efficacy in pediatric critical asthma is limited, with few published clinical trials and a heavy reliance on observational studies to inform clinical practice. This narrative review explores the current evidence, physiological rationale, practical considerations, and future research directions for the use of NRS in pediatric critical asthma. The goal is to provide clinicians with a comprehensive overview of the benefits and limitations of NRS modalities to better inform therapeutic decisions and improve patient outcomes.

Impact of mini-dose dexmedetomidine supplemented analgesia on sleep structure in patients at high risk of obstructive sleep apnea: a pilot trial.

Obstructive sleep apnea (OSA) is common in surgical patients and associated with worse perioperative outcomes. To investigate the effect of mini-dose dexmedetomidine supplemented analgesia on postoperative sleep quality pattern in patients at high risk of OSA. A pilot randomized, double-blind, placebo-controlled trial. A tertiary university hospital in Beijing, China. One hundred and fifty-two adult patients who had a STOP-Bang score ≥3 and a serum bicarbonate level ≥28 mmol/L and were scheduled for major noncardiac surgery between 29 January 2021 and 20 September 2022. After surgery, patients were provided with high-flow nasal cannula and randomized in a 1:1 ratio to receive self-controlled opioid analgesia supplemented with either mini-dose dexmedetomidine (median 0.02 μg/kg/h) or placebo. We monitored polysomnogram from 9:00 pm to 6:00 am during the first night. Our primary outcome was the percentage of stage 2 non-rapid eye movement (N2) sleep. Secondary and exploratory outcomes included other postoperative sleep structure parameters, sleep-respiratory parameters, and subjective sleep quality (Richards-Campbell Sleep Questionnaire; 0-100 score range, higher score better). All 152 patients were included in intention-to-treat analysis; 123 patients were included in sleep structure analysis. Mini-dose dexmedetomidine supplemented analgesia increased the percentage of stage N2 sleep (median difference, 10%; 95% CI, 1 to 21%; p = 0.029); it also decreased the percentage of stage N1 sleep (median difference, -10%; 95% CI, -20% to -1%; p = 0.042). Other sleep structure and sleep-respiratory parameters did not differ significantly between the two groups. Subjective sleep quality was slightly improved with dexmedetomidine on the night of surgery, but not statistically significant (median difference, 6; 95% CI, 0 to 13; p = 0.060). Adverse events were similar between groups. Among patients at high risk of OSA who underwent noncardiac surgery, mini-dose dexmedetomidine supplemented analgesia may improve sleep quality without increasing adverse events. Clinicaltrials.gov, identifier NCT04608331.

High-flow nasal cannula in adults with chronic respiratory diseases during physical exercise: a systematic review and meta-analysis

BackgroundChronic respiratory diseases (CRDs) affect at least 545 million people globally, leading to symptoms such as dyspnoea, fatigue and limited physical activity. Pulmonary rehabilitation (PR) programmes aim to improve the...

A high-flow nasal cannula versus noninvasive ventilation in acute exacerbations of chronic obstructive pulmonary disease

PurposeWe investigated the efficacy and safety of a high-flow nasal cannula (HFNC) at different flow rates compared to noninvasive ventilation (NIV) in patients with acute chronic obstructive pulmonary disease (COPD) exacerbations. MethodsThis prospective, randomized, single-blind study assigned patients to one of three study groups. The NIV group (n = 47) received bilevel positive airway pressure. The HFNC-30 (n = 44) and HFNC-50 (n = 46) groups received HFNC therapy at flow rates of 30 and 50 L/min, respectively. Demographic and clinical characteristics and arterial blood gas parameters before and 30, 60, and 120 min after treatment were compared among the treatment groups. ResultsThis study included 137 consecutive patients with acute exacerbations of COPD, comprising 90 males and 47 females, with a mean age of 68.1 ± 10.5 years. A total of 21 patients (15.33 %) were intubated, and the overall mortality rate was 10.2 %. The mean PaCO2 levels on admission were 64.69 ± 10.81, 61.51 ± 9.03, and 62.29 ± 9.87 in the NIV, HFNC-30, and HFNC-50 groups, respectively, with no significant differences observed (p = 0.372). A significant reduction in mean PaCO2 was observed in all treatment groups at 30, 60, and 120 min (p < 0.05 for all). However, the ΔPaCO2 at 60 min was significantly higher in the HFNC-30 group compared to the NIV group (p = 0.042). Additionally, neither intubation rates nor 28-day mortality differed among the treatment groups (p = 0.368 and p = 0.775, respectively). ConclusionHFNC was not inferior to NIV in improving arterial blood gas parameters, particularly PaCO2 in patients with COPD exacerbations, especially those with hypercarbia. Moreover, HFNC at a flow rate of 30 L/min was superior to NIV for reducing PaCO2 levels at 60 min. Trial RegistryNational Library of Medicine Clinical Trial Registry; No.: NCT06495086; URL: https://clinicaltrials.gov/study/NCT06495086

Awake prone positioning and ventilation distribution as assessed by electric impedance tomography in patients with non-COVID-19 acute respiratory failure: A prospective physiology study

BackgroundAwake prone positioning (APP) can reportedly reduce the need for intubation and help to improve the prognosis of patients with acute hypoxemic respiratory failure (AHRF) infected with COVID-19. However, its physiological mechanism remains unknown. In this study, we evaluated the effect of APP on lung ventilation in patients with moderate-to-severe AHRF in an attempt to better understand the effects on ventilation distribution and to prevent intubation in non-intubated patients. MethodsThe prospective study was performed in the Department of Critical Care Medicine at Shanghai General Hospital, China, from January 2021 to November 2022. The study included patients with AHRF (partial pressure of oxygen [PaO2]/inspired oxygen concentration [FiO2] <200 mmHg or oxygen saturation [SpO2]/FiO2 <235) treated with high-flow nasal oxygen. Electrical impedance tomography (EIT) measurements including center of ventilation (COV), global inhomogeneity (GI) index, and regional ventilation delay (RVD) index were performed in the supine position (T0), 30 min after the start of APP (T1), and at 30 min returning to supine position after the APP (T2). Clinical parameters like SpO2, respiratory rate (RR), FiO2, heart rate (HR), and ROX (the ratio of SpO2 as measured by pulse oximetry/FiO2 to RR) were also recorded simultaneously at T0, T1, and T2. To evaluate the effect of the time points on the variables, Mauchly's test was performed for sphericity and repeated measures analysis of variance was applied with Bonferroni's post hoc multiple comparisons. ResultsTen patients were enrolled. The PaO2/FiO2 ratio was (111.4±33.4) mmHg at the time of recruitment. ROX showed a significant increase after initiation of APP {median (interquartile range [IQR]): T0: 7.5 (6.0–10.1) vs. T1: 7.6 (6.4–9.3) vs. T2: 8.3 (7.2–11.0), P=0.043}. RR (P=0.409), HR (P=0.249), and SpO2/FiO2 (P=0.103) did not change significantly during prone positioning (PP). The COV moved from the ventral area to the dorsal area (T0: [48.8±6.2] % vs. T1: [54.8±6.8] % vs. T2: [50.3±6.1] %, P=0.03) after APP. The GI decreased significantly after APP (T0: median=42.7 %, [IQR: 38.3–47.5] % vs. T1: median=38.2 %, [IQR: 34.6–50.7] % vs. T2: median=37.4 %, [IQR: 34.2–41.4] %, P=0.049). RVD (P=0.794) did not change after APP. ConclusionsAPP can improve ventilation distribution and homogeneity of lung ventilation as assessed by EIT in non-intubated patients with AHRF.Trail Registration Chinese Clinical Trial Registry Identifier: ChiCTR2000035895.

What barriers do paediatric nurses encounter when attempting to wean paediatric patients off humidified high flow nasal cannula oxygen therapy? A qualitative study

PurposeThis study aimed to explore nurse perceptions of barriers and facilitators to weaning humidified high flow nasal cannula (HHFNC) in Australian paediatric settings. Design and methodsA qualitative descriptive two phased study was conducted across Australia. Purposeful sampling and snowballing technique were used to recruit nurses with the study advertised widely on social media nursing groups. Phase One data collection was via a survey with open and closed ended questions, and Phase Two via semi-structured interviews. Data were analysed using descriptive statistics (Phase One) and thematic analysis (Phase One and Two) to identify themes and patterns in the narrative. ResultsPhase one: 36(56.25 %) participants identified their workplace had clear guidelines, 57(89.06 %) received education on HHFNC and 34(57.63 %) experienced barriers when weaning. Three themes and nine subthemes were identified i) variable clinical process for weaning HHFNC, ii) knowledge and skills and iii) clinical observation and assessment of the child. Phase two: four themes and nine subthemes were identified, i) ‘There doesn't seem to be any pattern’: no evidence to guide practice, ii) Nursing and medical led weaning, iii) Knowledge and skills and iv) Family centred approaches to weaning. ConclusionsCurrent research on HHFNC does not consider best practice for weaning. This study identified barriers as inconsistency in weaning practice and availability of guidelines and facilitators were a robust education program and confidence in weaning. Multidisciplinary team need to collaborate to determine standardised weaning practice. Practice ImplicationsFurther research is essential to determine best practice weaning methods and inform national/international guidelines.

Ultra-fast-track cardiac anesthesia in minimally invasive cardiac surgery: a retrospective observational study.

There is no uniformity on the safety profile of ultra-fast-track cardiac anesthesia (UFTCA), and there is a lack of research on the postoperative lung function status of patients with UFTCA. This retrospective study was to examine the benefits of UFTCA on the postoperative recovery and pulmonary function of patients undergoing minimally invasive cardiac surgery (MICS). This retrospective study was performed on patients who underwent MICS at Zhejiang Provincial People's Hospital between January 2022 and July 2023. Patients were retrospectively segregated into two groups: UFTCA group and conventional general anesthesia (CGA group). Primary endpoints encompassed differences in the duration of postoperative intensive care unit (ICU) stay and overall hospital stay. Secondary observations included in-hospital mortality rate, 3-month post-discharge survival rate, oxygenation indexes of preoperative (T0), immediately after extubation (T1), 6 hours after extubation (T2), and 12 hours after extubation (T3), use of high-flow nasal cannula oxygen therapy in the ICU, postoperative total chest drainage volume, and the rate of complications. Group comparisons were performed using grouped t-tests and repeated measures analysis of variance (ANOVA). The UFTCA group (n=327) demonstrated shorter ICU and hospital stays when compared with the CGA group (n=216) (P=0.001). At the immediately after extubation, the UFTCA group exhibited a decrease in oxygenation index [arterial oxygen partial pressure (PaO2)/fraction of inspired oxygen (FiO2)] accompanied by elevated alveolar-arterial oxygen tension difference [P(A-a)O2] and respiratory index [P(A-a)O2/PaO2] values compared to the CGA group (P=0.001). However, by 12 hours after extubation, the UFTCA group manifested an improved PaO2/FiO2 and diminished P(A-a)O2/PaO2 values compared to the CGA group. The UFTCA group required high-flow oxygen therapy after extubation with greater frequency than the CGA group (P=0.001). However, neither the UFTCA nor CGA group had patients who needed reintubation (P>0.05). No significant differences were observed in postoperative atelectasis and pulmonary edema rates between the groups (P>0.05), the UFTCA group recorded a diminished total chest drainage volume postoperatively (P=0.001). Incidence of postoperative nausea and vomiting (PONV) was heightened in the UFTCA group (P=0.01), while the incidence of delirium was less frequent when compared with the CGA group (P=0.001). UFTCA demonstrates potential benefits in minimizing ICU and postoperative hospital stay in patients undergoing MICS. This approach also contributes to a reduction in postoperative chest drainage volume and a decreased likelihood of postoperative delirium. Despite the initial decline in lung oxygenation immediately following early post-extubation, subsequent lung function proves to be superior, with no differences in postoperative atelectasis or pulmonary edema rates. However, the implementation of UFTCA requires additional strategies to prevent the occurrence of PONV.

TCT-907 High-Flow Nasal Oxygenation in Sedation for Transcatheter Aortic Valve Replacement Procedures: Results of the Randomized Controlled HIGH-OXY-TAVR Study

TCT-907 High-Flow Nasal Oxygenation in Sedation for Transcatheter Aortic Valve Replacement Procedures: Results of the Randomized Controlled HIGH-OXY-TAVR Study

Oral feeding practices in medically complex infants receiving prolonged high-flow nasal cannula support: A retrospective cohort study.

To characterise the feeding profile and care pathway for infants receiving prolonged high-flow nasal cannula (HFNC) respiratory support for management of a chronic condition at one facility from January to December 2021. Data regarding medical history, HFNC admission details (reason for HFNC, HFNC duration, flow rate), feeding outcomes and speech pathology care were collected from electronic records of HFNC-dependent infants (requiring HFNC ≥2-3 L/kg for ≥5 consecutive days). Infants with acute respiratory conditions (e.g. bronchiolitis) were excluded. This study included 24 participants (median corrected age at admission 5.3 weeks, range -6 to 18.6). Of these, 15 (60%) had a condition/s that affected more than one body system (e.g. congenital diaphragmatic hernia), requiring the care of multiple specialities. Median length of HFNC use was 37.5 days (range 11-188). Twenty (83.3%) infants were referred for speech pathology (SLP) input while on HFNC support. For those referred, frequency of SLP input was variable (0-3 sessions/week), and HFNC support requirements were the most common barrier to SLP intervention (n = 9, 45%). Twelve (54.5%) infants demonstrated improvement in their primary feeding method by discharge; however, only two (9.1%) infants were discharged on full oral feeds. This study demonstrates variability in oral feeding management in infants with prolonged HFNC-dependence at our centre. Respiratory support with HFNC was identified as a barrier to progressing oral feeding. Further research is required to determine if oral feeding can be safely undertaken in this cohort. This is imperative to ensure that long-term feeding outcomes are not negatively impacted by current practice.

Incidence and severity of pertussis among hospitalized infants, Sarawak, Malaysia, 2015-2021.

A resurgence of pertussis has been reported in numerous countries. This study aimed to determine the incidence, clinical characteristics, and outcome of pertussis among infants in Sarawak, Malaysia. We conducted a descriptive retrospective study of infants aged < 12 months with laboratory-confirmed pertussis admitted to Bintulu Hospital in Sarawak, Malaysian Borneo, from 2015 until 2021. Pertussis was confirmed in all patients using a polymerase chain reaction of nasopharyngeal aspirates. Of 588 infants who had a nasopharyngeal aspirate, 108 (18%) had laboratory-confirmed pertussis. The average annual incidence was 482 per 100,000 infants aged < 12 months between 2015 and 2019, with a marked decline in 2020 and 2021. Eighty-two (76%) were < 3 months of age. Seventy-eight (72%) were unvaccinated for pertussis, including 75 (96%) who were too young to receive the first dose. A third of the cases had atypical presentations. Severe disease characterized by hypoxemia, pulmonary hypertension, recurrent apnea, encephalopathy, or cardiovascular dysfunction occurred in 32%. Forty-eight percent required humidified high-flow nasal cannula oxygen therapy and 22% required invasive ventilation. Twenty-four percent overall needed intensive care. One (1%) infant had a fatal outcome. Nearly all cases of severe disease or those that required invasive ventilation or intensive care had received ≤ 1 dose of pertussis vaccination. A high incidence of pertussis with a high rate of severe disease was observed in Sarawak, Malaysia, predominantly among infants too young to be vaccinated. Additional vaccination strategies such as maternal vaccination or cocooning should be considered.