Humidified High Flow Nasal Oxygen Research Articles

Retracted: Analysis of the Effects of Humidified High Flow Nasal Oxygen Therapy Combined with Noninvasive Mechanical Ventilation on Treatment Outcomes.

[This retracts the article DOI: 10.1155/2022/2910813.].

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 < 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 < 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 < 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.

Analysis of the Effects of Humidified High Flow Nasal Oxygen Therapy Combined with Noninvasive Mechanical Ventilation on Treatment Outcomes.

Objective To investigate the effects of humidified high flow nasal cannula (HFNC) oxygen therapy combined with noninvasive mechanical ventilation (NIV) on blood gas indexes, complications, and respiratory function in patients with AECOPD. Method 100 patients with AECOPD admitted to the Department of Respiratory and Critical Medicine of Pukou District Central Hospital of Nanjing from March 2020 to February 2021 were selected. The patients were randomly divided into study group (50 cases) and control group (50 cases); both groups were given routine treatment such as bronchodilators, low-dose glucocorticoids, and antibiotics. During the treatment, the vital signs, inflammatory response indexes, fluid balance, and nutrition were continuously monitored; the body position was changed every 2 hours; and the curative effect was evaluated one week after treatment. On this basis, the control group received routine oxygen therapy combined with NIV (low flow conventional oxygen therapy + NIV), and the study group received HFNC combined with NIV (HFNC + NIV). The oxygen partial pressure (PaO2), peak expiratory flow rate (PEFR), arterial oxygen saturation (SaO2), first-second forced expiratory volume (FEV1), and mixed venous oxygen saturation (SvO2) level were compared between the two groups before and after treatment. Moreover, SECS scores before ventilation and 2, 4, 6, and 12 hours after ventilation were collected and analyzed. In addition, complications during oxygen therapy were compared. Result Before treatment, there was no significant difference in the levels of PaCO2, FEV1, SaO2, PEFR, and SvO2 between the two groups (P > 0.05). After treatment, the levels of PaCO2 in the study group were lower than those in the control group, and the levels of FEV1, SaO2, PEFR, and SvO2 in the study group were higher than those in the control group P < 0.05(P < 0.05). There was no significant difference in SECS scores between the two groups before ventilation and 2 hours after ventilation (P > 0.05). The SECS scores of the study group at 4, 6, and 12 hours after ventilation were higher than those of the control group P < 0.05(P < 0.05). The total complication rate in the study group (8.00% vs. 24.00%) was lower than that in the control group (P < 0.05). Compared with low flow conventional oxygen therapy, NIV combined with HFNC can effectively reduce the incidence of complications in AECOPD patients during oxygen therapy, improve patients' ventilation comfort, and effectively improve blood gas indexes and respiratory function, with simple operation and high safety, which is worthy of clinical promotion and application.

Oxygen Management in Heart Failure Patients

Symptoms of heart failure (HF) should be alleviated as quickly as feasible. Apart from standard pharmacological therapy, supplementation of oxygen is lifesaving in hypoxemic (SpO2 &lt;90% or PaO2 &lt;60 mmHg) HF patients. For sick patients with SpO2 &lt;85%, respiratory distress (respiratory rate &gt;25 breaths per min) and pulmonary edema, along with oxygen administration, noninvasive positive pressure ventilation (NIPPV) methods, including BiPAP/CPAP or humidified high-flow nasal oxygen, should be tried to optimize oxygenation, reduce work of breathing and to reduce the venous return. If these noninvasive ventilatory support methods fail to improve hypoxemia, endotracheal intubation and mechanical ventilation should be instituted. Short-term mechanical circulatory support (extracorporeal membrane oxygenation) devices are reserved for cardiogenic shock patients due to advanced HF associated with reversible end-organ failure and hypoxia. These temporary mechanical circulatory support devices are also useful as a bridge to long-term mechanical circulatory support or heart transplant in end-stage HF with refractory cardiogenic shock. Even though the use of additional oxygen is a standard practice for hypoxemic patients, routine use of high concentrations of oxygen via inhalational therapy or NIPPV for normoxemic HF patients may result in hyperoxemia. Hyperoxemia has been shown to have negative hemodynamic effects like increased systemic vascular resistance, reduced cardiac index, and decreased coronary blood flow. Detailed prescription by the treating physician, careful monitoring, and meticulous titration of oxygen is essential for safe oxygen treatment for HF patients.

Synopsis on Non-invasive Ventilation in Neonatology

Non-invasive ventilation (NIV) is a mode of respiratory support commonly used on the neonatal unit. Since the advent of NIV, it has evolved from being used as a mode of respiratory support to wean infants from mechanical ventilation (MV) to a primary mode of respiratory support. NIV improve the functional residual capacity in the newborn (at term or preterm) avoiding invasive actions such as tracheal intubation. Newer methods of NIV support such as nasal bilevel positive airway pressure (BiPAP) and humidified high flow nasal cannula oxygen therapy (HHFNC) have emerged in attempts to reduce intubation rates and subsequent MV in preterm infants. With this synopsis, we aim to discuss various available NIV modes of ventilation in Neonatology, including indications, physiological principle, practical aspects and effects on important short and long-term morbidities associated with the use of NIV.

The utility of high-flow nasal oxygen for severe COVID-19 pneumonia in a resource-constrained setting: A multi-centre prospective observational study.

BackgroundThe utility of heated and humidified high-flow nasal oxygen (HFNO) for severe COVID-19-related hypoxaemic respiratory failure (HRF), particularly in settings with limited access to intensive care unit (ICU) resources, remains unclear, and predictors of outcome have been poorly studied.MethodsWe included consecutive patients with COVID-19-related HRF treated with HFNO at two tertiary hospitals in Cape Town, South Africa. The primary outcome was the proportion of patients who were successfully weaned from HFNO, whilst failure comprised intubation or death on HFNO.FindingsThe median (IQR) arterial oxygen partial pressure to fraction inspired oxygen ratio (PaO2/FiO2) was 68 (54–92) in 293 enroled patients. Of these, 137/293 (47%) of patients [PaO2/FiO2 76 (63–93)] were successfully weaned from HFNO. The median duration of HFNO was 6 (3–9) in those successfully treated versus 2 (1–5) days in those who failed (p<0.001). A higher ratio of oxygen saturation/FiO2 to respiratory rate within 6 h (ROX-6 score) after HFNO commencement was associated with HFNO success (ROX-6; AHR 0.43, 0.31–0.60), as was use of steroids (AHR 0.35, 95%CI 0.19–0.64). A ROX-6 score of ≥3.7 was 80% predictive of successful weaning whilst ROX-6 ≤ 2.2 was 74% predictive of failure. In total, 139 patents (52%) survived to hospital discharge, whilst mortality amongst HFNO failures with outcomes was 129/140 (92%).InterpretationIn a resource-constrained setting, HFNO for severe COVID-19 HRF is feasible and more almost half of those who receive it can be successfully weaned without the need for mechanical ventilation.

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.

The Utility of High-Flow Nasal Oxygen for Severe COVID-19 Pneumonia in a Resource-Constrained Setting: A Multi-Centre Prospective Observational Study

RATIONALE: The utility of heated and humidified high-flow nasal oxygen (HFNO) for severe COVID-19-related hypoxaemic respiratory failure (HRF), particularly in settings with limited access to intensive care unit (ICU) resources, remains unclear, and predictors of outcome have been poorly studied.METHODS: We included consecutive patients with COVID-19-related HRF treated with HFNO and awake proning at two tertiary hospitals in Cape Town, South Africa. The primary outcome was the proportion of patients who were successfully weaned from HFNO, whilst failure comprised intubation or death on HFNO.FINDINGS: The median (IQR) arterial oxygen partial pressure to fraction inspired oxygen ratio (PaO2/FiO2) was 68 (54-92) in 293 enrolled patients. 137/293 (47%) of patients [PaO2/FiO2 76 (63-93)] were successfully treated with HFNO. The median duration of HFNO was 6 (3-9) in those successfully treated versus 2 (1-5) days in those who failed (p2 to respiratory rate within 6 hours after HFNO commencement) was protective against HFNO failure (ROX-6; AHR 0.43, 0.31-0.60), as was use of steroids (AHR 0.35, 95%CI 0.19-0.64). A ROX-6 score of INTERPRETATION: In a resource-constrained setting, HFNO for severe COVID-19 HRF is feasible even outside of the ICU and averts death or the need for mechanical ventilation in almost half of those who receive it.FUNDING: South African MRC (RFA-EMU-02-2017).DECLARATION OF INTERESTS: All authors declare that they have no conflict of interest.ETHICS APPROVAL STATEMENT: The study was approved by the local ethics committees at each site (UCT HREC 295/2020 and SU HREC S20/05/001_COVID19), and informed consent was waived in acknowledgement that the intervention wa being assessed within the routine service.

Neonate with persisting respiratory distress after resolution of pneumothorax

A preterm baby boy was born in good condition at 31+5 weeks gestation with a birth weight of 1956 g, following a precipitous labour with no prolonged rupture of membranes...

Neonatal Respiratory Distress Syndrome in a Nutshell

Respiratory distress syndrome (RDS) is an important cause of mortality and morbidity in preterm neonates. With the increasing number of preterm deliveries globally according to the World Health Organization, it is imperative to consider a safe place for delivery and a good obstetric care to start with. Antenatal steroids are helpful not only in reducing the risk of RDS but also reducing necrotizing enterocolitis (NEC) and Intraventricular hemorrhage which further improves the outcome of a preterm delivery. Delayed cord clamping is recommended as it reduces mortality in preterm newborns. Use of optimal oxygen and getting CPAP into the delivery room has improved the outcome and reduced the need of mechanical ventilation thus reducing the risk of Chronic Lung Disease (CLD). Timing the administration of surfactant is important to avoid mechanical ventilation. The increasing use of non-invasive ventilation has reduced ventilator induced lung injury and CLD. Many have embraced Heated Humidified High Flow Nasal Oxygen (HHHFNC) as an alternative to CPAP and its use has increased in view of its ease of use and lesser trauma. Caffeine facilitates early extubation in intubated preemies on ventilators and improves neurodevelopment outcome. Adequate nutrition and proper temperature control starting from the point of delivery cannot be emphasized enough for this group of population.

Neonatal Respiratory Distress Syndrome in a Nutshell

Respiratory distress syndrome (RDS) is an important cause of mortality and morbidity in preterm neonates. With the increasing number of preterm deliveries globally according to the World Health Organization, it is imperative to consider a safe place for delivery and a good obstetric care to start with. Antenatal steroids are helpful not only in reducing the risk of RDS but also reducing necrotizing enterocolitis (NEC) and Intraventricular hemorrhage which further improves the outcome of a preterm delivery. Delayed cord clamping is recommended as it reduces mortality in preterm newborns. Use of optimal oxygen and getting CPAP into the delivery room has improved the outcome and reduced the need of mechanical ventilation thus reducing the risk of Chronic Lung Disease (CLD). Timing the administration of surfactant is important to avoid mechanical ventilation. The increasing use of non-invasive ventilation has reduced ventilator induced lung injury and CLD. Many have embraced Heated Humidified High Flow Nasal Oxygen (HHHFNC) as an alternative to CPAP and its use has increased in view of its ease of use and lesser trauma. Caffeine facilitates early extubation in intubated preemies on ventilators and improves neurodevelopment outcome. Adequate nutrition and proper temperature control starting from the point of delivery cannot be emphasized enough for this group of population.

Heated humidified high-flow nasal oxygen prevents intraoperative body temperature decrease in non-intubated thoracoscopy.

In patients receiving non-intubated video-assisted thoracic surgery (NIVATS), transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) has been applied instead of oxygen mask for better oxygenation. However, the THRIVE effects on intraoperative temperature decrease have not been investigated. Pre- and postoperative temperatures, measured by an infrared tympanic ear thermometer, taken before sending patients to the operation room and immediately upon their arrival in the postoperative anesthesia unit, were collected from medical records of patients who received NIVATS either with oxygen mask or THRIVE. Intraoperative temperature decrease, calculated by preoperative temperature minus postoperative temperature, was compared between different groups. Multiple linear regression analysis was performed to determine factors associated with intraoperative temperature decrease. Records of 256 adult patients with forced-air warming were retrospectively analyzed. 172 patients of them received THRIVE and 84 patients received oxygen mask. Preoperative temperatures were comparable between groups (THRIVE: 36.25 ± 0.46°C; mask: 36.30 ± 0.39°C, p = 0.43). Postoperative temperatures were significantly higher in patients using THRIVE than those using oxygen masks (36.05 ± 0.59 vs 35.87 ± 0.62°C, p = 0.025). Significantly less intraoperative temperature decrease was shown in THRIVE group (THRIVE: 0.20 ± 0.69°C; mask: 0.43 ± 0.69°C, p = 0.04). According to the multiple linear regression analysis, significant temperature decrease was associated with the advanced age (βage = 0.01) but not the anesthetic duration. Using THRIVE was correlated with significantly less body temperature decrease (βTRIVE = - 0.24). THRIVE effectively prevents intraoperative temperature decrease during NIVATS, especially in old patients.

Clinical profile of children treated with Heated Humidified High flow Nasal Cannula oxygen therapy (HHHFNC) and Non-Invasive ventilation (NIV) as a primary mode of respiratory support in a tertiary PICU

Clinical profile of children treated with Heated Humidified High flow Nasal Cannula oxygen therapy (HHHFNC) and Non-Invasive ventilation (NIV) as a primary mode of respiratory support in a tertiary PICU

Clinical effects of high flow nasal cannula oxygen therapy in post-extubation intensive care unit patients:a systematic review

Objective To evaluate the clinical effects of heated humidified high flow nasal cannula oxygen therapy on post-extubation intensive care unit (ICU) patients. Methods A computerized search was performed through Cochrane Library, EMBASE, PubMed, Elsevier, CNKI, Wanfang Database, SinoMed for randomized controlled trial(RCTs) which studied the effects of clinical effects of heated humidified high flow nasal cannula oxygen therapy on post-extubation ICU patients. Two reviewers separately searched the articles, evaluated the quality of the literatures, extracted date according to the inclusion and exclusion criteria. RevMan5.3 was used for Meta-analysis. Results Five RCTs were included involving 982 patients in the study. The results of meta-analysis showed that the HFNC group was lower than COT group on the re-intubation rate (OR=0.39, 95%CI 0.25-0.62, P 0.05) on post-extubation respiratory failure (OR=0.85, 95%CI 0.35-2.09), respiratory infection (OR=0.69, 95%CI 0.36-1.34), hospital length of stay (MD=0.51, 95%CI-0.02-1.03), mortality of hospital (OR=0.81, 95%CI 0.39-1.69). Conclusions The use of HFNC oxygen therapy can reduce there-intubation rate, improve oxygenation index, comfort level and tolerance on post-extubation ICU patients, while HFNC group has no significant impact on the post-extubation respiratory failure, respiratory infection, hospital length of stay, mortality of hospital compared with COTgroup. However, in view of the quantity and quality of study. More RCTs should be conducted to verify the results. Key words: Complication; Meta-analysis; Heated humidified high flow nasal cannula oxygen therapy; Post-extubation

Preliminary evaluation of sequential therapy by high flow nasal cannula oxygen therapy following endotracheal tube extubation in mechanically ventilated patients

To evaluate the feasibility and effect of sequential treatment by the heated humidified high flow nasal cannula oxygen therapy (HFNC) in mechanically ventilated patients following endotracheal tube extubation. A prospective randomized controlled trial was conducted. Forty-nine patients with the sequential treatment after tracheal intubation extraction admitted to Department of Critical Care Medicine of Shanghai Tenth People's Hospital from January 1st to December 31st 2016 were enrolled. The patients were randomly divided into HFNC group (n = 25) and non-invasive positive pressure ventilation (NPPV) group (n = 24) in accordance with the random number table. During the study, arterial blood gas and the sputum viscosity were assessed at 12, 24, and 48 hours after NPPV or HFNC treatment, and the nasal and facial pressure ulcers within 1 week was also recorded. Receiver operating characteristic curve (ROC) was plotted, and the effect of NPPV or HFNC on oxygenation was analyzed. Among the 25 patients in the HFNC group, 1 patient who was re-intubated and 2 patients who were changed to NPPV were excluded, and a total of 22 patients with complete data were enrolled in HFNC group. Among the 24 patients in the NPPV group, 1 patient who gave up the treatment and 1 patient who was re-intubated were excluded, and a total of 22 patients with complete data were enrolled in NPPV group. After the sequential treatment, most patients in NPPV group showed moderate viscous sputum (12, 12 and 10 cases at 12, 24 and 48 hours, respectively), whereas the patients in HFNC group showed thin sputum (15, 16 and 15 cases at 12, 24 and 48 hours, respectively). Sputum viscosity of patients in HFNC group at each time point was significantly lower than that in NPPV group (all P < 0.01). Arterial oxygen saturation (SaO2) and arterial partial pressure of oxygen (PaO2) at 12, 24 and 48 hours in the HFNC group were significantly higher than those in the NPPV group [SaO2: 0.978±0.009 vs. 0.906±0.139 at 12 hours, 0.976±0.019 vs. 0.924±0.103 at 24 hours, 0.973±0.019 vs. 0.935±0.079 at 48 hours; PaO2 (mmHg, 1 mmHg = 0.133 kPa): 97.85±22.99 vs. 79.24±25.86 at 12 hours, 108.10±43.87 vs. 84.44±29.24 at 24 hours, 102.31±39.02 vs. 79.04±27.46 at 48 hours, all P < 0.05], however, the difference in arterial partial pressure of carbon dioxide (PaCO2) at all of the time points between the two groups was not significant. In NPPV group, 4 patients with nasal and facial pressure ulcers was found, and all with I phase of pressure ulcers, and no nasal and facial pressure ulcers was found in HFNC group, which was significantly decreased as compared with NPPV group (χ 2 = 4.400, P = 0.036). A good effect of oxygen therapy was defined as PaO2 at 48 hours after the sequential treatment was increased by 20% as compared with that before the treatment. ROC curve analysis showed that the area under the ROC curve (AUC) of HFNC on improving oxygenation was higher than that of NPPV (0.917 vs. 0.830); when PaO2 at 48 hours after HFNC treatment was 76.25 mmHg, the sensitivity was 100%, and the specificity was 75.0%. Compared with NPPV, adoption of HFNC as sequential treatment is a feasible manner in dealing with the mechanically ventilated patients after endotracheal tube extubation, which can improve the oxygenation as well as reducing the degree of sputum viscosity and incidence of nasal and facial pressure ulcers. HFNC is a promising therapy, which may be worthy to recommend broadly in such a clinical situation.

Humidified high flow nasal cannula oxygen therapy in acute bronchiolitis

Background: Bronchiolitis is a major cause of morbidity and leading cause of hospitalization, mostly in early childhood without coexisting illnesses. Traditionally dry oxygen is provided at 100% concentration via low flow nasal prongs. However, the latest studies have revealed that oxygen therapy via heated, humidified, high flow nasal cannula (HFNC) allows the delivery of high inspired gas flows which is better than the traditional one. Methods: All previously healthy children between 1 and 24 months of age with an established clinical diagnosis of moderate to severe bronchiolitis (clinical severity score ?4) were enrolled for study. The patients were divided into two groups: Patients in Group 1 received HFNC oxygen therapy (HFNC group) while those in Group 2 received conventional oxygen therapy (non-HFNC group). The patients were randomized in each arm by simple randomization. Outcome parameters measured were duration of hospital stay, duration of pediatric intensive care unit (PICU) stay, oxygen saturation (SPO2), respiratory rate, adverse event (respiratory failure), need for intermittent positive pressure ventilation or continuous positive airway pressure. Results: Out of 100 patients studied, 50 received HFNC oxygen and 50 received conventional oxygen. There was early and better improvement in SPO2 and respiratory rate (p&lt;0.001), decreased length of hospital stay (p&lt;0.001) and PICU stay (p&lt;0.01) among the patients in HFNC group as compared to non-HFNC group. The most common adverse event during the hospital course was respiratory failure which was seen among 4 patients in non-HFNC group and none among HFNC group developed such complication. Conclusion: The use of HFNC oxygen therapy in infants hospitalized with acute bronchiolitis reduces PICU and hospital stay as well as the potential complications which will substantially reduce the hospital cost.

The mechanism of heated humidified high flow nasal cannula oxygen therapy and its application in pediatrics

Heated humidified high flow nasal cannula oxygen therapy (HFNC) has the characteristics of improving the work of breathing, creating the effect of positive end-expiratory pressure, being setted up easily, well tolerated by patients and high safety.At present, it has been widely used in neonatal respiratory support, but lack of its extensive use and research in infants and children.HFNC is suitable for use in infants with viral bronchiolitis, pneumonia, asthma, ARDS, and postextubation respiratory support from the aspect of the mechanism of action of HFNC and the pediatric physiology.HFNC should be the preferred mode of conventional oxygen therapy in pediatrics. Key words: Pediatrics; Heated humidified; High flow; Oxygen therapy,

The application of actively heated humidified high flow nasal cannula oxygen therapy in adults

Actively heated, humidified high flow nasal cannula oxygen therapy (HFNC) is a new type of oxygen therapy. Because of its unique physiological effects, the clinical application is becoming more and more popular. This article is to summarize the physiological effects, clinical application and short comings of HFNC. Compared with conventional oxygen therapy, HFNC helps to improve oxygenation better, and it is more comfortable than non-invasive ventilation (NIV) in use. Proper use of HFNC may be able to reduce the use of NIV and decrease the rate of endotracheal intubation. It can be used for adults with mild to moderate hypoxia, or for patients undergoing palliative care. However, the experience of the use of HFNC in adults is limited, and there is yet no corresponding clinical guideline. Therefore, further research with a large sample is required to determine the long-term effect of this technique, and to identify the adult patient population to whom is most beneficial.

Randomized Controlled Trial of Humidified High-Flow Nasal Oxygen for Acute Respiratory Distress in the Emergency Department: The HOT-ER Study.

Humidified high-flow nasal cannula (HFNC) is a novel method of oxygen delivery with increasing use in emergency departments and intensive care settings despite little evidence showing benefit over standard oxygen delivery methods (standard O2). The aim of this study was to determine whether HFNC compared with standard O2 given to subjects in acute respiratory distress would reduce the need for noninvasive ventilation or invasive ventilation. This was a pragmatic open randomized controlled trial in adult subjects with hypoxia and tachypnea presenting to a tertiary academic hospital emergency department. The primary outcome was the need for mechanical ventilation in the emergency department. We screened 1,287 patients, 322 met entry criteria and 19 were excluded from analysis. Of these, 165 randomized to HFNC and 138 to standard O2 were analyzed. Baseline characteristics were similar. In the HFNC group, 3.6% (95% CI 1.5-7.9%) versus 7.2% (95% CI 3.8-13%) in the standard O2 group required mechanical ventilation in the emergency department (P = .16), and 5.5% (95% CI 2.8-10.2%) in HFNC versus 11.6% (95% CI 7.2-18.1%) in the standard O2 group required mechanical ventilation within 24 h of admission (P = .053). There was no difference in mortality or stay. Adverse effects were infrequent; however, fewer subjects in the HFNC group had a fall in Glasgow coma score due to CO2 retention, 0% (95% CI 0-3%) versus 2.2% (95% CI 0.4-6%). One in 12 subjects did not tolerate HFNC. HFNC was not shown to reduce the need for mechanical ventilation in the emergency department for subjects with acute respiratory distress compared with standard O2, although it was safe and may reduce the need for escalation of oxygen therapy within the first 24 h of admission.

The impact of humidified high nasal flow oxygen in different groups of intensive care patients with respiratory failure

Recently, humidified high flow nasal cannula oxygen (HFNC) has gained popularity in treating patients with respiratory insufficiency. Studies have shown that HFNC generates a low level of positive airway pressure, reduction of airway resistance and flushes nasopharyngeal dead space leading to less work of breathing. We are using HFNC in a variety of patients since 2010.