High-flow Nasal Cannula Research Articles

Epidemiological and clinical features of bronchiolitis after the COVID-19 outbreak: comparison of two epidemic seasons.

The first aim of this study was to compare Pediatric Emergency Department (PED) admissions for acute bronchiolitis during the 2022-2023 season to those of the season 2021-2022. The secondary aim was to assess the difference in the recurrence of bronchiolitis episodes in the same patient between the two seasons. This is a retrospective, observational, cross-sectional study conducted at the PED of IRCCS A. Gemelli University Polyclinic Foundation (Rome, Italy). We included all children aged between 0 and 2 years admitted to PED with the diagnosis of bronchiolitis. We compared features of seasons 2021-2022 and 2022-2023. The median age of children enrolled during the 2022-23 season was 5 months (IQR: 2-8) compared to 7 months (IQR: 2-14) in the previous one (P=0.02). We observed in the last season a higher number of children admitted to PED with a high priority code and an increased therapeutic use of high-flow nasal cannula and inhaled adrenaline. During the 2022-23 season we found 31 (12.8%) children presenting more than one episode of bronchiolitis in the same epidemic season, compared to 16 (7.6%) children in the previous season (P=0.048). Our data emphasize that the epidemiological features of bronchiolitis after COVID-19 outbreak have changed and are still evolving.

Non-intubated bronchoscopic tracheobronchial surgeries with electroencephalogram-monitored intravenous anesthesia: feasibility and outcomes.

Anesthesia remains challenging for bronchoscopic tracheobronchial surgeries (BTS) involving surgical manipulations for central airway obstruction within shared airways. To provide complete airway use through intervention with spontaneous breathing without endotracheal tubes, monitored non-intubated anesthesia has been successfully applied with electroencephalogram-derived monitored total intravenous anesthesia. This study evaluated the feasibility and the outcomes of BTS with monitored non-intubated anesthesia. The factors associated with desaturation and complications were also analyzed. Data from patients receiving non-intubated BTS performed between October 2019 and August 2022 were retrospectively collected. Intraoperative results and postoperative outcomes were analyzed. Data of 92 patients were collected. Supraglottic airways devices and high-flow nasal oxygen were used in 68 and 24 patients respectively. Surgery was successfully completed in 87 patients (94.6%), whereas three patients required conversion to intubation because of substantial bleeding. In total, 11% of patients experienced desaturation [oxygen saturation (SpO2) <90%] for an average of 9 minutes. Unexpected admission to the intensive care unit (ICU) occurred in 12.2% (5/41) of patients from outpatient department and 7.8% (4/51) of hospitalization settings because of high-grade surgical bleeding. With comparable desaturation incidence, tracheal surgery had significantly longer desaturation times (14.5±6.9 min) than bronchial surgeries (5.8±2.6 min) did. Monitored non-intubated anesthesia with spontaneous breathing is feasible for BTS, with high success rate, few complications, and rapid recovery. High-grade bleeding remains the most unpredictable risk for intraoperative desaturation and postoperative ICU admission, especially in tracheal obstruction cases.

Implementing High-Flow Nasal Oxygen Therapy in Medical Wards: A Scoping Review to Understand Hospital Protocols and Procedures.

Acute hypoxemic respiratory failure (ARF) is a common cause for hospital admission. High-flow nasal oxygen (HFNO) is increasingly used as a first-line treatment for patients with ARF, including in medical wards. Clinical guidance is crucial when providing HFNO, and health services use local health guidance documents (LHGDs) to achieve this. It is unknown what hospital LHGDs recommend regarding ward administration of HFNO. This study examined Australian hospitals' LHGDs regarding ward-based HFNO administration to determine content that may affect safe delivery. A scoping review was undertaken on 2 May 2022 and updated on 29 January 2024 to identify public hospitals' LHGDs regarding delivery of HFNO to adults with ARF in medical wards in two Australian states. Data were extracted and analysed regarding HFNO initiation, monitoring, maintenance and weaning, and management of clinical deterioration. Of the twenty-six included LHGDs, five documents referenced Australian Oxygen Guidelines. Twenty LHGDs did not define a threshold level of hypoxaemia where HFNO use was recommended over conventional oxygen therapy. Thirteen did not provide target oxygen saturation ranges whilst utilising HFNO. Recommendations varied regarding maximal levels of inspired oxygen and flow rates in the medical ward. Eight LHGDs did not specify any system to identify and manage deteriorating patients. Five LHGDs did not provide guidance for weaning patients from HFNO. There was substantial variation in the LHGDs regarding HFNO care for adult patients with ARF in Australian hospitals. These findings have implications for the delivery of high-quality, safe clinical care in hospitals.

High-flow nasal cannula oxygen therapy is equally effective to noninvasive ventilation for mild-moderate acute respiratory distress syndrome in patients with acute pancreatitis: A single-center, retrospective cohort study.

The use of high-flow nasal cannula (HFNC) oxygen therapy is gaining popularity for the treatment of acute hypoxic respiratory failure. However, limited evidence exists regarding the effectiveness of HFNC for acute respiratory distress syndrome (ARDS) in patients with acute pancreatitis (AP). This retrospective analysis focused on AP patients with mild-moderate ARDS, who were treated with either HFNC or noninvasive ventilation (NIV) in the emergency medicine department, from January 2020 to December 2022. The primary endpoint was treatment failure, defined as either invasive ventilation or a switch to any other study treatment (NIV for patients in the NFNC group and vice versa). A total of 146 patients with AP (68 in the HFNC group and 78 in the NIV group) were included in this study. The treatment failure rate in the HFNC group was 17.6% and 19.2% in the NIV group - a risk difference of -1.6% (95% CI, -11.3 to 14.0%; P = 0.806). The most common causes of failure in the HFNC group were aggravation of respiratory distress and hypoxemia. However, in the NIV group, the most common reasons for failure were treatment intolerance and exacerbation of respiratory distress. Treatment intolerance in the HFNC group was significantly lower than that in the NIV group (16.7% vs 60.0%, 95% CI -66.8 to -6.2; P = 0.023). Multivariate logistic regression analysis showed that body mass index (≥28), acute physiology and chronic health evaluation II score (≥15), partial arterial oxygen tension/fraction of inspired oxygen (≤200), and respiratory rate (≥32/min) at 1 hour were independent predictors of HFNC failure. In AP patients with mild-moderate ARDS, the usage of HFNC did not lead to a higher rate of treatment failure when compared to NIV. HFNC is an ideal choice of respiratory support for patients with NIV intolerance, but clinical application should pay attention to the influencing factors of its treatment failure.

Comparison of high-flow nasal cannula and conventional oxygen therapy in treating COVID-19 patients referred to the emergency department: A randomized, single-blind clinical trial

Objective: High-flow nasal cannula (HFNC) oxygen therapy has been recently implicated in the treatment of patients with acute respiratory failure (ARF). This study investigated the effect of this treatment on COVID-19 patients. Methods: This was a prospective, randomized, single-blind clinical trial performed between June and November 2021 (Delta variant of the coronavirus) at Al-Zahra Hospital in Iran, on patients with COVID-19 referred to the emergency department (ED). COVID-19 patients who had peripheral oxygen saturation (SpO2)≤90% despite receiving nasal oxygen (up to 6 L/min) were included in the study and randomly assigned to receive either HFNC or conventional oxygen therapy (COT) treatment. The patients were compared regarding vital signs, SpO2, and the need for endotracheal intubation and intensive care unit (ICU) admission. The calculated sample size was 35 patients in each group. The variables were compared using the chi-square, student’s t-test, or Mann-Whitney U tests. The data was analyzed using SPSS version 25. Results: Eighty-seven patients with a mean age of 65.3±14.8 (62.1% male) were included. The two groups were similar in terms of age, sex, time interval from onset to diagnosis, and underlying diseases (hypertension, diabetes, coronary artery disease, etc.) (P&lt;0.05). No statistically significant difference was reported between SpO2 and PaO2/FiO2 vital signs at the beginning of treatment between the two groups. One hour after treatment, respiratory rate, SpO2, and PaO2/ FiO2 were better in the HFNC group compared to the COT group (P&lt;0.05). Also, there was no significant difference between the two groups regarding in-hospital mortality or the need for endotracheal intubation or ICU admission. Conclusion: Early use of HFNC oxygen therapy in patients with COVID-19 can improve SpO2, respiratory rate, and PaO2/FiO2 levels, making it highly valuable from a clinical point of view.

Digital Twins of Acute Hypoxemic Respiratory Failure Patients Suggest a Mechanistic Basis for Success and Failure of Noninvasive Ventilation.

To clarify the mechanistic basis for the success or failure of noninvasive ventilation (NIV) in acute hypoxemic respiratory failure (AHRF). We created digital twins based on mechanistic computational models of individual patients with AHRF. Interdisciplinary Collaboration in Systems Medicine Research Network. We used individual patient data from 30 moderate-to-severe AHRF patients who had failed high-flow nasal cannula (HFNC) therapy and subsequently underwent a trial of NIV. Using the digital twins, we evaluated lung mechanics, quantified the separate contributions of external support and patient respiratory effort to lung injury indices, and investigated their relative impact on NIV success or failure. In digital twins of patients who successfully completed/failed NIV, after 2 hours of the trial the mean (sd) of the change in total lung stress was -10.9 (6.2)/-0.35 (3.38) cm H2O, mechanical power -13.4 (12.2)/-1.0 (5.4) J/min, and total lung strain 0.02 (0.24)/0.16 (0.30). In the digital twins, positive end-expiratory pressure (PEEP) produced by HFNC was similar to that set during NIV. In digital twins of patients who failed NIV vs. those who succeeded, intrinsic PEEP was 3.5 (0.6) vs. 2.3 (0.8) cm H2O, inspiratory pressure support was 8.3 (5.9) vs. 22.3 (7.2) cm H2O, and tidal volume was 10.9 (1.2) vs. 9.4 (1.8) mL/kg. In digital twins, successful NIV increased respiratory system compliance +25.0 (16.4) mL/cm H2O, lowered inspiratory muscle pressure -9.7 (9.6) cm H2O, and reduced the contribution of patient spontaneous breathing to total driving pressure by 57.0%. In digital twins of AHRF patients, successful NIV improved lung mechanics, lowering respiratory effort and indices associated with lung injury. NIV failed in patients for whom only low levels of positive inspiratory pressure support could be applied without risking patient self-inflicted lung injury due to excessive tidal volumes.

Oxygen concentration titration guided by oxygen reserve index during pediatric laryngeal surgery with high-flow nasal cannula oxygen: a randomized controlled trial.

The objective of this study was to evaluate whether adjusting the oxygen concentration guided by the Oxygen Reserve Index (ORI) during pediatric laryngeal surgery with High Flow Nasal Cannula Oxygen (HFNO) could achieve postoperative PaO2 close to physiological levels while ensuring adequate oxygenation in surgery. Sixty pediatric patients undergoing laryngeal surgery or examination were randomly assigned to two groups. The ORI group received oxygen concentration adjustments every 5min to maintain a target ORI value of 0.21, whereas the control group did not undergo any adjustments. Postoperative PaO2, time weighted average fraction of inspired oxygen (FiO2), and mean Peripheral Oxygen Saturation (SpO2) were compared between groups. Finally, some analyses were conducted to examine the relationship of ORI with PaO2. In general, the postoperative PaO2 was 164.9 ± 48.8mmHg in ORI group and 323.0 ± 87.7mmHg in control group (P < 0.01). The time weighted average FiO2 in the ORI group was 85.9 [81.8-92.7] %. There was no significant difference in mean SpO2 between the two groups (ORI vs. control: 98.4 [97.7-99.2] vs. 98.8 [97.7-99.5]; P = 0.36). According to the analyses, the optimal cut value for ORI was determined to be 0.195 when PaO2 was 150mmHg. In pediatric laryngeal surgery with HFNO, reducing oxygen concentration guided by ORI helped achieve postoperative PaO2 levels closer to physiological norms without compromising intra-operative oxygenation.

Hospital Oxygen Supply Overwhelmed Due to COVID-19: When Demand Exceeds Supply.

During the first wave of COVID-19, we experienced problems with our hospital oxygen supply system. This study aimed to analyze factors that stressed this system and rethink the design criteria of the gas pipeline system considering the varying oxygen demand. A retrospective study was conducted to describe problems that occurred at different stages in the oxygen supply system at our hospital due to increases in oxygen use in general, and the creation of an intermediate respiratory care unit (IRCU) and use of high-flow nasal cannula (HFNC) in particular. Herein, the characteristics and design criteria of the medical gas pipeline system are analyzed, and the steps taken to avoid future problems are outlined. Increases in oxygen use were observed at times of maximum occupancy, and these created vulnerabilities in the oxygen supply due to insufficient capacity in terms of cryogenic tanks, evaporators, and the piping network. The peak consumption was 3 times higher than the peak in the preceding 4 years. The use of HFNC therapy aggravated the problem; IRCU use accounting for as much as two-fifths of the total across the hospital. Steps taken subsequently prevented the recurrence of vulnerabilities. The design criteria for storage and distribution networks of medical gases in hospitals need to be revised considering new parameters for their implementation and the use of HFNC therapy in an IRCU. In particular, the cryogenic tanks, evaporators, and piping network for hospital wards are critical.

High-flow nasal cannula oxygen reduced hypoxemia in patients undergoing gastroscopy under general anesthesia at ultra-high altitude: a randomized controlled trial.

Hypoxemia can occur in people at ultra-high altitude (above 3500m) even at rest, and patients undergoing gastroscopy under general anesthesia have higher risk of hypoxemia. Supplementary oxygen via standard nasal cannula (SNC) is the standard of care for most patients who undergo gastroscopy under general anesthesia, which provides oxygen flow up to 15L/min. High-flow nasal cannula (HFNC) could deliver oxygen at a rate up to 60L/min, which is recommended by the American Society of Anesthesiologists Practice Guidelines. We speculated that the benefit with HFNC is more prominent in high-altitude areas, and aimed to compare the incidence of hypoxemia during gastroscopy under general anesthesia at ultra-high altitude with oxygen supply via either HFNC or SNC. The trial was registered at at Chinese Clinical Trial Registry (ChiCTR2100045513; date of registration on 18/04/2021). Adult patients undergoing gastroscopy with anesthesia (estimated duration of anesthesia at ≥ 15min) were randomized at a 1:1 ratio to receive HFNC oxygen or SNC oxygen. The primary outcome was hypoxemia (SpO2 < 90% for any duration). Secondary outcomes included severe hypoxemia (SpO2 < 75% for any duration or SpO2 < 90% but ≥ 75% for ≥ 60s) and hypotension, as defined by reduction of mean arterial blood pressure by ≥ 25% from the baseline. A total of 262 patients were enrolled: 129 in the HFNC group and 133 in the SNC group. All patients received the designated intervention. Student's t-test, Mann-Whitney U test and χ2 test were employed in the study. The rate of hypoxemia was 9.3% (12/129) in the HFNC group versus 36.8% (49/133) in the SNC group [risk ratio (95% confidence interval): 0.25(0.14-0.45); P < 0.001). The HFNC group also had lower rate of severe hypoxemia [0.0% (0/129) versus 11.3% (15/133); risk ratio (95% confidence interval): 0.03(0.00-0.55); P < 0.001, respectively]. The rate of hypotension did not differ between the 2 groups [22.5% (29/129) in HFNC group versus 21.1% (28/133) in SNC group; risk ratio (95% confidence interval): 1.07(0.67-1.69) ; P = 0.779]. HFNC oxygen reduced the incidence of hypoxemia during anesthesia in adult patients undergoing gastroscopy at ultra-high altitude.

Factors related to mortality of patients with COVID-19 who are admitted to the ICU: Prognostic mortality factors of COVID-19 patients.

During the severe acute respiratory syndrome coronavirus 2 pandemic, hospital resources, particularly critical care units, were overburdened and this had a significant impact on both the therapies and the prognosis of these patients. This study aimed to identify factors and therapies that may improve prognosis and other factors associated with increased mortality. A secondary objective was to evaluate the impact that obesity had on these patients. An observational study was conducted on 482 patients aged 18 years or older who were diagnosed with SARS-CoV-2 pneumonia and admitted to the Intensive Care Units of 3 national hospitals registered in the CIBERESUCICOVID database between September 2020 and March 2021. After identifying the sample profile, risk factors were analyzed, the predictive model was constructed, and crude odd ratios were calculated for each factor. Additionally, logistic regression was used to build the multivariate model adjusting for potential confounders. The final model included only the variables selected using the Backward method. A sample of 335 men (69.5%) and 145 women (30.08%) aged 61.94 ± 12.75 years with a body mass index (BMI) of 28.05 (25.7; 31.2) was obtained. A total of 113 patients received noninvasive mechanical ventilation. The most common comorbidities were: high blood pressure (51.04%), obesity (28%), diabetes mellitus (23.44%), other metabolic diseases (21.16%), chronic heart failure (18.05%), chronic obstructive pulmonary disease (11.62%), and chronic kidney disease (10.16%). In-hospital, 3-month and 6-month post-discharge mortality in patients with BMI > 30 (n = 135) versus BMI ≤ 30 (n = 347) was significantly different (P = .06). Noninvasive mechanical ventilation failed in 42.4% of patients with BMI > 30 compared to 55% of patients with BMI ≤ 30. This study identified the factors associated with failure of mechanical ventilation. The most common comorbidities were congestive heart failure, high blood pressure, chronic kidney disease, severe liver disease, diabetes mellitus, and solid organ transplantation. In terms of ventilatory support, patients who received high-flow nasal oxygen therapy on admission had lower mortality rates. The use of renal replacement therapy was also significantly associated with higher mortality.

Perioperative use of high flow nasal cannula

High flow nasal cannula (HFNC) is an innovative oxygen therapy system that has gained increasing popularity in recent decades, particularly in the field of critical care medicine. The device provides a more constant and higher FiO2, generates low levels of PEEP, reduces dead space ventilation, and conditions the inspired gas, which collectively results in a reduction in work of breathing (WOB) and improved patient comfort. While the application of HFNC in critically ill patients is well-established and supported by a large body of evidence, studies of HFNC during the perioperative period are limited. However, the working mechanisms of HFNC align with physiological demands across various anesthetic processes. Consequently, this system could potentially serve as an alternative oxygen delivery system for surgical patients during perioperative care. In this article, we summarize the working principles and the effects provided by HFNC, review its implementation during the perioperative period, and discuss the current evidence regarding its use.

Nasal high flow therapy for bronchiolitis.

Uptake of nasal high-flow therapy in infants with bronchiolitis has grown in the last decade with some evidence suggesting a reduction in escalation of care. The effect of the implementation of recent available evidence on clinical practice remains unclear. In a prospective observational study over 6 months in six metropolitan hospitals in Australia, we investigated the clinical practice of high-flow in infants admitted with bronchiolitis and an oxygen requirement. To assess the choice by clinicians of the initial oxygen therapy (standard oxygen or high-flow) the disease severity was measured by physiological parameters obtained prior to oxygen therapy commencement. Additional secondary outcomes were hospital length of stay and transfers to intensive care. Two hundred thirty-five infants with bronchiolitis were admitted for oxygen therapy over 6 months during the winter season. Infants who received high-flow on admission to hospital displayed significantly higher respiratory rates, higher heart rates and higher early warning tool scores with more severe work of breathing than those commenced on standard oxygen therapy as a first line of oxygen therapy. A significantly longer hospital length of stay of 0.6 days occurred in infants commenced on high-flow. A significantly greater proportion on high-flow (23.3%) were admitted to intensive care compared to infants commenced on SOT (10.4%) despite the severity of disease in both groups being similar. Infants with bronchiolitis presenting with greater disease severity are more likely to receive high-flow therapy. Escalation of care in an intensive care unit occurred more frequently on infants on high-flow. This trial is registered in the Australian New Zealand Clinical Trial Registry ACTRN12618001206213.

Effects of acute carbon monoxide poisoning on liver damage and comparisons of related oxygen therapies in a rat model

Acute carbon monoxide (CO) poisoning may cause liver damage and liver dysfunction. Therefore, in this study, we aimed to compare the efficiency of normobaric oxygen (NBO) and high-flow nasal cannula oxygen (HFNCO) treatments on liver injury. For that purpose, 28 male Wistar albino rats were divided into four groups (Control, CO, CO + NBO, and CO + HFNCO). The control group was allowed to breath room air for 30 min. Acute CO poisoning in CO, CO + NBO, CO + HFNCO was induced by CO exposure for 30 min. Thereafter, NBO group received 100% NBO with reservoir mask for 30 min. HFNCO group received high-flow oxygen through nasal cannula for 30 min. At the end of the experiment, all animals were sacrificed by cardiac puncture under anesthesia. Serum liver function tests were measured. Liver tissue total antioxidant status (TAS), total oxidant status (TOS), and oxidative stress index (OSI) levels, tissue histomorphology and immunoexpression levels of Bax, Caspase 3, TNF-α, IL-1β, and NF-κB were also examined. Our observations indicated that acute CO poisoning caused significant increases in blood COHb, serum aminotransferase (AST), alanine aminotransferase (ALT0, alkaline phosphatase (ALP), total protein, albumin, and globulin levels but a decrease in albumin to globulin ratio (all, p < 0.05). Furthermore, acute CO poisoning significantly increased the OSI value, and the immunoexpresssion of Bax, Caspase 3, TNF-α, IL-1β, and NF-κB in liver tissue (all, p < 0.05). These pathological changes in serum and liver tissue were alleviated through both of the treatment methods. In conclusion, both the NBO and HFNCO treatments were beneficial to alleviate the acute CO poisoning associated with liver injury and dysfunction.

Management of neonates with respiratory distress syndrome in resource-limited settings.

In South Africa, prematurity stands as one of the foremost causes of neonatal mortality. A significant proportion of these deaths occur because of respiratory distress syndrome of prematurity. The implementation of non-invasive respiratory support, such as continuous positive airway pressure (CPAP), has demonstrated both safety and efficacy in reducing mortality rates and decreasing the need for mechanical ventilation. Given the absence of blood gas analysers and limited radiological services in many district hospitals, the severity of respiratory distress is often assessed through observation of the infant's work of breathing and the utilisation of bedside scoring systems. Based on the work of breathing, non-invasive therapy can be commenced timeously. While evidence supporting the use of high-flow nasal cannula as a primary treatment for respiratory distress syndrome remains limited, it may be considered as an alternative, provided that CPAP machines are available. The purpose of this article is to advocate the use of non-invasive therapy in low resource-limited settings and describe the indications, contraindications, complications, and application of CPAP therapy. This would benefit healthcare workers, especially in low-care settings and district hospitals.

High-flow nasal oxygen for children's airway surgery to reduce hypoxaemic events: a randomised controlled trial

Tubeless upper airway surgery in children is a complex procedure in which surgeons and anaesthetists share the same operating field. These procedures are often interrupted for rescue oxygen therapy. The efficacy of nasal high-flow oxygen to decrease the frequency of rescue interruptions in children undergoing upper airway surgery is unknown. In this multicentre randomised trial conducted in five tertiary hospitals in Australia, children aged 0-16 years who required tubeless upper airway surgery were randomised (1:1) by a web-based randomisation tool to either nasal high-flow oxygen delivery or standard oxygen therapy (oxygen flows of up to 6 L/min). Randomisation was stratified by site and age (<1 year, 1-4 years, and 5-16 years). Subsequent tubeless upper airway surgery procedures in the same child could be included if there were more than 2 weeks between the procedures, and repeat surgical procedures meeting this condition were considered to be independent events. The oxygen therapy could not be masked, but the investigators remained blinded until outcome data were locked. The primary outcome was successful anaesthesia without interruption of the surgical procedure for rescue oxygenation. A rescue oxygenation event was defined as an interruption of the surgical procedure to deliver positive pressure ventilation using either bag mask technique, insertion of an endotracheal tube, or laryngeal mask to improve oxygenation. There were ten secondary outcomes, including the proportion of procedures with a hypoxaemic event (SpO2 <90%). Analyses were done on an intention-to-treat (ITT) basis. Safety was assessed in all enrolled participants. This trial is registered in the Australian New Zealand Clinical Trials Registry, ACTRN12618000949280, and is completed. From Sept 4, 2018, to April 12, 2021, 581 procedures in 487 children were randomly assigned to high-flow oxygen (297 procedures) or standard care (284 procedures); after exclusions, 528 procedures (267 assigned to high-flow oxygen and 261 assigned to standard care) in 483 children (293 male and 190 female) were included in the ITT analysis. The primary outcome of successful anaesthesia without interruption for tubeless airway surgery was achieved in 236 (88%) of 267 procedures on high-flow oxygen and in 229 (88%) of 261 procedures on standard care (adjusted risk ratio [RR] 1·02, 95% CI 0·96-1·08, p=0·82). There were 51 (19%) procedures with a hypoxaemic event in the high-flow oxygen group and 57 (22%) in the standard care group (RR 0·86, 95% CI 0·58-1·24). Of the other prespecified secondary outcomes, none showed a significant difference between groups. Adverse events of epistaxis, laryngospasm, bronchospasm, hypoxaemia, bradycardia, cardiac arrest, hypotension, or death were similar in both study groups. Nasal high-flow oxygen during tubeless upper airway surgery did not reduce the proportion of interruptions of the procedures for rescue oxygenation compared with standard care. There were no differences in adverse events between the intervention groups. These results suggest that both approaches, nasal high-flow or standard oxygen, are suitable alternatives to maintain oxygenation in children undergoing upper airway surgery. Thrasher Research Fund, the Australian and New Zealand College of Anaesthetists, the Society for Paediatric Anaesthesia in New Zealand and Australia.

Comparison of Treatment Outcomes of High-Flow Nasal Cannula and Nasal Continuous Positive Airway Pressure in Preterm Neonates with Respiratory Distress Syndrome in the NICU of Shahid Sadoughi Hospital in Yazd

Background: Neonatal respiratory distress syndrome (RDS) is a common and urgent condition in newborns, caused by a lack of surfactant production and secretion. This study aimed to compare two non-invasive methods, nasal continuous positive airway pressure (nCPAP) and highflow nasal cannula (HFNC), for managing RDS. Methods: The study was conducted in the Neonatal Intensive Care Unit (NICU) of Shahid Sadoughi Hospital between 2020 and 2021 and included 49 premature neonates (with gestation ≤34 weeks and birth weight ≤2,000 g) diagnosed with RDS. The neonates were randomly assigned to either the HFNC group (n = 24) or the nCPAP group (n = 25). Results: No significant differences in demographic features were observed between the two groups. The HFNC group had lower rates of intubation, shorter hospitalization duration, and less need for full nutritional support and oxygen therapy compared to the nCPAP group, but these differences were not statistically significant. Additionally, there were no significant differences in complications such as traumatic nasal injury, apnea, necrotizing enterocolitis (NEC), bronchopulmonary dysplasia (BPD), pneumothorax, pulmonary hemorrhage, and mortality between the two groups. Conclusion: The results of this study suggest that both HFNC and nCPAP are equally effective in treating premature neonates with RDS, with no significant differences in clinical outcomes. Given the cost-effectiveness of HFNC, medical staff expertise, and equipment accessibility, this approach could be considered a viable alternative to nCPAP.

High-Flow Nasal Cannula System in Respiratory Failure Associated with Interstitial Lung Diseases: A Systematic Review and Narrative Synthesis.

Background: High-flow nasal cannula (HFNC) therapy has emerged as a promising treatment modality for interstitial lung disease (ILD)-related respiratory failure. This systematic review aims to evaluate the efficacy and safety of HFNC therapy in patients with ILDs. Methods: A comprehensive literature search was conducted using major electronic databases to identify relevant studies investigating the use of HFNC therapy in ILD patients with respiratory failure. Outcome measures of interest included improvements in oxygenation, dyspnea relief, respiratory rate control, hospital length of stay, and mortality. Results: Twelve studies were analyzed with an overall population of 715 patients included. Idiopathic Pulmonary Fibrosis (IPF) was the most prevalent type of ILD. Evaluated clinical settings were acute (7 studies), chronic (2 studies), and end-stage (3 studies) ILDs. The HFNC as a support for acute respiratory failure seems not inferior to non-invasive ventilation while offering better comfort and patient's perception. Poor data are available about use in chronic/long-term or rehabilitative settings. In end of life/palliative care, an HFNC might improve quality of life. Despite the promising results, further research is warranted to establish optimal HFNC protocols, identify patient subgroups most likely to benefit, and explore long-term outcomes. Conclusions: Overall, the HFNC appears to be a valuable therapeutic option for managing respiratory failure in ILD patients, offering potential improvements in oxygenation and symptom relief.

A reduced proteomic signature in critically ill Covid-19 patients determined with plasma antibody micro-array and machine learning

BackgroundCOVID-19 is a complex, multi-system disease with varying severity and symptoms. Identifying changes in critically ill COVID-19 patients’ proteomes enables a better understanding of markers associated with susceptibility, symptoms, and treatment. We performed plasma antibody microarray and machine learning analyses to identify novel proteins of COVID-19.MethodsA case-control study comparing the concentration of 2000 plasma proteins in age- and sex-matched COVID-19 inpatients, non-COVID-19 sepsis controls, and healthy control subjects. Machine learning was used to identify a unique proteome signature in COVID-19 patients. Protein expression was correlated with clinically relevant variables and analyzed for temporal changes over hospitalization days 1, 3, 7, and 10. Expert-curated protein expression information was analyzed with Natural language processing (NLP) to determine organ- and cell-specific expression.ResultsMachine learning identified a 28-protein model that accurately differentiated COVID-19 patients from ICU non-COVID-19 patients (accuracy = 0.89, AUC = 1.00, F1 = 0.89) and healthy controls (accuracy = 0.89, AUC = 1.00, F1 = 0.88). An optimal nine-protein model (PF4V1, NUCB1, CrkL, SerpinD1, Fen1, GATA-4, ProSAAS, PARK7, and NET1) maintained high classification ability. Specific proteins correlated with hemoglobin, coagulation factors, hypertension, and high-flow nasal cannula intervention (P < 0.01). Time-course analysis of the 28 leading proteins demonstrated no significant temporal changes within the COVID-19 cohort. NLP analysis identified multi-system expression of the key proteins, with the digestive and nervous systems being the leading systems.ConclusionsThe plasma proteome of critically ill COVID-19 patients was distinguishable from that of non-COVID-19 sepsis controls and healthy control subjects. The leading 28 proteins and their subset of 9 proteins yielded accurate classification models and are expressed in multiple organ systems. The identified COVID-19 proteomic signature helps elucidate COVID-19 pathophysiology and may guide future COVID-19 treatment development.

Apnoeic oxygenation with high flow nasal oxygen for interventional surgery of the larynx and pharynx

BackgroundHighflow nasal cannula oxygen (HFNO) is known to be used for noninvasive oxygenation in intensive care patients but it has rarely been used in airway management for elective surgery of the upper aerodigestive tract.ObjectivesHFNO offers opportunities of a tubeless oxygenation system which is easy to handle and not limited only on surgery of the endolarynx.MethodsWe evaluated this method for oxygenation during brief interventional procedures of the larynx and pharynx in 92 adult patients for safety and intraoperative complications. The need of secondary endotracheal intubation and limiting comorbidities as pulmonal and cardiac diseases were documented.ResultsHFNO showed a good safety profile concerning saturation and hypercapnia. Oxygen desaturation below 90% occurred only in 5 patients, mask ventilation led to quick recovery except in one patient who was secondary intubated. A significant influence of the body mass index on the minimal O2 saturation was shown (p < 0,001) so that a possible limitation of the method exists here. Comorbidities were grouped into the ASA classification. There was a significant difference between ASA I/II and ASA III patients in terms of minimum O2saturation.ConclusionWe conclude that HFNO may hold great promise for changing ventilator technique in general anesthesia, particularly in short elective laryngeal and pharyngeal surgery. Safety and feasibility were proven in this study.

A descriptive phenomenological study of critically ill elderly patients’ experiences of treatment using high-flow nasal cannula after extubation

A descriptive phenomenological study of critically ill elderly patients’ experiences of treatment using high-flow nasal cannula after extubation