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Nasal high-flow oxygen therapy in patients with hypoxic respiratory failure: effect on functional and subjective respiratory parameters compared to conventional oxygen therapy and non-invasive ventilation (NIV).
BMC Anesthesiol. 2014; 14:66.BA

Abstract

BACKGROUND

Aim of the study was to compare the short-term effects of oxygen therapy via a high-flow nasal cannula (HFNC) on functional and subjective respiratory parameters in patients with acute hypoxic respiratory failure in comparison to non-invasive ventilation (NIV) and standard treatment via a Venturi mask.

METHODS

Fourteen patients with acute hypoxic respiratory failure were treated with HFNC (FiO2 0.6, gas flow 55 l/min), NIV (FiO2 0.6, PEEP 5 cm H2O Hg, tidal volume 6-8 ml/kg ideal body weight,) and Venturi mask (FiO2 0.6, oxygen flow 15 l/min,) in a randomized order for 30 min each. Data collection included objective respiratory and circulatory parameters as well as a subjective rating of dyspnea and discomfort by the patients on a 10-point scale. In a final interview, all three methods were comparatively evaluated by each patient using a scale from 1 (=very good) to 6 (=failed) and the patients were asked to choose one method for further treatment.

RESULTS

PaO2 was highest under NIV (129 ± 38 mmHg) compared to HFNC (101 ± 34 mmHg, p <0.01 vs. NIV) and VM (85 ± 21 mmHg, p <0.001 vs. NIV, p <0.01 vs. HFNC, ANOVA). All other functional parameters showed no relevant differences. In contrast, dyspnea was significantly better using a HFNC (2.9 ± 2.1, 10-point Borg scale) compared to NIV (5.0 ± 3.3, p <0.05), whereas dyspnea rating under HFNC and VM (3.3 ± 2.3) was not significantly different. A similar pattern was found when patients rated their overall discomfort on the 10 point scale: HFNC 2.7 ± 1.8, VM 3.1 ± 2.8 (ns vs. HFNC), NIV 5.4 ± 3.1 (p <0.05 vs. HFNC). In the final evaluation patients gave the best ratings to HFNC 2.3 ± 1.4, followed by VM 3.2 ± 1.7 (ns vs. HFNC) and NIV 4.5 ± 1.7 (p <0.01 vs. HFNC and p <0.05 vs. VM). For further treatment 10 patients chose HFNC, three VM and one NIV.

CONCLUSIONS

In hypoxic respiratory failure HFNC offers a good balance between oxygenation and comfort compared to NIV and Venturi mask and seems to be well tolerated by patients.

TRIAL REGISTRATION

GERMAN CLINICAL TRIALS REGISTER: DRKS00005132.

Authors+Show Affiliations

Department of Internal Medicine, Medical Intensive Care Unit, University of Tübingen, Otfried-Müller-Str, 10, Tübingen 72076, Germany.Department of Internal Medicine, Medical Intensive Care Unit, University of Tübingen, Otfried-Müller-Str, 10, Tübingen 72076, Germany.Department of Clinical Epidemiology and Applied Biometry, University of Tübingen, Tübingen, Germany.Department of Internal Medicine, Medical Intensive Care Unit, University of Tübingen, Otfried-Müller-Str, 10, Tübingen 72076, Germany.Department of Internal Medicine, Division of Pulmonary Medicine, University of Tübingen, Tübingen, Germany.Department of Internal Medicine, Medical Intensive Care Unit, University of Tübingen, Otfried-Müller-Str, 10, Tübingen 72076, Germany.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

25110463

Citation

Schwabbauer, Norbert, et al. "Nasal High-flow Oxygen Therapy in Patients With Hypoxic Respiratory Failure: Effect On Functional and Subjective Respiratory Parameters Compared to Conventional Oxygen Therapy and Non-invasive Ventilation (NIV)." BMC Anesthesiology, vol. 14, 2014, p. 66.
Schwabbauer N, Berg B, Blumenstock G, et al. Nasal high-flow oxygen therapy in patients with hypoxic respiratory failure: effect on functional and subjective respiratory parameters compared to conventional oxygen therapy and non-invasive ventilation (NIV). BMC Anesthesiol. 2014;14:66.
Schwabbauer, N., Berg, B., Blumenstock, G., Haap, M., Hetzel, J., & Riessen, R. (2014). Nasal high-flow oxygen therapy in patients with hypoxic respiratory failure: effect on functional and subjective respiratory parameters compared to conventional oxygen therapy and non-invasive ventilation (NIV). BMC Anesthesiology, 14, 66. https://doi.org/10.1186/1471-2253-14-66
Schwabbauer N, et al. Nasal High-flow Oxygen Therapy in Patients With Hypoxic Respiratory Failure: Effect On Functional and Subjective Respiratory Parameters Compared to Conventional Oxygen Therapy and Non-invasive Ventilation (NIV). BMC Anesthesiol. 2014;14:66. PubMed PMID: 25110463.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Nasal high-flow oxygen therapy in patients with hypoxic respiratory failure: effect on functional and subjective respiratory parameters compared to conventional oxygen therapy and non-invasive ventilation (NIV). AU - Schwabbauer,Norbert, AU - Berg,Björn, AU - Blumenstock,Gunnar, AU - Haap,Michael, AU - Hetzel,Jürgen, AU - Riessen,Reimer, Y1 - 2014/08/07/ PY - 2013/12/22/received PY - 2014/07/25/accepted PY - 2014/8/12/entrez PY - 2014/8/12/pubmed PY - 2015/4/18/medline KW - High-flow nasal cannula KW - Non-invasive ventilation KW - Oxygen KW - Respiratory failure KW - Venturi mask SP - 66 EP - 66 JF - BMC anesthesiology JO - BMC Anesthesiol VL - 14 N2 - BACKGROUND: Aim of the study was to compare the short-term effects of oxygen therapy via a high-flow nasal cannula (HFNC) on functional and subjective respiratory parameters in patients with acute hypoxic respiratory failure in comparison to non-invasive ventilation (NIV) and standard treatment via a Venturi mask. METHODS: Fourteen patients with acute hypoxic respiratory failure were treated with HFNC (FiO2 0.6, gas flow 55 l/min), NIV (FiO2 0.6, PEEP 5 cm H2O Hg, tidal volume 6-8 ml/kg ideal body weight,) and Venturi mask (FiO2 0.6, oxygen flow 15 l/min,) in a randomized order for 30 min each. Data collection included objective respiratory and circulatory parameters as well as a subjective rating of dyspnea and discomfort by the patients on a 10-point scale. In a final interview, all three methods were comparatively evaluated by each patient using a scale from 1 (=very good) to 6 (=failed) and the patients were asked to choose one method for further treatment. RESULTS: PaO2 was highest under NIV (129 ± 38 mmHg) compared to HFNC (101 ± 34 mmHg, p <0.01 vs. NIV) and VM (85 ± 21 mmHg, p <0.001 vs. NIV, p <0.01 vs. HFNC, ANOVA). All other functional parameters showed no relevant differences. In contrast, dyspnea was significantly better using a HFNC (2.9 ± 2.1, 10-point Borg scale) compared to NIV (5.0 ± 3.3, p <0.05), whereas dyspnea rating under HFNC and VM (3.3 ± 2.3) was not significantly different. A similar pattern was found when patients rated their overall discomfort on the 10 point scale: HFNC 2.7 ± 1.8, VM 3.1 ± 2.8 (ns vs. HFNC), NIV 5.4 ± 3.1 (p <0.05 vs. HFNC). In the final evaluation patients gave the best ratings to HFNC 2.3 ± 1.4, followed by VM 3.2 ± 1.7 (ns vs. HFNC) and NIV 4.5 ± 1.7 (p <0.01 vs. HFNC and p <0.05 vs. VM). For further treatment 10 patients chose HFNC, three VM and one NIV. CONCLUSIONS: In hypoxic respiratory failure HFNC offers a good balance between oxygenation and comfort compared to NIV and Venturi mask and seems to be well tolerated by patients. TRIAL REGISTRATION: GERMAN CLINICAL TRIALS REGISTER: DRKS00005132. SN - 1471-2253 UR - https://www.unboundmedicine.com/medline/citation/25110463/Nasal_high_flow_oxygen_therapy_in_patients_with_hypoxic_respiratory_failure:_effect_on_functional_and_subjective_respiratory_parameters_compared_to_conventional_oxygen_therapy_and_non_invasive_ventilation__NIV__ L2 - https://bmcanesthesiol.biomedcentral.com/articles/10.1186/1471-2253-14-66 DB - PRIME DP - Unbound Medicine ER -