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Sequential application of oxygen therapy via high-flow nasal cannula and noninvasive ventilation in acute respiratory failure: an observational pilot study.
Respir Care. 2015 Feb; 60(2):170-8.RC

Abstract

BACKGROUND

The aim of this study was to evaluate the clinical efficacy of humidified oxygen via high-flow nasal cannula (HFNC) alternating with noninvasive ventilation (NIV) in acute hypoxemic respiratory failure (AHRF).

METHODS

We performed a prospective observational study in a 12-bed ICU of a university hospital. All subjects with a PaO2 /FIO2 of ≤300 mm Hg with standard mask oxygen and a breathing frequency of > 30 breaths/min or signs of respiratory distress were included and treated with HFNC first and then NIV. Ventilatory parameters, blood gases, and tolerance were recorded during 2 consecutive sessions of NIV and HFNC. Outcome was assessed after continuation of this noninvasive strategy.

RESULTS

Twenty-eight subjects with AHRF were studied, including 23 (82%) with ARDS. Compared with standard oxygen therapy, PaO2 significantly increased from 83 (68-97) mm Hg to 108 (83-140) mm Hg using HFNC and to 125 (97-200) mm Hg using NIV (P<.01), whereas breathing frequency significantly decreased. HFNC was significantly better tolerated than NIV, with a lower score on the visual analog scale. The non-intubated subjects received HFNC for 75 (27-127) h and NIV for 23 (8-31) h. Intubation was required in 10 of 28 subjects (36%), including 8 of 23 subjects with ARDS (35%). After HFNC initiation, a breathing frequency of ≥30 breaths/min was an early factor associated with intubation.

CONCLUSIONS

HFNC was better tolerated than NIV and allowed for significant improvement in oxygenation and tachypnea compared with standard oxygen therapy in subjects with AHRF, a large majority of whom had ARDS. Thus, HFNC may be used between NIV sessions to avoid marked impairment of oxygenation.

Authors+Show Affiliations

Réanimation Médicale Institut National de la Santé et de la Recherche Médicale, CIC-1402, Université de Poitiers, Poitiers, France. jean-pierre.frat@chu-poitiers.fr.Réanimation Médicale.Institut National de la Santé et de la Recherche Médicale, CIC-1402, Université de Poitiers, Poitiers, France.Réanimation Médicale.Réanimation Médicale.Réanimation Médicale.Réanimation Médicale.Département d'Anesthésie-Réanimation, Centre Hospitalier Universitaire de Poitiers, Poitiers, France.Réanimation Médicale Institut National de la Santé et de la Recherche Médicale, CIC-1402, Université de Poitiers, Poitiers, France.Réanimation Médicale Institut National de la Santé et de la Recherche Médicale, CIC-1402, Université de Poitiers, Poitiers, France.Medical Intensive Care Department, Centre Hospitalier Universitaire de Rouen, Charles Nicolle University Hospital, Rouen, France and UPRES EA 3830-IRIB, Rouen University, Rouen, France.

Pub Type(s)

Journal Article
Observational Study

Language

eng

PubMed ID

25294935

Citation

Frat, Jean-Pierre, et al. "Sequential Application of Oxygen Therapy Via High-flow Nasal Cannula and Noninvasive Ventilation in Acute Respiratory Failure: an Observational Pilot Study." Respiratory Care, vol. 60, no. 2, 2015, pp. 170-8.
Frat JP, Brugiere B, Ragot S, et al. Sequential application of oxygen therapy via high-flow nasal cannula and noninvasive ventilation in acute respiratory failure: an observational pilot study. Respir Care. 2015;60(2):170-8.
Frat, J. P., Brugiere, B., Ragot, S., Chatellier, D., Veinstein, A., Goudet, V., Coudroy, R., Petitpas, F., Robert, R., Thille, A. W., & Girault, C. (2015). Sequential application of oxygen therapy via high-flow nasal cannula and noninvasive ventilation in acute respiratory failure: an observational pilot study. Respiratory Care, 60(2), 170-8. https://doi.org/10.4187/respcare.03075
Frat JP, et al. Sequential Application of Oxygen Therapy Via High-flow Nasal Cannula and Noninvasive Ventilation in Acute Respiratory Failure: an Observational Pilot Study. Respir Care. 2015;60(2):170-8. PubMed PMID: 25294935.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Sequential application of oxygen therapy via high-flow nasal cannula and noninvasive ventilation in acute respiratory failure: an observational pilot study. AU - Frat,Jean-Pierre, AU - Brugiere,Benjamin, AU - Ragot,Stéphanie, AU - Chatellier,Delphine, AU - Veinstein,Anne, AU - Goudet,Véronique, AU - Coudroy,Rémi, AU - Petitpas,Franck, AU - Robert,René, AU - Thille,Arnaud W, AU - Girault,Christophe, Y1 - 2014/10/07/ PY - 2014/10/9/entrez PY - 2014/10/9/pubmed PY - 2016/5/10/medline KW - acute respiratory distress syndrome (ARDS) KW - acute respiratory failure KW - intensive care unit (ICU) KW - nasal high-flow oxygen therapy KW - noninvasive ventilation SP - 170 EP - 8 JF - Respiratory care JO - Respir Care VL - 60 IS - 2 N2 - BACKGROUND: The aim of this study was to evaluate the clinical efficacy of humidified oxygen via high-flow nasal cannula (HFNC) alternating with noninvasive ventilation (NIV) in acute hypoxemic respiratory failure (AHRF). METHODS: We performed a prospective observational study in a 12-bed ICU of a university hospital. All subjects with a PaO2 /FIO2 of ≤300 mm Hg with standard mask oxygen and a breathing frequency of > 30 breaths/min or signs of respiratory distress were included and treated with HFNC first and then NIV. Ventilatory parameters, blood gases, and tolerance were recorded during 2 consecutive sessions of NIV and HFNC. Outcome was assessed after continuation of this noninvasive strategy. RESULTS: Twenty-eight subjects with AHRF were studied, including 23 (82%) with ARDS. Compared with standard oxygen therapy, PaO2 significantly increased from 83 (68-97) mm Hg to 108 (83-140) mm Hg using HFNC and to 125 (97-200) mm Hg using NIV (P<.01), whereas breathing frequency significantly decreased. HFNC was significantly better tolerated than NIV, with a lower score on the visual analog scale. The non-intubated subjects received HFNC for 75 (27-127) h and NIV for 23 (8-31) h. Intubation was required in 10 of 28 subjects (36%), including 8 of 23 subjects with ARDS (35%). After HFNC initiation, a breathing frequency of ≥30 breaths/min was an early factor associated with intubation. CONCLUSIONS: HFNC was better tolerated than NIV and allowed for significant improvement in oxygenation and tachypnea compared with standard oxygen therapy in subjects with AHRF, a large majority of whom had ARDS. Thus, HFNC may be used between NIV sessions to avoid marked impairment of oxygenation. SN - 1943-3654 UR - https://www.unboundmedicine.com/medline/citation/25294935/Sequential_application_of_oxygen_therapy_via_high_flow_nasal_cannula_and_noninvasive_ventilation_in_acute_respiratory_failure:_an_observational_pilot_study_ L2 - http://rc.rcjournal.com/cgi/pmidlookup?view=short&amp;pmid=25294935 DB - PRIME DP - Unbound Medicine ER -