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Physiologic Effects of High-Flow Nasal Cannula in Acute Hypoxemic Respiratory Failure.
Am J Respir Crit Care Med. 2017 05 01; 195(9):1207-1215.AJ

Abstract

RATIONALE

High-flow nasal cannula (HFNC) improves the clinical outcomes of nonintubated patients with acute hypoxemic respiratory failure (AHRF).

OBJECTIVES

To assess the effects of HFNC on gas exchange, inspiratory effort, minute ventilation, end-expiratory lung volume, dynamic compliance, and ventilation homogeneity in patients with AHRF.

METHODS

This was a prospective randomized crossover study in nonintubated patients with AHRF with PaO2/setFiO2 less than or equal to 300 mm Hg admitted to the intensive care unit. We randomly applied HFNC set at 40 L/min compared with a standard nonocclusive facial mask at the same clinically set FiO2 (20 min/step).

MEASUREMENTS AND MAIN RESULTS

Toward the end of each phase, we measured arterial blood gases, inspiratory effort, and work of breathing by esophageal pressure swings (ΔPes) and pressure time product, and we estimated changes in lung volumes and ventilation homogeneity by electrical impedance tomography. We enrolled 15 patients aged 60 ± 14 years old with PaO2/setFiO2 130 ± 35 mm Hg. Seven (47%) had bilateral lung infiltrates. Compared with the facial mask, HFNC significantly improved oxygenation (P < 0.001) and lowered respiratory rate (P < 0.01), ΔPes (P < 0.01), and pressure time product (P < 0.001). During HFNC, minute ventilation was reduced (P < 0.001) at constant arterial CO2 tension and pH (P = 0.27 and P = 0.23, respectively); end-expiratory lung volume increased (P < 0.001), and tidal volume did not change (P = 0.44); the ratio of tidal volume to ΔPes (an estimate of dynamic lung compliance) increased (P < 0.05); finally, ventilation distribution was more homogeneous (P < 0.01).

CONCLUSIONS

In patients with AHRF, HFNC exerts multiple physiologic effects including less inspiratory effort and improved lung volume and compliance. These benefits might underlie the clinical efficacy of HFNC.

Authors+Show Affiliations

1 Department of Anesthesia, Critical Care and Emergency, IRCCS (Institute for Treatment and Research) Ca' Granda Maggiore Policlinico Hospital Foundation, Milan, Italy. 2 Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.1 Department of Anesthesia, Critical Care and Emergency, IRCCS (Institute for Treatment and Research) Ca' Granda Maggiore Policlinico Hospital Foundation, Milan, Italy. 3 Department of Morphology, Surgery and Experimental Medicine, Section of Anesthesia and Intensive Care, University of Ferrara, Ferrara, Italy.4 Department of Emergency, San Gerardo Hospital, Monza, Italy; and.1 Department of Anesthesia, Critical Care and Emergency, IRCCS (Institute for Treatment and Research) Ca' Granda Maggiore Policlinico Hospital Foundation, Milan, Italy.3 Department of Morphology, Surgery and Experimental Medicine, Section of Anesthesia and Intensive Care, University of Ferrara, Ferrara, Italy.4 Department of Emergency, San Gerardo Hospital, Monza, Italy; and. 5 Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy.1 Department of Anesthesia, Critical Care and Emergency, IRCCS (Institute for Treatment and Research) Ca' Granda Maggiore Policlinico Hospital Foundation, Milan, Italy. 2 Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

27997805

Citation

Mauri, Tommaso, et al. "Physiologic Effects of High-Flow Nasal Cannula in Acute Hypoxemic Respiratory Failure." American Journal of Respiratory and Critical Care Medicine, vol. 195, no. 9, 2017, pp. 1207-1215.
Mauri T, Turrini C, Eronia N, et al. Physiologic Effects of High-Flow Nasal Cannula in Acute Hypoxemic Respiratory Failure. Am J Respir Crit Care Med. 2017;195(9):1207-1215.
Mauri, T., Turrini, C., Eronia, N., Grasselli, G., Volta, C. A., Bellani, G., & Pesenti, A. (2017). Physiologic Effects of High-Flow Nasal Cannula in Acute Hypoxemic Respiratory Failure. American Journal of Respiratory and Critical Care Medicine, 195(9), 1207-1215. https://doi.org/10.1164/rccm.201605-0916OC
Mauri T, et al. Physiologic Effects of High-Flow Nasal Cannula in Acute Hypoxemic Respiratory Failure. Am J Respir Crit Care Med. 2017 05 1;195(9):1207-1215. PubMed PMID: 27997805.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Physiologic Effects of High-Flow Nasal Cannula in Acute Hypoxemic Respiratory Failure. AU - Mauri,Tommaso, AU - Turrini,Cecilia, AU - Eronia,Nilde, AU - Grasselli,Giacomo, AU - Volta,Carlo Alberto, AU - Bellani,Giacomo, AU - Pesenti,Antonio, PY - 2016/12/21/pubmed PY - 2017/7/14/medline PY - 2016/12/21/entrez KW - acute lung injury KW - electrical impedance tomography KW - esophageal pressure KW - high-flow nasal oxygen SP - 1207 EP - 1215 JF - American journal of respiratory and critical care medicine JO - Am J Respir Crit Care Med VL - 195 IS - 9 N2 - RATIONALE: High-flow nasal cannula (HFNC) improves the clinical outcomes of nonintubated patients with acute hypoxemic respiratory failure (AHRF). OBJECTIVES: To assess the effects of HFNC on gas exchange, inspiratory effort, minute ventilation, end-expiratory lung volume, dynamic compliance, and ventilation homogeneity in patients with AHRF. METHODS: This was a prospective randomized crossover study in nonintubated patients with AHRF with PaO2/setFiO2 less than or equal to 300 mm Hg admitted to the intensive care unit. We randomly applied HFNC set at 40 L/min compared with a standard nonocclusive facial mask at the same clinically set FiO2 (20 min/step). MEASUREMENTS AND MAIN RESULTS: Toward the end of each phase, we measured arterial blood gases, inspiratory effort, and work of breathing by esophageal pressure swings (ΔPes) and pressure time product, and we estimated changes in lung volumes and ventilation homogeneity by electrical impedance tomography. We enrolled 15 patients aged 60 ± 14 years old with PaO2/setFiO2 130 ± 35 mm Hg. Seven (47%) had bilateral lung infiltrates. Compared with the facial mask, HFNC significantly improved oxygenation (P < 0.001) and lowered respiratory rate (P < 0.01), ΔPes (P < 0.01), and pressure time product (P < 0.001). During HFNC, minute ventilation was reduced (P < 0.001) at constant arterial CO2 tension and pH (P = 0.27 and P = 0.23, respectively); end-expiratory lung volume increased (P < 0.001), and tidal volume did not change (P = 0.44); the ratio of tidal volume to ΔPes (an estimate of dynamic lung compliance) increased (P < 0.05); finally, ventilation distribution was more homogeneous (P < 0.01). CONCLUSIONS: In patients with AHRF, HFNC exerts multiple physiologic effects including less inspiratory effort and improved lung volume and compliance. These benefits might underlie the clinical efficacy of HFNC. SN - 1535-4970 UR - https://www.unboundmedicine.com/medline/citation/27997805/Physiologic_Effects_of_High_Flow_Nasal_Cannula_in_Acute_Hypoxemic_Respiratory_Failure_ L2 - https://www.atsjournals.org/doi/10.1164/rccm.201605-0916OC?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -