Physiological Comparison of High-Flow Nasal Cannula and Helmet Noninvasive Ventilation in Acute Hypoxemic Respiratory Failure.Am J Respir Crit Care Med. 2020 02 01; 201(3):303-312.AJ
Abstract
Rationale:
High-flow nasal cannula (HFNC) and helmet noninvasive ventilation (NIV) are used for the management of acute hypoxemic respiratory failure.Objectives:
Physiological comparison of HFNC and helmet NIV in patients with hypoxemia.Methods:
Fifteen patients with hypoxemia with PaO2/FiO2 < 200 mm Hg received helmet NIV (positive end-expiratory pressure ≥ 10 cm H2O, pressure support = 10-15 cm H2O) and HFNC (50 L/min) in randomized crossover order. Arterial blood gases, dyspnea, and comfort were recorded. Inspiratory effort was estimated by esophageal pressure (Pes) swings. Pes-simplified pressure-time product and transpulmonary pressure swings were measured.Measurements and Main Results:
As compared with HFNC, helmet NIV increased PaO2/FiO2 (median [interquartile range]: 255 mm Hg [140-299] vs. 138 [101-172]; P = 0.001) and lowered inspiratory effort (7 cm H2O [4-11] vs. 15 [8-19]; P = 0.001) in all patients. Inspiratory effort reduction by NIV was linearly related to inspiratory effort during HFNC (r = 0.84; P < 0.001). Helmet NIV reduced respiratory rate (24 breaths/min [23-31] vs. 29 [26-32]; P = 0.027), Pes-simplified pressure-time product (93 cm H2O ⋅ s ⋅ min-1 [43-138] vs. 200 [168-335]; P = 0.001), and dyspnea (visual analog scale 3 [2-5] vs. 8 [6-9]; P = 0.002), without affecting PaCO2 (P = 0.80) and comfort (P = 0.50). In the overall cohort, transpulmonary pressure swings were not different between treatments (NIV = 18 cm H2O [14-21] vs. HFNC = 15 [8-19]; P = 0.11), but patients exhibiting lower inspiratory effort on HFNC experienced increases in transpulmonary pressure swings with helmet NIV. Higher transpulmonary pressure swings during NIV were associated with subsequent need for intubation.Conclusions:
As compared with HFNC in hypoxemic respiratory failure, helmet NIV improves oxygenation, reduces dyspnea, inspiratory effort, and simplified pressure-time product, with similar transpulmonary pressure swings, PaCO2, and comfort.Links
MeSH
Pub Type(s)
Comparative Study
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
Language
eng
PubMed ID
31687831
Clinical Trial Links
Citation
Grieco, Domenico Luca, et al. "Physiological Comparison of High-Flow Nasal Cannula and Helmet Noninvasive Ventilation in Acute Hypoxemic Respiratory Failure." American Journal of Respiratory and Critical Care Medicine, vol. 201, no. 3, 2020, pp. 303-312.
Grieco DL, Menga LS, Raggi V, et al. Physiological Comparison of High-Flow Nasal Cannula and Helmet Noninvasive Ventilation in Acute Hypoxemic Respiratory Failure. Am J Respir Crit Care Med. 2020;201(3):303-312.
Grieco, D. L., Menga, L. S., Raggi, V., Bongiovanni, F., Anzellotti, G. M., Tanzarella, E. S., Bocci, M. G., Mercurio, G., Dell'Anna, A. M., Eleuteri, D., Bello, G., Maviglia, R., Conti, G., Maggiore, S. M., & Antonelli, M. (2020). Physiological Comparison of High-Flow Nasal Cannula and Helmet Noninvasive Ventilation in Acute Hypoxemic Respiratory Failure. American Journal of Respiratory and Critical Care Medicine, 201(3), 303-312. https://doi.org/10.1164/rccm.201904-0841OC
Grieco DL, et al. Physiological Comparison of High-Flow Nasal Cannula and Helmet Noninvasive Ventilation in Acute Hypoxemic Respiratory Failure. Am J Respir Crit Care Med. 2020 02 1;201(3):303-312. PubMed PMID: 31687831.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR
T1 - Physiological Comparison of High-Flow Nasal Cannula and Helmet Noninvasive Ventilation in Acute Hypoxemic Respiratory Failure.
AU - Grieco,Domenico Luca,
AU - Menga,Luca S,
AU - Raggi,Valeria,
AU - Bongiovanni,Filippo,
AU - Anzellotti,Gian Marco,
AU - Tanzarella,Eloisa S,
AU - Bocci,Maria Grazia,
AU - Mercurio,Giovanna,
AU - Dell'Anna,Antonio M,
AU - Eleuteri,Davide,
AU - Bello,Giuseppe,
AU - Maviglia,Riccardo,
AU - Conti,Giorgio,
AU - Maggiore,Salvatore Maurizio,
AU - Antonelli,Massimo,
PY - 2019/11/7/pubmed
PY - 2020/5/7/medline
PY - 2019/11/6/entrez
KW - acute respiratory failure
KW - high-flow nasal oxygen
KW - noninvasive ventilation
SP - 303
EP - 312
JF - American journal of respiratory and critical care medicine
JO - Am J Respir Crit Care Med
VL - 201
IS - 3
N2 - Rationale: High-flow nasal cannula (HFNC) and helmet noninvasive ventilation (NIV) are used for the management of acute hypoxemic respiratory failure.Objectives: Physiological comparison of HFNC and helmet NIV in patients with hypoxemia.Methods: Fifteen patients with hypoxemia with PaO2/FiO2 < 200 mm Hg received helmet NIV (positive end-expiratory pressure ≥ 10 cm H2O, pressure support = 10-15 cm H2O) and HFNC (50 L/min) in randomized crossover order. Arterial blood gases, dyspnea, and comfort were recorded. Inspiratory effort was estimated by esophageal pressure (Pes) swings. Pes-simplified pressure-time product and transpulmonary pressure swings were measured.Measurements and Main Results: As compared with HFNC, helmet NIV increased PaO2/FiO2 (median [interquartile range]: 255 mm Hg [140-299] vs. 138 [101-172]; P = 0.001) and lowered inspiratory effort (7 cm H2O [4-11] vs. 15 [8-19]; P = 0.001) in all patients. Inspiratory effort reduction by NIV was linearly related to inspiratory effort during HFNC (r = 0.84; P < 0.001). Helmet NIV reduced respiratory rate (24 breaths/min [23-31] vs. 29 [26-32]; P = 0.027), Pes-simplified pressure-time product (93 cm H2O ⋅ s ⋅ min-1 [43-138] vs. 200 [168-335]; P = 0.001), and dyspnea (visual analog scale 3 [2-5] vs. 8 [6-9]; P = 0.002), without affecting PaCO2 (P = 0.80) and comfort (P = 0.50). In the overall cohort, transpulmonary pressure swings were not different between treatments (NIV = 18 cm H2O [14-21] vs. HFNC = 15 [8-19]; P = 0.11), but patients exhibiting lower inspiratory effort on HFNC experienced increases in transpulmonary pressure swings with helmet NIV. Higher transpulmonary pressure swings during NIV were associated with subsequent need for intubation.Conclusions: As compared with HFNC in hypoxemic respiratory failure, helmet NIV improves oxygenation, reduces dyspnea, inspiratory effort, and simplified pressure-time product, with similar transpulmonary pressure swings, PaCO2, and comfort.
SN - 1535-4970
UR - https://www.unboundmedicine.com/medline/citation/31687831/Physiological_Comparison_of_High_Flow_Nasal_Cannula_and_Helmet_Noninvasive_Ventilation_in_Acute_Hypoxemic_Respiratory_Failure_
L2 - https://www.atsjournals.org/doi/10.1164/rccm.201904-0841OC?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed
DB - PRIME
DP - Unbound Medicine
ER -