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Clinical efficacy of high-flow nasal humidified oxygen therapy in patients with hypoxemia.

ABSTRACT: To evaluate the effectiveness of high-flow nasal humidified oxygen (HFNHO) therapy in patients with mild hypoxemia after extubation. This study included 316 patients with mild hypoxemia after extubation from May 2016 to May 2018 from two intensive care units in China. Compare the effects of the Venturi Mask and High-Flow Nasal Humidified Oxygen (HFNHO) therapy on Heart Rate (HR), Respiratory Rate (RR), Oxygen Saturation (SpO2), Oxygen Partial Pressure (PO2), Partial Pressure Of Carbon Dioxide (PCO2), Oxygenation Index (PO2/FiO2) after extubation, the use of noninvasive mechanical ventilation and tracheal intubation after treatment failure were observed and recorded. Patients have both lower HR and RR than those who received mask treatment (75.4±18.5 vs. 83.0±20.4, p = 0.0004; 18±6.5 vs. 23.6±10.3, p<0.001, respectively). There was significant difference between those who had HFNHO and mask administration's SpO2 and PO2 (94.1±6.4 vs. 87.5±1.5, p<0.001; 88.16±2.9 vs. 77.3±2.3, p<0.001, respectively). For the HFNHO group, patients had lower PCO2 with the mask group. (41.3±0.99 vs 42.2±1.2, p<0.001). On the other hand, the levels of PO2/FiO2 was significantly higher in the HFNHO Group, (181.0±8.3 vs. 157.2±4.9, p<0.05). We concluded HFNHO therapy could significantly relieve the symptoms of dyspnea, improve oxygenation, reduce the use of noninvasive mechanical ventilation and reduce the rate of secondary tracheal intubation in patients with mild hypoxemia after extubation.

SUBMITTER: Hou Q

PROVIDER: S-EPMC6553847 | biostudies-literature | 2019

REPOSITORIES: biostudies-literature

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Clinical efficacy of high-flow nasal humidified oxygen therapy in patients with hypoxemia.

Hou Qiliang Q Zhang Zhigang Z Lei Ting T Gan Maozhou M Wu Xiangjun X Yue Weigang W Li Bin B Deng Lin L Gong Hongchang H

PloS one 20190606 6

To evaluate the effectiveness of high-flow nasal humidified oxygen (HFNHO) therapy in patients with mild hypoxemia after extubation. This study included 316 patients with mild hypoxemia after extubation from May 2016 to May 2018 from two intensive care units in China. Compare the effects of the Venturi Mask and High-Flow Nasal Humidified Oxygen (HFNHO) therapy on Heart Rate (HR), Respiratory Rate (RR), Oxygen Saturation (SpO2), Oxygen Partial Pressure (PO2), Partial Pressure Of Carbon Dioxide (P ...[more]

PMID: 31170182

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Project description:ObjectivesTo investigate the indications of high-flow nasal cannula (HFNC) oxygen therapy among patients with mild hypercapnia and to explore the predictors of intubation when HFNC fails.MethodsThis retrospective study was conducted based on the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. Adult patients with mild hypercapnia (45 < PaCO2 ≤ 60 mmHg) received either HFNC or non-invasive ventilation (NIV) oxygen therapy. Propensity score matching (PSM) was implemented to increase between-group comparability. The Kaplan-Meier method was used to estimate overall survival and cumulative intubation rates, while 28-day mortality and 48-h and 28-day intubation rates were compared using the Chi-squared test. The predictive performances of HR/SpO2 and the ROX index (the ratio of SpO2/FiO2 to respiratory rate) at 4 h were assessed regarding HFNC failure, which was determined if intubation was given within 48 h after the initiation of oxygen therapy. The area under the receiver operating characteristic curve (AUC) for HR/SpO2 and the ROX index were calculated and compared.ResultsA total of 524,520 inpatient hospitalization records were screened, 106 patients in HFNC group and 106 patients in NIV group were successfully matched. No significant difference in 48-h intubation rate between the HFNC group (the treatment group) and the NIV group (the control group) (14.2% vs. 8.5%, p = 0.278); patients receiving HFNC had higher 28-day intubation rate (26.4% vs. 14.2%, p = 0.029), higher 28-day mortality (17.9% vs. 8.5%, p = 0.043), and longer ICU length of stay (4.4 vs. 3.3 days, p = 0.019), compared to those of NIV group. The AUC of HR/SpO2 at 4 h after the initiation of HFNC yielded around 0.660 for predicting 48-h intubation, greater than that of the ROX index with an AUC of 0.589 (p < 0.01).ConclusionPatients with impending respiratory failure had lower intubation rate, shorter ICU length of stay, and lower mortality when treated mild hypercapnia with NIV over HFNC. As opposed to the ROX index, a modest, yet improved predictive performance is demonstrated using HR/SpO2 in predicting the failure of HFNC among these patients.

Project description:BackgroundHypoxemia frequently occurs during bronchoscopy. High-flow nasal cannula (HFNC) oxygen therapy may be a feasible alternative to prevent the deterioration of gas exchange during bronchoscopy. With the convenience of clinical use in mind, we modified an HFNC using a single cannula. This clinical trial was designed to test the hypothesis that a modified HFNC would decrease the proportion of patients with a single moment of peripheral arterial oxygen saturation (SpO2) < 90% during bronchoscopy.MethodsIn this single-center, prospective randomized controlled trial, hospitalized patients in the respiratory department in need of diagnostic bronchoscopy were randomly assigned to a modified HFNC oxygen therapy group or a conventional oxygen therapy (COT) group. The primary outcome was the proportion of patients with a single moment of SpO2 < 90% during bronchoscopy.ResultsEight hundred and twelve patients were randomized to the modified HFNC (n = 406) or COT (n = 406) group. Twenty-four patients were unable to cooperate or comply with bronchoscopy. Thus, 788 patients were included in the analysis. The proportion of patients with a single moment of SpO2 < 90% during bronchoscopy in the modified HFNC group was significantly lower than that in the COT group (12.5% vs. 28.8%, p < 0.001). There were no significant differences in the fraction of inspired oxygen between the two groups. The lowest SpO2 during bronchoscopy and 5 min after bronchoscopy in the modified HFNC group was significantly higher than that in the COT group. Multivariate analysis showed that a baseline forced vital capacity (FVC) < 2.7 L (OR, 0.276; 95% CI, 0.083-0.919, p = 0.036) and a volume of fluid instilled > 60 ml (OR, 1.034; 95% CI, 1.002-1.067, p = 0.036) were independent risk factors for hypoxemia during bronchoscopy in the modified HFNC group.ConclusionsA modified HFNC could decrease the proportion of patients with a single moment of SpO2 < 90% during bronchoscopy. A lower baseline FVC and large-volume bronchoalveolar lavage may predict desaturation during bronchoscopy when using a modified HFNC. Trial registration ClinicalTrials. Gov: NCT02606188. Registered 17 November 2015.

Project description:PurposeWe evaluated the effect of heated and humidified high flow nasal cannula (HFNC) oxygen supplementation to promote regression of high-risk prethreshold retinopathy of prematurity (Hrp-ROP) in premature infants.MethodsA prospective study was designed for Hrp-ROP premature infants undergoing HFNC oxygen supplementation to evaluate its capacity for promoting ROP regression. Statistical analysis with independent samples t-tests and Fisher's exact tests was performed, and forest plots were created to illuminate the odds ratio of factors associated with ROP regression as well as HFNC complication.ResultsWith HFNC, 16 of 20 infants with Hrp-ROP experienced regression, which is higher than the natural regression rate, comparing to the data in other clinical trials (52% in the STOP-ROP study). Among four progressed ROP infants, three were treated with laser photocoagulation and one received anti-vascular endothelial growth factor (VEGF) therapy. The anti-VEGF treated patient encountered ROP recurrence one month after injection and was treated successfully by additional HFNC. No significant differences between regression and progression cases were found for gestational age, birth weight, plus disease, age for HFNC, and SO2 level. The blood saturation of oxygen was significantly increased after HFNC (92 ± 1.3% vs. 96.6 ± 0.8%, P < 0.001), while the heartbeat rate (HR) and respiratory rate (RR) had no significant differences (139.4 ± 5.4 vs. 140.6 ± 4.5, P = 0.409; 37.7 ± 2.3 vs. 37 ± 1.9, P = 0.330, respectively). The main complication of HNFC was nasal erosion associated with airflow and HFNC duration (RR = 1.8, P = 0.026; RR = 1.8, P = 0.026, respectively).ConclusionsThe progression of Hrp-ROP was significantly decreased after HFNC oxygen supplementation with slightly tolerable complication.Translational relevanceOur study suggests that HNFC can be an alternative treatment for Hrp-ROP, potentially avoiding the problems caused by other invasive treatment.

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Clinical efficacy of high-flow nasal humidified oxygen therapy in patients with hypoxemia.

Publications

Clinical efficacy of high-flow nasal humidified oxygen therapy in patients with hypoxemia.

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