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Effect of postextubation high-flow nasal cannula therapy on lung recruitment and overdistension in high-risk patient.

ABSTRACT: BACKGROUND:Postextubation high-flow nasal cannula (HFNC) is used as a support therapy in high-risk patients in ICU. This study aimed to determine the effects of HFNC therapy on lung recruitment and overdistension assessed by electrical impedance tomography (EIT). METHODS:Twenty-four patients who received HFNC within 24?h after extubation were prospectively enrolled in this study. EIT was used to monitor regional lung ventilation distributions at baseline (conventional oxygen therapy) and three flow rate levels of HFNC therapy (20, 40, and 60?L/min). Change of end-expiratory lung impedance (?EELI), regional recruitment (recruited-pixels) and overdistension (overdistended-pixels), and lung strain change were determined by EIT. EIT images were equally divided into four ventral-to-dorsal horizontal regions of interest (ROIs 1, 2, 3, and 4). "Overdistension-by HFNC" due to HFNC is defined as an increase of overdistened-pixels >?10 than baseline. Patients were divided into two groups: (1) high potential of recruitment (HPR), recruited-pixels >?10 pixels at 60?L/min than baseline, and (2) low potential of recruitment (LPR), recruited-pixels

SUBMITTER: Zhang R

PROVIDER: S-EPMC7060646 | biostudies-literature | 2020 Mar

REPOSITORIES: biostudies-literature

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Effect of postextubation high-flow nasal cannula therapy on lung recruitment and overdistension in high-risk patient.

Zhang Rui R He Huaiwu H Yun Long L Zhou Xiang X Wang Xu X Chi Yi Y Yuan Siyi S Zhao Zhanqi Z

Critical care (London, England) 20200306 1

<h4>Background</h4>Postextubation high-flow nasal cannula (HFNC) is used as a support therapy in high-risk patients in ICU. This study aimed to determine the effects of HFNC therapy on lung recruitment and overdistension assessed by electrical impedance tomography (EIT).<h4>Methods</h4>Twenty-four patients who received HFNC within 24 h after extubation were prospectively enrolled in this study. EIT was used to monitor regional lung ventilation distributions at baseline (conventional oxygen thera ...[more]

PMID: 32143664

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Project description:BACKGROUND:Despite the extensive use of high-flow nasal cannula (HFNC) therapy in intensive care units (ICU) for acute respiratory failure (ARF), its daily clinical practice has not been assessed. We designed a regional survey in ICUs in North-west France to evaluate ICU physicians' clinical practice with HFNC. MATERIALS AND METHODS:We sent an observational survey to ICU physicians from 34 French ICUs over a 6-month period in 2016-2017. The survey included questions regarding the indications and expected efficiency of HFNC, practical aspects of use (initiation, weaning) and satisfaction. Comparisons between junior and senior ICU physicians were performed using a Fischer exact test. RESULTS:Among the 235 ICU physicians contacted, 137 responded (58.3%) all of whom regularly used HFNC. Hypoxemic ARF was considered a good indication for HFNC by all 137, but only 30% expected HFNC success (i.e., avoiding intubation in at least 60% of cases). Among hypoxemic indications, 30% of juniors considered acute pulmonary edema a good indication versus 74% of seniors (p?<?0.0001). Hypercapnic ARF was considered a good indication by 33% with only 2% expecting HFNC success. A need for conventional oxygen therapy???6 L/min justified HFNC therapy for 40% and???9 L/min for 39% of responders. 58% of ICU physicians started HFNC therapy with a FiO2???50% and 28% with a gas flow???50 L/min. Practices for HFNC weaning were heterogeneous: 48% considered a FiO2???30%; whereas, 30% considered a FiO2???30% with a high flow???20 L/min. Criteria for HFNC failure (i.e., need for intubation) were ventilatory pauses or arrest (97%), persistent hypoxemia (95%), respiratory acidosis (81%), worsening of breathing (95%, 100% of seniors and 86% of juniors, p?=?0.003), bronchial congestion (75%) and circulatory failure (61%, 72% of seniors and 44% of juniors, p?=?0.007). CONCLUSION:HFNC is used by ICU physicians in many situations of ARF, despite their relatively low expectations of success, especially in cases of hypercapnia. Clinical practices appear somewhat heterogeneous. Despite the physiological benefit of HFNC, further prospective observational studies are still required on HFNC outcomes and daily practices.

Dataset Information

Effect of postextubation high-flow nasal cannula therapy on lung recruitment and overdistension in high-risk patient.

Publications

Effect of postextubation high-flow nasal cannula therapy on lung recruitment and overdistension in high-risk patient.

Similar Datasets

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