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Lytra E, Kokkoris S, Poularas I, Filippiadis D, Cokkinos D, Exarhos D, Zakynthinos S, Routsi C. The effect of high-flow oxygen via tracheostomy on respiratory pattern and diaphragmatic function in patients with prolonged mechanical ventilation: A randomized, physiological, crossover study. J Intensive Med 2024; 4:202-208. [PMID: 38681788 PMCID: PMC11043636 DOI: 10.1016/j.jointm.2023.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 11/08/2023] [Accepted: 11/14/2023] [Indexed: 05/01/2024]
Abstract
Background Compared to conventional oxygen devices, high-flow oxygen treatment (HFOT) through the nasal cannulae has demonstrated clinical benefits. Limited data exist on whether such effects are also present in HFOT through tracheostomy. Hence, we aimed to examine the short-term effects of HFOT through tracheostomy on diaphragmatic function and respiratory parameters in tracheostomized patients on prolonged mechanical ventilation. Methods A randomized, crossover, physiological study was conducted in our ICU between December 2020 and April 2021, in patients with tracheostomy and prolonged mechanical ventilation. The patients underwent a 30-min spontaneous breathing trial (SBT) and received oxygen either via T-piece or by HFOT through tracheostomy, followed by a washout period of 15-min breathing through the T-piece and receipt of 30-min oxygen with the other modality in a randomized crossover manner. At the start and end of each session, blood gasses, breathing frequency (f), and tidal volume (VT) via a Wright's spirometer were measured, along with diaphragm ultrasonography including diaphragm excursion and diaphragmatic thickening fraction, which expressed the inspiratory muscle effort. Results Eleven patients were enrolled in whom 19 sessions were uneventfully completed; eight patients were studied twice on two different days with alternate sessions; and three patients were studied once. Patients were randomly assigned to start the SBT with a T-piece (n=10 sessions) or with HFOT (n=9 sessions). With HFOT, VT and minute ventilation (VE) significantly increased during SBT (from [465±119] mL to [549±134] mL, P <0.001 and from [12.4±4.3] L/min to [13.1±4.2] L/min, P <0.05, respectively), but they did not change significantly during SBT with T-piece (from [495±132] mL to [461±123] mL and from [12.8±4.4] mL to [12.0±4.4] mL, respectively); f/VT decreased during HFOT (from [64±31] breaths/(min∙L) to [49±24] breaths/(min∙L), P <0.001), but it did not change significantly during SBT with T-piece (from [59±28] breaths/(min∙L) to [64±33] breaths/(min∙L)); partial pressure of arterial oxygen increased during HFOT (from [99±39] mmHg to [132±48] mmHg, P <0.001), but it decreased during SBT with T-piece (from [124±50] mmHg to [83±22] mmHg, P <0.01). In addition, with HFOT, diaphragmatic excursion increased (from [12.9±3.3] mm to [15.7±4.4] mm, P <0.001), but it did not change significantly during SBT with T-piece (from [13.4±3.3] mm to [13.6±3.3] mm). The diaphragmatic thickening fraction did not change during SBT either with T-piece or with HFOT. Conclusion In patients with prolonged mechanical ventilation, HFOT through tracheostomy compared with T-piece improves ventilation, pattern of breathing, and oxygenation without increasing the inspiratory muscle effort. Trial Registration Clinicaltrials.gov ldentifer: NCT04758910.
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Affiliation(s)
- Elena Lytra
- 1st Department of Intensive Care, Medical School, National and Kapodistrian University of Athens, Evangelismos Hospital, Athens, Greece
- Radiology Department, Evangelismos Hospital, Athens, Greece
| | - Stelios Kokkoris
- 1st Department of Intensive Care, Medical School, National and Kapodistrian University of Athens, Evangelismos Hospital, Athens, Greece
| | - Ioannis Poularas
- 1st Department of Intensive Care, Medical School, National and Kapodistrian University of Athens, Evangelismos Hospital, Athens, Greece
| | - Dimitrios Filippiadis
- 2nd Radiology Department, Medical School, National and Kapodistrian University of Athens, Attikon Hospital, Athens, Greece
| | | | | | - Spyros Zakynthinos
- 1st Department of Intensive Care, Medical School, National and Kapodistrian University of Athens, Evangelismos Hospital, Athens, Greece
| | - Christina Routsi
- 1st Department of Intensive Care, Medical School, National and Kapodistrian University of Athens, Evangelismos Hospital, Athens, Greece
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Vaithialingam B, Arun BG. High-flow Tracheal Oxygenation with Airway Exchange Catheter: A Novel Approach. Indian J Crit Care Med 2023; 27:456. [PMID: 37378365 PMCID: PMC10291670 DOI: 10.5005/jp-journals-10071-24476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2023] Open
Abstract
How to cite this article: Vaithialingam B, Arun BG. High-flow Tracheal Oxygenation with Airway Exchange Catheter: A Novel Approach. Indian J Crit Care Med 2023;27(6):456.
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Affiliation(s)
- Balaji Vaithialingam
- Department of Anaesthesiology, Sakra World Hospital, Bengaluru, Karnataka, India
| | - BG Arun
- Department of Anaesthesiology, Sakra World Hospital, Bengaluru, Karnataka, India
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Bouetard L, Flamand T, Vignes D, Robert A, Sterpu R, Lemonnier L, Mion M, Gerber V, Abgrall S, Martinot M. High-flow cannula for frail patients with SARS-CoV-2 infection non-eligible for intensive care unit management. Infect Dis Now 2023; 53:104635. [PMID: 36436803 PMCID: PMC9686049 DOI: 10.1016/j.idnow.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 10/22/2022] [Accepted: 11/18/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVES High-flow nasal cannula (HFNC) was widely used during the COVID-19 pandemic in intensive care units (ICU), but there is no recommendation for elderly patients non-eligible for ICU management. We aimed to describe the outcomes of HFNC treatment in patients with COVID-19 who are not eligible for ICU management. METHODS Retrospective bicentric cohort study performed between September 1, 2020 and June 30, 2021 in two infectious diseases departments of Colmar Hospital and Antoine Beclere University Hospital, France. RESULTS Sixty-four patients were treated with HFNC: 33 in Colmar and 31 in Beclere hospital (median age: 85 years; IQ, 82-92). Of these, 16 patients survived (25%). Surviving patients had a lower Charlson comorbidity index score than deceased patients (five vs six; p = 0.02). CONCLUSIONS Despite a high death rate, with survivors being younger and having fewer comorbidities, HFNC is an easy tool to implement in non-ICU wards for the frailest patients.
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Affiliation(s)
- L Bouetard
- Infectious Diseases Department, Antoine Beclere University Hospital, APHP, Paris, France; Université Paris-Saclay, UVSQ, INSERM U1018, CESP, Le Kremlin-Bicêtre, France
| | - T Flamand
- Infectious Diseases Department, Hôpitaux Civils de Colmar, Colmar, France
| | - D Vignes
- Infectious Diseases Department, Antoine Beclere University Hospital, APHP, Paris, France
| | - A Robert
- Infectious Diseases Department, Hôpitaux Civils de Colmar, Colmar, France
| | - R Sterpu
- Infectious Diseases Department, Antoine Beclere University Hospital, APHP, Paris, France
| | - L Lemonnier
- Infectious Diseases Department, Hôpitaux Civils de Colmar, Colmar, France
| | - M Mion
- Geriatrics Department, Antoine Béclère University Hospital, APHP, Paris, France
| | - V Gerber
- Intensive Care Department, Hôpitaux Civils de Colmar, Colmar, France
| | - S Abgrall
- Infectious Diseases Department, Antoine Beclere University Hospital, APHP, Paris, France; Université Paris-Saclay, UVSQ, INSERM U1018, CESP, Le Kremlin-Bicêtre, France
| | - M Martinot
- Infectious Diseases Department, Hôpitaux Civils de Colmar, Colmar, France.
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Lee HY, Lee J, Lee SM. Effect of high-flow oxygen versus T-piece ventilation strategies during spontaneous breathing trials on weaning failure among patients receiving mechanical ventilation: a randomized controlled trial. Crit Care 2022; 26:402. [PMID: 36564808 PMCID: PMC9783722 DOI: 10.1186/s13054-022-04281-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND A spontaneous breathing trial (SBT) is used to determine whether patients are ready for extubation, but the best method for choosing the SBT strategy remains controversial. We investigated the effect of high-flow oxygen versus T-piece ventilation strategies during SBT on rates of weaning failure among patients receiving mechanical ventilation. METHODS This randomized clinical trial was conducted from June 2019 through January 2022 among patients receiving mechanical ventilation for ≥ 12 h who fulfilled the weaning readiness criteria at a single-center medical intensive care unit. Patients were randomized to undergo either T-piece SBT or high-flow oxygen SBT. The primary outcome was weaning failure on day 2, and the secondary outcomes were weaning failure on day 7, ICU and hospital length of stay, and ICU and in-hospital morality. RESULTS Of 108 patients (mean age, 67.0 ± 11.1 years; 64.8% men), 54 received T-piece SBT and 54 received high-flow oxygen SBT. Weaning failure on day 2 occurred in 5 patients (9.3%) in the T-piece group and 3 patients (5.6%) in the high-flow group (difference, 3.7% [95% CI, - 6.1-13.6]; p = 0.713). Weaning failure on day 7 occurred in 13 patients (24.1%) in the T-piece group and 7 patients (13.0%) in the high-flow group (difference, 11.1% [95% CI, - 3.4-25.6]; p = 0.215). A post hoc subgroup analysis showed that high-flow oxygen SBT was significantly associated with a lower rate of weaning failure on day 7 (OR, 0.17 [95% CI, 0.04-0.78]) among those patients intubated because of respiratory failure (p for interaction = 0.020). The ICU and hospital length of stay and mortality rates did not differ significantly between the two groups. During the study, no serious adverse events were recorded. CONCLUSIONS Among patients receiving mechanical ventilation, high-flow oxygen SBT did not significantly reduce the risk of weaning failure compared with T-piece SBT. However, the study may have been underpowered to detect a clinically important treatment effect for the comparison of high-flow oxygen SBT versus T-piece SBT, and a higher percentage of patients with simple weaning and a lower weaning failure rate than expected should be considered when interpreting the findings. Clinical trial registration This trial was registered with ClinicalTrials.gov (number NCT03929328) on April 26, 2019.
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Affiliation(s)
- Hong Yeul Lee
- grid.412484.f0000 0001 0302 820XDepartment of Critical Care Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jinwoo Lee
- grid.412484.f0000 0001 0302 820XDivision of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080 Republic of Korea
| | - Sang-Min Lee
- grid.412484.f0000 0001 0302 820XDepartment of Critical Care Medicine, Seoul National University Hospital, Seoul, Republic of Korea ,grid.412484.f0000 0001 0302 820XDivision of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080 Republic of Korea
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Hultström M, Hellkvist O, Covaciu L, Fredén F, Frithiof R, Lipcsey M, Perchiazzi G, Pellegrini M. Limitations of the ARDS criteria during high-flow oxygen or non-invasive ventilation: evidence from critically ill COVID-19 patients. Crit Care 2022; 26:55. [PMID: 35255949 PMCID: PMC8899791 DOI: 10.1186/s13054-022-03933-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 02/16/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The ratio of partial pressure of arterial oxygen to inspired oxygen fraction (PaO2/FIO2) during invasive mechanical ventilation (MV) is used as criteria to grade the severity of respiratory failure in acute respiratory distress syndrome (ARDS). During the SARS-CoV2 pandemic, the use of PaO2/FIO2 ratio has been increasingly used in non-invasive respiratory support such as high-flow nasal cannula (HFNC) and non-invasive ventilation (NIV). The grading of hypoxemia in non-invasively ventilated patients is uncertain. The main hypothesis, investigated in this study, was that the PaO2/FIO2 ratio does not change when switching between MV, NIV and HFNC. METHODS We investigated respiratory function in critically ill patients with COVID-19 included in a single-center prospective observational study of patients admitted to the intensive care unit (ICU) at Uppsala University Hospital in Sweden. In a steady state condition, the PaO2/FIO2 ratio was recorded before and after any change between two of the studied respiratory support techniques (i.e., HFNC, NIV and MV). RESULTS A total of 148 patients were included in the present analysis. We find that any change in respiratory support from or to HFNC caused a significant change in PaO2/FIO2 ratio. Changes in respiratory support between NIV and MV did not show consistent change in PaO2/FIO2 ratio. In patients classified as mild to moderate ARDS during MV, the change from HFNC to MV showed a variable increase in PaO2/FIO2 ratio ranging between 52 and 140 mmHg (median of 127 mmHg). This made prediction of ARDS severity during MV from the apparent ARDS grade during HFNC impossible. CONCLUSIONS HFNC is associated with lower PaO2/FIO2 ratio than either NIV or MV in the same patient, while NIV and MV provided similar PaO2/FIO2 and thus ARDS grade by Berlin definition. The large variation of PaO2/FIO2 ratio indicates that great caution should be used when estimating ARDS grade as a measure of pulmonary damage during HFNC.
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Affiliation(s)
- Michael Hultström
- Anaesthesiology and Intensive Care Medicine, Department of Surgical Sciences, Uppsala University, Akademiska sjukhuset, ANOPIVA, Ing70, 2tr, 75185, Uppsala, Sweden. .,Integrative Physiology, Department of Medical Cell Biology, Uppsala University, Uppsala, Sweden.
| | - Ola Hellkvist
- Anaesthesiology and Intensive Care Medicine, Department of Surgical Sciences, Uppsala University, Akademiska sjukhuset, ANOPIVA, Ing70, 2tr, 75185, Uppsala, Sweden
| | - Lucian Covaciu
- Anaesthesiology and Intensive Care Medicine, Department of Surgical Sciences, Uppsala University, Akademiska sjukhuset, ANOPIVA, Ing70, 2tr, 75185, Uppsala, Sweden
| | - Filip Fredén
- Anaesthesiology and Intensive Care Medicine, Department of Surgical Sciences, Uppsala University, Akademiska sjukhuset, ANOPIVA, Ing70, 2tr, 75185, Uppsala, Sweden
| | - Robert Frithiof
- Anaesthesiology and Intensive Care Medicine, Department of Surgical Sciences, Uppsala University, Akademiska sjukhuset, ANOPIVA, Ing70, 2tr, 75185, Uppsala, Sweden
| | - Miklós Lipcsey
- Anaesthesiology and Intensive Care Medicine, Department of Surgical Sciences, Uppsala University, Akademiska sjukhuset, ANOPIVA, Ing70, 2tr, 75185, Uppsala, Sweden.,Hedenstierna Laboratory, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Gaetano Perchiazzi
- Anaesthesiology and Intensive Care Medicine, Department of Surgical Sciences, Uppsala University, Akademiska sjukhuset, ANOPIVA, Ing70, 2tr, 75185, Uppsala, Sweden.,Hedenstierna Laboratory, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Mariangela Pellegrini
- Anaesthesiology and Intensive Care Medicine, Department of Surgical Sciences, Uppsala University, Akademiska sjukhuset, ANOPIVA, Ing70, 2tr, 75185, Uppsala, Sweden.,Hedenstierna Laboratory, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
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Gottlieb J, Capetian P, Hamsen U, Janssens U, Karagiannidis C, Kluge S, König M, Markewitz A, Nothacker M, Roiter S, Unverzagt S, Veit W, Volk T, Witt C, Wildenauer R, Worth H, Fühner T. [Oxygen in the acute care of adults : Short version of the German S3 guideline]. Med Klin Intensivmed Notfmed 2021; 117:4-15. [PMID: 34651197 PMCID: PMC8516090 DOI: 10.1007/s00063-021-00884-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Hintergrund Sauerstoff (O2) ist ein Arzneimittel mit spezifischen Eigenschaften, einem definierten Dosis-Wirkungs-Bereich und O2 hat unerwünschte Wirkungen. Im Jahr 2015 wurden 14 % einer Stichprobe von britischen Krankenhauspatienten mit Sauerstoff behandelt, davon hatten nur 42 % eine Verordnung. Gesundheitspersonal ist häufig unsicher über die Relevanz einer Hypoxämie und es besteht ein eingeschränktes Bewusstsein für die Risiken einer Hyperoxämie. In den letzten Jahren wurden zahlreiche randomisierte, kontrollierte Studien zur Sauerstofftherapie veröffentlicht. Methoden Im Rahmen des Leitlinienprogramms der Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e. V. (AWMF) wurde unter Beteiligung von 10 Fachgesellschaften diese S3-Leitlinie auf Basis einer Literaturrecherche bis zum 01.02.2021 entwickelt. Zur Literaturbewertung wurde das System des Oxford Centre for Evidence-Based Medicine (CEBM; „The Oxford 2011 Levels of Evidence“) verwendet. Die Bewertung der Evidenzqualität erfolgte anhand des Grading of Recommendations Assessment, Development and Evaluation (GRADE) und die Leitlinienempfehlungen wurden formal konsentiert. Ergebnisse Die Leitlinie enthält 34 evidenzbasierte Empfehlungen zu Indikation, Verordnung, Überwachung und Abbruch der Sauerstofftherapie in der Akutversorgung. Die Indikation für Sauerstoff ist hauptsächlich die Hypoxämie. Hypoxämie und Hyperoxämie sollten aufgrund der Assoziation mit einer erhöhten Sterblichkeit vermieden werden. Die Leitlinie empfiehlt Zielbereiche der Sauerstoffsättigung für die Sauerstoff-Akuttherapie ohne Differenzierung zwischen verschiedenen Diagnosen. Zielbereiche sind abhängig vom Hyperkapnierisiko und Beatmungsstatus. Die Leitlinie bietet einen Überblick über verfügbare Sauerstoffzufuhrsysteme und enthält Empfehlungen für deren Auswahl basierend auf Patientensicherheit und -komfort. Fazit Dies ist die erste nationale Leitlinie zum Einsatz von Sauerstoff in der Akutmedizin. Sie richtet sich an medizinisches Fachpersonal, das Sauerstoff außerklinisch und stationär anwendet, und ist bis zum 30.06.2024 gültig.
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Affiliation(s)
- Jens Gottlieb
- Klinik für Pneumologie OE 6870, Medizinische Hochschule Hannover, 30625, Hannover, Deutschland. .,Biomedical Research in End-stage and Obstructive Lung Disease Hannover (BREATH), Deutsches Zentrum für Lungenforschung (DZL), Hannover, Deutschland.
| | - Philipp Capetian
- Klinik für Neurologie, Neurologische Intensivstation, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - Uwe Hamsen
- Fachbereich für Unfallchirurgie und Orthopädie, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bochum, Deutschland
| | - Uwe Janssens
- Innere Medizin und internistische Intensivmedizin, Sankt Antonius Hospital GmbH, Eschweiler, Deutschland
| | - Christian Karagiannidis
- Abteilung für Pneumologie und Beatmungsmedizin, ARDS/ECMO Zentrum, Lungenklinik Köln-Merheim, Köln, Deutschland
| | - Stefan Kluge
- Klinik für Intensivmedizin, Universitätsklinikum Eppendorf, Hamburg, Deutschland
| | - Marco König
- Deutscher Berufsverband Rettungsdienst e. V., Lübeck, Deutschland
| | - Andreas Markewitz
- ehem. Klinik für Herz- und Gefäßchirurgie, Bundeswehrzentralkrankenhaus Koblenz, Koblenz, Deutschland
| | - Monika Nothacker
- Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e. V., Marburg, Deutschland
| | - Sabrina Roiter
- Intensivstation, Israelitisches Krankenhaus Hamburg, Hamburg, Deutschland
| | - Susanne Unverzagt
- Abteilung für Allgemeinmedizin, Universität Leipzig, Leipzig, Deutschland
| | - Wolfgang Veit
- Bundesverband der Organtransplantierten e. V., Marne, Deutschland
| | - Thomas Volk
- Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum des Saarlandes, Homburg/Saar, Deutschland
| | - Christian Witt
- Seniorprofessor Innere Medizin und Pneumologie, Charité Berlin, Berlin, Deutschland
| | | | | | - Thomas Fühner
- Biomedical Research in End-stage and Obstructive Lung Disease Hannover (BREATH), Deutsches Zentrum für Lungenforschung (DZL), Hannover, Deutschland.,Krankenhaus Siloah, Klinik für Pneumologie und Beatmungsmedizin, Klinikum Region Hannover, Hannover, Deutschland
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7
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Rodriguez M, Ragot S, Coudroy R, Quenot JP, Vignon P, Forel JM, Demoule A, Mira JP, Ricard JD, Nseir S, Colin G, Pons B, Danin PE, Devaquet J, Prat G, Merdji H, Petitpas F, Vivier E, Mekontso-Dessap A, Nay MA, Asfar P, Dellamonica J, Argaud L, Ehrmann S, Fartoukh M, Girault C, Robert R, Thille AW, Frat JP. Noninvasive ventilation vs. high-flow nasal cannula oxygen for preoxygenation before intubation in patients with obesity: a post hoc analysis of a randomized controlled trial. Ann Intensive Care 2021; 11:114. [PMID: 34292408 PMCID: PMC8295638 DOI: 10.1186/s13613-021-00892-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 06/21/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Critically ill patients with obesity may have an increased risk of difficult intubation and subsequent severe hypoxemia. We hypothesized that pre-oxygenation with noninvasive ventilation before intubation as compared with high-flow nasal cannula oxygen may decrease the risk of severe hypoxemia in patients with obesity. METHODS Post hoc subgroup analysis of critically ill patients with obesity (body mass index ≥ 30 kg·m-2) from a multicenter randomized controlled trial comparing preoxygenation with noninvasive ventilation and high-flow nasal oxygen before intubation of patients with acute hypoxemic respiratory failure (PaO2/FiO2 < 300 mm Hg). The primary outcome was the occurrence of severe hypoxemia (pulse oximetry < 80%) during the intubation procedure. RESULTS Among the 313 patients included in the original trial, 91 (29%) had obesity with a mean body mass index of 35 ± 5 kg·m-2. Patients with obesity were more likely to experience an episode of severe hypoxemia during intubation procedure than patients without obesity: 34% (31/91) vs. 22% (49/222); difference, 12%; 95% CI 1 to 23%; P = 0.03. Among patients with obesity, 40 received preoxygenation with noninvasive ventilation and 51 with high-flow nasal oxygen. Severe hypoxemia occurred in 15 patients (37%) with noninvasive ventilation and 16 patients (31%) with high-flow nasal oxygen (difference, 6%; 95% CI - 13 to 25%; P = 0.54). The lowest pulse oximetry values during intubation procedure were 87% [interquartile range, 77-93] with noninvasive ventilation and 86% [78-92] with high-flow nasal oxygen (P = 0.98). After multivariable analysis, factors independently associated with severe hypoxemia in patients with obesity were intubation difficulty scale > 5 points and respiratory primary failure as reason for admission. CONCLUSIONS Patients with obesity and acute hypoxemic respiratory failure had an increased risk of severe hypoxemia during intubation procedure as compared to patients without obesity. However, preoxygenation with noninvasive ventilation may not reduce this risk compared with high-flow nasal oxygen. Trial registration Clinical trial number: NCT02668458 ( http://www.clinicaltrials.gov ).
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Affiliation(s)
- Maeva Rodriguez
- Médecine Intensive Réanimation, CHU de Poitiers, Poitiers, France.,INSERM, CIC-1402 ALIVE, University of Poitiers, Poitiers, France
| | - Stéphanie Ragot
- INSERM, CIC-1402, Biostatistics, Université de Poitiers, Faculté de Médecine Et de Pharmacie de Poitiers, Poitiers, France
| | - Rémi Coudroy
- Médecine Intensive Réanimation, CHU de Poitiers, Poitiers, France.,INSERM, CIC-1402 ALIVE, University of Poitiers, Poitiers, France
| | - Jean-Pierre Quenot
- Service de Médecine Intensive Réanimation, CHU Dijon Bourgogne, Dijon, France.,Université Bourgogne Franche-Comté Lipness Team UMR 1231 Et INSERM CIC 1432 Epidémiologie Clinique, Dijon, France
| | - Philippe Vignon
- Réanimation Polyvalente, CHU Dupuytren, 87042, Limoges, France.,Clinical Investigation Centre INSERM 1435, 87042, Limoges, France
| | - Jean-Marie Forel
- Médecine Intensive Réanimation Détresses Respiratoires Et Infection Sévères, AP-HM, CHU Nord and CEReSS - Center for Studies and Research On Health Services and Quality of Life EA3279, Aix-Marseille University, Marseille, France
| | - Alexandre Demoule
- AP-HP 6, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie Et Réanimation Médicale du Département R3S, Paris, France.,INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale Et Clinique, Sorbonne Université, Paris, France
| | - Jean-Paul Mira
- Assistance Publique des Hôpitaux de Paris, Groupe Hospitalier Universitaire de Paris Centre, Hôpital Cochin, Réanimation médicale, Paris, France.,Faculté de Médecine, Université Paris Descartes, Paris, France
| | - Jean-Damien Ricard
- AP-HP, Hôpital Louis Mourier, Service de Réanimation Médico-Chirurgicale, 92700, Colombes, France.,UMR IAME 1137, Université Paris Diderot, Sorbonne Paris Cité, 75018, Paris, France.,INSERM, IAME 1137, 75018, Paris, France
| | - Saad Nseir
- Médecine Intensive-Réanimation, CHU de Lille, Inserm U1285, Univ. Lille, CNRS, UMR 8576 - UGSF - Unité de Glycobiologie Structurale Et Fonctionnelle, 59000, Lille, France
| | - Gwenhael Colin
- Centre Hospitalier Départemental de La Roche Sur Yon, Service de Réanimation Polyvalente, La Roche sur Yon, France
| | - Bertrand Pons
- Service de Réanimation, CHU Point-À-Pitre, Pointe-à-Pitre, Guadeloupe, France
| | - Pierre-Eric Danin
- Réanimation Chirurgicale, CHU de Nice, Nice, France.,INSERM U1065, team 8, C3M, Nice, France
| | | | - Gwenael Prat
- Service de Réanimation Médicale, CHU de La Cavale Blanche, Brest, France
| | - Hamid Merdji
- Faculté de Médecine, Hôpitaux universitaires de Strasbourg, Service de Médecine Intensive-Réanimation, Nouvel Hôpital Civil, Université de Strasbourg (UNISTRA), Strasbourg, France.,INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine (RNM), FMTS, Strasbourg, France
| | | | - Emmanuel Vivier
- Service de Réanimation Polyvalente, Centre Hospitalier Saint Joseph-Saint Luc, Lyon, France
| | - Armand Mekontso-Dessap
- Assistance Publique des Hôpitaux de Paris, CHU Henri Mondor, DHU A-TVB, Service Médecine Intensive Réanimation Médicale, 94010, Créteil, France.,Faculté de Médecine de Créteil, Groupe de Recherche Clinique CARMAS, Université Paris Est Créteil, 94010, Créteil, France.,INSERM, Unité UMR 955, IMRB, 94010, Créteil, France
| | - Mai-Anh Nay
- Service de Médecine Intensive Réanimation, Centre Hospitalier Régional D'Orléans, Orléans, France
| | - Pierre Asfar
- Département de Médecine Intensive-Réanimation, CHU D'Angers, Angers, France
| | - Jean Dellamonica
- Médecine Intensive Réanimation, CHU de Nice, Nice, France.,UR2CA, Université Cote D'Azur, Nice, France
| | - Laurent Argaud
- Service de Réanimation Médicale, Hospices Civils de Lyon, Groupement Hospitalier Universitaire Edouard Herriot, 69003, Lyon, France
| | - Stephan Ehrmann
- CHRU de Tours, Médecine Intensive Réanimation, CIC1415,, CRICS-TriggerSEP Research Network, Tours, France.,Centre D'Etudes Des Pathologies Respiratoires, INSERM U1100, Université de Tours, Tours, France
| | - Muriel Fartoukh
- Assistance Publique - Hôpitaux de Paris, Hôpital Tenon, Service de Médecine Intensive Réanimation, Sorbonne Université, 75020, Paris, France
| | - Christophe Girault
- CHU de Rouen, Normandie Univ, UNIROUEN, Department of Medical Intensive Care, Charles Nicolle University, Hospital, Rouen, France.,EA3830-GRHV, Institute for Research and Innovation in Biomedicine (IRIB), Rouen University, 76000, Rouen, France
| | - René Robert
- Médecine Intensive Réanimation, CHU de Poitiers, Poitiers, France.,INSERM, CIC-1402 ALIVE, University of Poitiers, Poitiers, France
| | - Arnaud W Thille
- Médecine Intensive Réanimation, CHU de Poitiers, Poitiers, France.,INSERM, CIC-1402 ALIVE, University of Poitiers, Poitiers, France
| | - Jean-Pierre Frat
- Médecine Intensive Réanimation, CHU de Poitiers, Poitiers, France. .,INSERM, CIC-1402 ALIVE, University of Poitiers, Poitiers, France.
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8
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Ogawa K, Asano K, Ikeda J, Fujii T. Non-invasive oxygenation strategies for respiratory failure with COVID-19: A concise narrative review of literature in pre and mid-COVID-19 era. Anaesth Crit Care Pain Med 2021; 40:100897. [PMID: 34087432 PMCID: PMC8168344 DOI: 10.1016/j.accpm.2021.100897] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 05/17/2021] [Accepted: 05/26/2021] [Indexed: 01/16/2023]
Abstract
The coronavirus disease 2019 (COVID-19) has spread globally and can cause a shortage of medical resources, in particular, mechanical ventilators. High-flow nasal cannula oxygen therapy (HFNC) and non-invasive positive pressure ventilation (NPPV) are frequently used for acute respiratory failure patients as alternatives to invasive mechanical ventilation. They are drawing attention because of a potential role to save mechanical ventilators. However, their effectiveness and risk of viral spread are unclear. The latest network meta-analysis of pre-COVID-19 trials reported that treatment with non-invasive oxygenation strategies was associated with improved survival when compared with conventional oxygen therapy. During the COVID-19 pandemic, a lot of clinical research on COVID-19 related acute respiratory failure has been reported. Several observational studies and small trials have suggested HFNC or NPPV as an alternative of standard oxygen therapy to manage COVID-19 related acute respiratory failure, provided that appropriate infection prevention is applied by health care workers to avoid risks of the virus transmission. Awake proning is an emerging strategy to optimise the management of patients with COVID-19 acute respiratory failure. However, the benefits of awake proning have yet to be assessed in properly designed clinical research. Although HFNC and NPPV are probably effective for acute respiratory failure, the safety data are mostly based on observational and experimental reports. As such, they should be implemented carefully if adequate personal protective equipment and negative pressure rooms are available.
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Affiliation(s)
- Kenta Ogawa
- Intensive Care Unit, Jikei University Hospital, Tokyo, Japan
| | - Kengo Asano
- Intensive Care Unit, Jikei University Hospital, Tokyo, Japan
| | - Junpei Ikeda
- Department of Clinical Engineering Technology, Jikei University Hospital, Tokyo, Japan
| | - Tomoko Fujii
- Intensive Care Unit, Jikei University Hospital, Tokyo, Japan.
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9
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Martínez Santos L, Olabarrieta Zarain U, García Trancho A, Serna de la Rosa RM, Vallinas Hidalgo I, Maroño Boedo MJ, Martínez Ruiz A. Anesthetic planning and management for a caesarian section in a pregnant woman affected by SARS-COV-2 pneumonía. ACTA ACUST UNITED AC 2020; 68:46-49. [PMID: 33139017 PMCID: PMC7474885 DOI: 10.1016/j.redar.2020.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 08/13/2020] [Accepted: 08/21/2020] [Indexed: 12/03/2022]
Abstract
Las mujeres embarazadas experimentan cambios fisiológicos e inmunológicos que les hacen más susceptibles a infecciones víricas o bacterianas, por lo que se les ha considerado grupo vulnerable frente al SARS-CoV-2. Así mismo, pueden desarrollar una forma grave de la enfermedad que requiera finalizar la gestación para mejorar la situación respiratoria o para salvaguardar el bienestar fetal que puede verse afectado por el estado crítico de la madre. En este contexto, cualquier intervención demanda una minuciosa planificación por parte del equipo quirúrgico en general y del anestesiólogo en particular tanto para asegurar el bienestar maternofetal como para evitar posibles contagios del personal sanitario. Describimos el caso de una gestante de 37 semanas ingresada en la Unidad de Reanimación con soporte ventilatorio mediante alto flujo por insuficiencia respiratoria severa debida a COVID-19 que precisa ser sometida a cesárea urgente.
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Affiliation(s)
- L Martínez Santos
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Universitario de Cruces, Baracaldo, Vizcaya, España.
| | - U Olabarrieta Zarain
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Universitario de Cruces, Baracaldo, Vizcaya, España
| | - A García Trancho
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Universitario de Cruces, Baracaldo, Vizcaya, España
| | - R M Serna de la Rosa
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Universitario de Cruces, Baracaldo, Vizcaya, España
| | - I Vallinas Hidalgo
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Universitario de Cruces, Baracaldo, Vizcaya, España
| | - M J Maroño Boedo
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Universitario de Cruces, Baracaldo, Vizcaya, España
| | - A Martínez Ruiz
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Universitario de Cruces, Baracaldo, Vizcaya, España
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10
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Roldan CJ, Chung M, Mc C, Cata J, B H. High-flow oxygen and pro-serotonin agents for non-interventional treatment of post-dural-puncture headache. Am J Emerg Med 2020; 38:2625-2628. [PMID: 33041133 DOI: 10.1016/j.ajem.2020.07.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 07/07/2020] [Accepted: 07/28/2020] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE Post dural puncture headache (PDPH) is a common complication in patients following diagnostic or therapeutic lumbar puncture, procedures requiring epidural access, and spinal surgery. Epidural blood patch (EBP), the gold standard for the treatment of this pathology requires training not provided to emergency physicians. In addition, the presence of concomitant pathology and abnormal laboratory values are contraindications to perform EBP. In presence of these limitations, we sought for a non-interventional management of PDPH utilizing high-flow oxygen and pro-serotonin agents. We reviewed the mechanism of action of this therapy METHODS: To illustrate our proposal, we report a series of twelve consecutive patients with PDPH treated with high-flow oxygen therapy at 12 L/min via a non-rebreathing mask and intravenous metoclopramide. RESULTS All patients were treated with this conservative therapy, no adverse reactions were observed. After the intervention, the headache resolved without further indications for PDPH. CONCLUSION Our series suggests that combining high-flow oxygen and pro-serotonin agents such metoclopramide in the ED might be a feasible option as effective as the invasive methods used in treating PDPH. This therapy appears to be efficient and to minimize risk, cost and side effects. It presents an easily accessible alternative that should be considered when PDPH is not a viable option.
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Affiliation(s)
- Carlos J Roldan
- Department of Pain Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America; Department of Emergency Medicine, The University of Texas Health Science Center at Houston, Houston, TX, South America.
| | - Matthew Chung
- Department of Pain Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America
| | - Correa Mc
- CES Medical School, Medellin, Colombia, South America
| | - J Cata
- Department of Anesthesia, The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America
| | - Huh B
- Department of Pain Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America
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11
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Mitaka C, Odoh M, Satoh D, Hashiguchi T, Inada E. High-flow oxygen via tracheostomy facilitates weaning from prolonged mechanical ventilation in patients with restrictive pulmonary dysfunction: two case reports. J Med Case Rep 2018; 12:292. [PMID: 30309381 PMCID: PMC6182792 DOI: 10.1186/s13256-018-1832-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 09/03/2018] [Indexed: 11/25/2022] Open
Abstract
Background Weaning from prolonged mechanical ventilation is extremely difficult in tracheostomized patients with restrictive pulmonary dysfunction. High-flow oxygen via tracheostomy supplies heated and humidified oxygen gas at > 10 L/minute. However, little has been reported on the use of high-flow oxygen via tracheostomy during weaning from ventilators in patients with restrictive pulmonary dysfunction. We report successful weaning from ventilators in patients with restrictive pulmonary dysfunction using high-flow oxygen via tracheostomy. Case presentation The first patient is a 78-year-old Japanese man with severe pneumococcal pneumonia who was mechanically ventilated for more than 1 month after esophagectomy for esophageal cancer. After he underwent tracheostomy because of prolonged mechanical ventilation, restrictive pulmonary dysfunction appeared: tidal volume 230–240 mL and static compliance 14–15 mL/cmH2O with 10 cmH2O pressure support ventilation. He was weaned from the ventilator under inspiratory support with high-flow oxygen via tracheostomy over a period of 16 days (flow at 40 L/minute and fraction of inspired oxygen of 0.25). The second patient is a 69-year-old Japanese man who developed aspiration pneumonia after esophagectomy and received prolonged mechanical ventilation via tracheostomy. He developed restrictive pulmonary dysfunction. High-flow oxygen via tracheostomy (flow at 40 L/minute with fraction of inspired oxygen of 0.25) was administered with measurement of the airway pressure and at the entrance of the tracheostomy tube. The measured values were as follows: 0.21–0.3 cmH2O, 0.21–0.56 cmH2O, 0.54–0.91 cmH2O, 0.76–2.01 cmH2O, 1.17–2.01 cmH2O, and 1.76–2.01 cmH2O at 10 L/minute, 20 L/minute, 30 L/minute, 40 L/minute, 50 L/minute, and 60 L/minute, respectively. The airway pressures were continuously positive and did not become negative even during inspiration, suggesting that high-flow oxygen via tracheostomy reduces inspiratory effort. He was weaned from the ventilator under inspiratory support with high-flow oxygen via tracheostomy over a period of 12 days. Conclusions High-flow oxygen via tracheostomy may reduce the inspiratory effort and enhance tidal volume by delivering high-flow oxygen and facilitate weaning from prolonged mechanical ventilation in patients with restrictive pulmonary dysfunction.
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Affiliation(s)
- Chieko Mitaka
- Department of Anesthesiology and Pain Medicine, Juntendo University, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
| | - Masahiko Odoh
- Department of Anesthesiology and Pain Medicine, Juntendo University, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Daizoh Satoh
- Department of Anesthesiology and Pain Medicine, Juntendo University, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Tadasuke Hashiguchi
- Department of Esophageal and Gastroenterological Surgery, Juntendo University, Tokyo, Japan
| | - Eiichi Inada
- Department of Anesthesiology and Pain Medicine, Juntendo University, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
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Azoulay E, Lemiale V, Mokart D, Nseir S, Argaud L, Pène F, Kontar L, Bruneel F, Klouche K, Barbier F, Reignier J, Stoclin A, Louis G, Constantin JM, Mayaux J, Wallet F, Kouatchet A, Peigne V, Perez P, Girault C, Jaber S, Oziel J, Nyunga M, Terzi N, Bouadma L, Lebert C, Lautrette A, Bigé N, Raphalen JH, Papazian L, Rabbat A, Darmon M, Chevret S, Demoule A. High-flow nasal oxygen vs. standard oxygen therapy in immunocompromised patients with acute respiratory failure: study protocol for a randomized controlled trial. Trials 2018; 19:157. [PMID: 29506579 PMCID: PMC5836389 DOI: 10.1186/s13063-018-2492-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 01/10/2018] [Indexed: 12/15/2022] Open
Abstract
Background Acute respiratory failure (ARF) is the leading reason for intensive care unit (ICU) admission in immunocompromised patients. High-flow nasal oxygen (HFNO) therapy is an alternative to standard oxygen. By providing warmed and humidified gas, HFNO allows the delivery of higher flow rates via nasal cannula devices, with FiO2 values of nearly 100%. Benefits include alleviation of dyspnea and discomfort, decreased respiratory distress and decreased mortality in unselected patients with acute hypoxemic respiratory failure. However, in preliminary reports, HFNO benefits are controversial in immunocompromised patients in whom it has never been properly evaluated. Methods/design This is a multicenter, open-label, randomized controlled superiority trial in 30 intensive care units, part of the Groupe de Recherche Respiratoire en Réanimation Onco-Hématologique (GRRR-OH). Inclusion criteria will be: (1) adults, (2) known immunosuppression, (3) ARF, (4) oxygen therapy ≥ 6 L/min, (5) written informed consent from patient or proxy. Exclusion criteria will be: (1) imminent death (moribund patient), (2) no informed consent, (3) hypercapnia (PaCO2 ≥ 50 mmHg), (4) isolated cardiogenic pulmonary edema, (5) pregnancy or breastfeeding, (6) anatomical factors precluding insertion of a nasal cannula, (7) no coverage by the French statutory healthcare insurance system, and (8) post-surgical setting from day 1 to day 6 (patients with ARF occurring after day 6 of surgery can be included). The primary outcome measure is day-28 mortality. Secondary outcomes are intubation rate, comfort, dyspnea, respiratory rate, oxygenation, ICU length of stay, and ICU-acquired infections. Based on an expected 30% mortality rate in the standard oxygen group, and 20% in the HFNO group, error rate set at 5%, and a statistical power at 90%, 389 patients are required in each treatment group (778 patients overall). Recruitment period is estimated at 30 months, with 28 days of additional follow-up for the last included patient. Discussion The HIGH study will be the largest multicenter, randomized controlled trial seeking to demonstrate that survival benefits from HFNO reported in unselected patients also apply to a large immunocompromised population. Trial registration ClinicalTrials.gov, ID: NCT02739451. Registered on 15 April 2016. Electronic supplementary material The online version of this article (10.1186/s13063-018-2492-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Elie Azoulay
- Medical Intensive Care Unit, APHP, Hôpital Saint-Louis. ECSTRA Team, and Clinical Epidemiology, UMR 1153, (Center of Epidemiology and Biostatistics, Sorbonne Paris Cité, CRESS), INSERM, Paris Diderot Sorbonne University, Paris, France.
| | - Virginie Lemiale
- Medical Intensive Care Unit, APHP, Hôpital Saint-Louis. ECSTRA Team, and Clinical Epidemiology, UMR 1153, (Center of Epidemiology and Biostatistics, Sorbonne Paris Cité, CRESS), INSERM, Paris Diderot Sorbonne University, Paris, France
| | - Djamel Mokart
- Intensive Care Unit, Paoli Calmettes Institut, Marseille, France
| | - Saad Nseir
- Critical Care Center, CHU de Lille, Lille, France
| | - Laurent Argaud
- Medical Intensive Care Unit, Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon, France
| | - Frédéric Pène
- Medical Intensive Care Unit, Hôpital Cochin, APHP, Université Paris Descartes, Paris, France
| | - Loay Kontar
- Medical Intensive Care Unit and INSERM U1088, Amiens University Hospital, Amiens, France
| | - Fabrice Bruneel
- Medical Intensive Care Unit, André Mignot Hospital, Versailles, France
| | - Kada Klouche
- Medical Intensive Care Unit, CHU de Montpellier, Montpellier, France
| | - François Barbier
- Medical Intensive Care Unit, La Source Hospital, CHR Orléans, Orléans, France
| | - Jean Reignier
- Medical Intensive Care Unit, Hotel Dieu, CHU de Nantes, Nantes, France
| | | | | | | | - Julien Mayaux
- Medical Intensive Care Unit and Respiratory Division, La Pitié-Salpêtrière University Hospital; Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Universités, UPMC Univiversité Paris 06, INSERM, UMRS_1158, Paris, France
| | - Florent Wallet
- Intensive Care Unit, Lyon Sud Medical Center, Lyon, France
| | | | - Vincent Peigne
- Intensive Care Unit, Centre Hospitalier Métropole-Savoie, Chambery, France
| | - Pierre Perez
- Medical Intensive Care Unit, Hôpital Brabois, Vandoeuvre Les Nancy, France
| | | | - Samir Jaber
- Department of Anesthesiology and Critical Care Medicine B (DAR B), Saint-Eloi Hospital, University Teaching Hospital of Montpellier; INSERM U1046, CNRS, UMR 9214, Montpellier, France
| | - Johanna Oziel
- Medical Intensive Care Unit, Avicenne University Hospital, Bobigny, France
| | | | - Nicolas Terzi
- Medical Intensive Care Unit, CHU de Grenoble Alpes, Grenoble, France
| | - Lila Bouadma
- Medical Intensive Care Unit, CHU Bichat, Paris, France
| | - Christine Lebert
- Intensive Care Unit, Centre Hospitalier Départemental Les Oudairies, La Roche Sur Yon, France
| | - Alexandre Lautrette
- Medical Intensive Care Unit, Gabriel-Montpied University Hospital, Clermont-Ferrand, France
| | - Naike Bigé
- Medical Intensive Care Unit, CHU Saint-Antoine, Paris, France
| | | | - Laurent Papazian
- Réanimation des Détresses Respiratoires et Infections Sévères, Assistance Publique - Hôpitaux de Marseille, Hôpital Nord, Aix-Marseille Université, Faculté de Médecine, Marseille, France
| | - Antoine Rabbat
- Respiratory Intensive Care Unit, Hôpital Cochin, Paris, France
| | - Michael Darmon
- Medical Intensive Care Unit, Hôpital Nord, Saint Etienne, France
| | - Sylvie Chevret
- Biostatistics department, Saint Louis Teaching Hospital, Paris, France
| | - Alexandre Demoule
- Medical Intensive Care Unit and Respiratory Division, La Pitié-Salpêtrière University Hospital; Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Universités, UPMC Univiversité Paris 06, INSERM, UMRS_1158, Paris, France
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13
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Vogelsinger H, Halank M, Braun S, Wilkens H, Geiser T, Ott S, Stucki A, Kaehler CM. Efficacy and safety of nasal high-flow oxygen in COPD patients. BMC Pulm Med 2017; 17:143. [PMID: 29149867 PMCID: PMC5693800 DOI: 10.1186/s12890-017-0486-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 11/10/2017] [Indexed: 11/17/2022] Open
Abstract
Background Nasal high-flow oxygen therapy (HFOT) is a novel treatment option for patients suffering from acute or chronic respiratory failure. Aim of our study was to compare safety and efficacy of HFOT with those of conventional oxygen treatment (COT) in normo- and hypercapnic COPD patients. Methods A single cohort of 77 clinically stable hypoxemic patients with an indication for long-term oxygen treatment (LTOT) with or without hypercapnia successively received COT and HFOT for 60 min each, including oxygen adaption and separated by a 30 min washout phase. Results HFOT was well-tolerated in all patients. A significant decrease in PaCO2 was observed during oxygen adaption of HFOT, and increased PaO2 coincided with significantly increased SpO2 and decreased AaDO2 during both treatment phases. Even at a flow rate of 15 L/min, oxygen requirement delivered as air mixture by HFOT tended to be lower than that of COT (2.2 L/min). Not only was no increase in static or dynamic lung volumes observed during HFOT, but even was a significant reduction of residual lung volume measured in 36 patients (28%). Conclusions Thus, short-term use of HFOT is safe in both normocapnic and hypercapnic COPD patients. Lower oxygen levels were effective in correcting hypoxemic respiratory failure and reducing hypercapnia, leading to a reduced amount of oxygen consumption. Long-term studies are needed to assess safety, tolerability, and clinical efficacy of HFOT. Trial registration ClinicalTrials.gov NCT01686893 13.09.2012 retrospectively registered (STIT-1) and NCT01693146 14.09.2012 retrospectively registered (STIT-2). Studies were approved by the local ethics committee (Ethikkommission der Medizinischen Universität Innsbruck, Studienkennzahl UN3547, Sitzungsnummer 274/4.19).
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Affiliation(s)
- Helene Vogelsinger
- Pneumology, Internal Medicine II, Department of Internal Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Michael Halank
- Pneumology, Medical Clinic and Polyclinic, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Silke Braun
- Pneumology, Medical Clinic and Polyclinic, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Heinrike Wilkens
- Pneumology, Saarland University Medical Centre, Homburg, Germany
| | - Thomas Geiser
- Department for Pulmonary Medicine, University Hospital Inselspital, Bern, Switzerland
| | - Sebastian Ott
- Department for Pulmonary Medicine, University Hospital Inselspital, Bern, Switzerland
| | - Armin Stucki
- Pneumology, Berner REHA Zentrum Heiligenschwendi, Heiligenschwendi, Switzerland
| | - Christian M Kaehler
- Pneumology, Internal Medicine II, Department of Internal Medicine, Medical University of Innsbruck, Innsbruck, Austria. .,Pneumology, Lung Centre Southwest, Wangen im Allgäu, Germany.
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14
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Fernandez R, Subira C, Frutos-Vivar F, Rialp G, Laborda C, Masclans JR, Lesmes A, Panadero L, Hernandez G. High-flow nasal cannula to prevent postextubation respiratory failure in high-risk non-hypercapnic patients: a randomized multicenter trial. Ann Intensive Care 2017; 7:47. [PMID: 28466461 PMCID: PMC5413462 DOI: 10.1186/s13613-017-0270-9] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 04/17/2017] [Indexed: 11/16/2022] Open
Abstract
Background Extubation failure is associated with increased morbidity and mortality, but cannot be safely predicted or avoided. High-flow nasal cannula (HFNC) prevents postextubation respiratory failure in low-risk patients. Objective To demonstrate that HFNC reduces postextubation respiratory failure in high-risk non-hypercapnic patients compared with conventional oxygen. Methods Randomized, controlled multicenter trial in patients who passed a spontaneous breathing trial. We enrolled patients meeting criteria for high-risk of failure to randomly receive HFNC or conventional oxygen for 24 h after extubation. Primary outcome was respiratory failure within 72-h postextubation. Secondary outcomes were reintubation, intensive care unit (ICU) and hospital lengths of stay, and mortality. Statistical analysis included multiple logistic regression models. Results The study was stopped due to low recruitment after 155 patients were enrolled (78 received high-flow and 77 received conventional oxygen). Groups were similar at enrollment, and all patients tolerated 24-h HFNC. Postextubation respiratory failure developed in 16 (20%) HFNC patients and in 21 (27%) conventional patients [OR 0.69 (0.31–1.54), p = 0.2]. Reintubation was needed in 9 (11%) HFNC patients and in 12 (16%) conventional patients [OR 0.71 (0.25–1.95), p = 0.5]. No difference was found in ICU or hospital length of stay, or mortality. Logistic regression models suggested HFNC [OR 0.43 (0.18–0.99), p = 0.04] and cancer [OR 2.87 (1.04–7.91), p = 0.04] may be independently associated with postextubation respiratory failure. Conclusion Our study is inconclusive as to a potential benefit of HFNC over conventional oxygen to prevent occurrence of respiratory failure in non-hypercapnic patients at high risk for extubation failure. Registered at Clinicaltrials.gov NCT01820507. Electronic supplementary material The online version of this article (doi:10.1186/s13613-017-0270-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Rafael Fernandez
- Critical Care Department, Hospital Sant Joan de Deu- Fundacio Althaia, CIBERES, Universitat Internacional de Catalunya, Dr Joan Soler 1, 08243, Manresa, Spain.
| | - Carles Subira
- Critical Care Department, Hospital Sant Joan de Deu- Fundacio Althaia, CIBERES, Universitat Internacional de Catalunya, Dr Joan Soler 1, 08243, Manresa, Spain
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