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Medicina 2022Although the references warn about the adverse effects of adding O2 without ventilatory assistance in patients with neuromuscular diseases (NMD), patients are still to...
Although the references warn about the adverse effects of adding O2 without ventilatory assistance in patients with neuromuscular diseases (NMD), patients are still to be admitted to intensive care units with severe hypercapnia and CO2 narcosis. It seems that the problem is rediscovered as the years and generations go by. Unfortunately, many patients and their network of formal and informal caregivers are unaware of this risk, leading to significant worsening of symptoms, acute events, hospital admissions, and, in some cases, cause death. This article focuses on the dangers of O2 administration as well as its precise indications in people with NMD. The central problem is that the administration of O2 can remove the hypoxic impulse to ventilate, however, other mechanisms could be involved, but. The complete withdrawal of oxygen therapy is an even greater mistake if it is not supported by ventilatory assistance. It is possible to supply O2 and control CO2 safely. Oxygen should never be administered without constantly monitoring the CO2 level. Bi-level non-invasive ventilation (BiPAP) through a buccal, nasal interface or mouthpiece is the primary measure to reverse hypoventilation and achieve a decrease in PaCO2. The indications for oxygen therapy in people with NMD have been agreed upon and are reserved for specific situations. To improve the care of those with NMD and avoid iatrogenic interventions, education of the health team and support in the patient's environment is required.
Topics: Carbon Dioxide; Humans; Hypercapnia; Neuromuscular Diseases; Oxygen; Oxygen Inhalation Therapy
PubMed: 35417389
DOI: No ID Found -
Respiratory Care Jun 2023Hypoxemia is a relatively common complication in stable patients during fiberoptic bronchoscopy (FOB). To prevent this complication, high-flow nasal cannula (HFNC) has... (Observational Study)
Observational Study
BACKGROUND
Hypoxemia is a relatively common complication in stable patients during fiberoptic bronchoscopy (FOB). To prevent this complication, high-flow nasal cannula (HFNC) has been described as an alternative to standard oxygen therapy. However, the advantages of HFNC over standard oxygen therapy in acute care patients receiving supplemental oxygen before FOB performed with an oral approach are unknown.
METHODS
We conducted an observational study that involved subjects with a presumptive diagnosis of pneumonia and a clinical indication for a bronchial aspirate sample. The type of oxygen support (standard oxygen therapy vs HFNC) was selected according to availability. The oxygen flow in the HFNC group was 60 L/min. In both groups, the F was set at 0.40. Hemodynamic, respiratory dynamics, and gas exchange data were collected at baseline, before, during, and 24 h after FOB.
RESULTS
Forty subjects were included, 20 in each group (HFNC and standard oxygen therapy). The study was performed on day 5 of hospitalization in the HFNC group and on day 4 in the standard oxygen therapy group ( = .10). No significant between-group differences in baseline characteristics were observed. HFNC vs standard oxygen therapy was associated with a smaller decrease in S levels during the procedure (94% vs 90%; = .040, respectively) and with less variation between the last S measured before FOB and the lowest S during FOB (Δ S ): 2% versus 4.5% ( = .01, respectively).
CONCLUSIONS
In acute subjects who required oxygen support before FOB, the use of HFNC during FOB with an oral approach was associated with a smaller decrease in S and lower Δ S compared with standard oxygen therapy.
Topics: Humans; Oxygen; Cannula; Bronchoscopy; Oxygen Saturation; Oxygen Inhalation Therapy; Respiratory Insufficiency; Noninvasive Ventilation
PubMed: 36878643
DOI: 10.4187/respcare.10598 -
Respiratory Medicine and Research Nov 2020
Topics: Administration, Inhalation; Aerosols; COVID-19; Cross Infection; Disease Transmission, Infectious; Equipment Contamination; Humans; Nebulizers and Vaporizers; Oxygen Inhalation Therapy; Pandemics; Respiratory Therapy; Risk Factors; SARS-CoV-2
PubMed: 32763845
DOI: 10.1016/j.resmer.2020.100778 -
Annals of the American Thoracic Society Nov 2023
Topics: Humans; Pulmonary Disease, Chronic Obstructive; Oximetry; Oxygen Inhalation Therapy; Oxygen
PubMed: 37909796
DOI: 10.1513/AnnalsATS.202309-754ED -
Respiratory Care Mar 2020Various studies have been performed to examine the effect of high-flow nasal cannula (HFNC) in immunocompromised patients with acute respiratory failure (ARF). However,... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Various studies have been performed to examine the effect of high-flow nasal cannula (HFNC) in immunocompromised patients with acute respiratory failure (ARF). However, the results were inconsistent. Thus, we conducted a meta-analysis to evaluate the effect of HFNC oxygen therapy in immunocompromised patients with ARF versus conventional oxygen therapy and noninvasive ventilation (NIV).
METHODS
Relevant studies published prior to May 11, 2019, were systematically searched. The primary outcome was intubation rate; secondary outcomes were mortality (ICU mortality, in-hospital mortality, and 90-d mortality) and ICU-acquired infections. Data were pooled using the random effects model.
RESULTS
Of 832 identified studies, 8 were eligible for inclusion in our analysis ( = 2,167 subjects). HFNC was associated with lower intubation rates compared to conventional oxygen therapy (risk ratio [RR] 0.89, 95% CI 0.79-1.00, = .040), but we found no significant difference in the rate between HFNC and NIV (RR 0.74, 95% CI 0.46-1.19, = .22). We also found that HFNC did not increase the risk of ICU-acquired infections (RR 0.86, 95% CI 0.63-1.18, = .35). However, in comparison to other noninvasive therapies, HFNC exhibited no differences in ICU mortality (RR 0.82, 95% CI 0.58-1.17, = .28), in-hospital mortality (RR 0.92, 95% CI 0.74-1.15, = .48), or 90-d mortality (RR 0.98, 95% CI 0.81-1.18, = .82).
CONCLUSIONS
Our results suggest that HFNC may be a feasible alternative to NIV, with lower intubation rates and no increased risk for ICU-acquired infections compared to standard oxygen therapy. However, HFNC did not appear to reduce mortality in immunocompromised subjects with ARF compared with other noninvasive therapies. Further high-quality randomized controlled trials should be performed to confirm these findings.
Topics: Cannula; Hospital Mortality; Humans; Immunocompromised Host; Intensive Care Units; Intubation; Noninvasive Ventilation; Odds Ratio; Oxygen; Oxygen Inhalation Therapy; Respiratory Insufficiency
PubMed: 31744865
DOI: 10.4187/respcare.07205 -
American Journal of Respiratory and... Dec 2022When compared with VenturiMask after extubation, high-flow nasal oxygen provides physiological advantages. To establish whether high-flow oxygen prevents endotracheal... (Randomized Controlled Trial)
Randomized Controlled Trial
When compared with VenturiMask after extubation, high-flow nasal oxygen provides physiological advantages. To establish whether high-flow oxygen prevents endotracheal reintubation in hypoxemic patients after extubation, compared with VenturiMask. In this multicenter randomized trial, 494 patients exhibiting Pa:Fi ratio ⩽ 300 mm Hg after extubation were randomly assigned to receive high-flow or VenturiMask oxygen, with the possibility to apply rescue noninvasive ventilation before reintubation. High-flow use in the VenturiMask group was not permitted. The primary outcome was the rate of reintubation within 72 hours according to predefined criteria, which were validated by an independent adjudication committee. Main secondary outcomes included reintubation rate at 28 days and the need for rescue noninvasive ventilation according to predefined criteria. After intubation criteria validation ( = 492 patients), 32 patients (13%) in the high-flow group and 27 patients (11%) in the VenturiMask group required reintubation at 72 hours (unadjusted odds ratio, 1.26 [95% confidence interval (CI), 0.70-2.26]; = 0.49). At 28 days, the rate of reintubation was 21% in the high-flow group and 23% in the VenturiMask group (adjusted hazard ratio, 0.89 [95% CI, 0.60-1.31]; = 0.55). The need for rescue noninvasive ventilation was significantly lower in the high-flow group than in the VenturiMask group: at 72 hours, 8% versus 17% (adjusted hazard ratio, 0.39 [95% CI, 0.22-0.71]; = 0.002) and at 28 days, 12% versus 21% (adjusted hazard ratio, 0.52 [95% CI, 0.32-0.83]; = 0.007). Reintubation rate did not significantly differ between patients treated with VenturiMask or high-flow oxygen after extubation. High-flow oxygen yielded less frequent use of rescue noninvasive ventilation. Clinical trial registered with www.clinicaltrials.gov (NCT02107183).
Topics: Humans; Airway Extubation; Respiratory Insufficiency; Oxygen Inhalation Therapy; Noninvasive Ventilation; Intubation, Intratracheal; Oxygen
PubMed: 35849787
DOI: 10.1164/rccm.202201-0065OC -
Acta Anaesthesiologica Scandinavica Sep 2022Oxygen therapy is a common treatment in the intensive care unit (ICU) with both potentially desirable and undesirable long-term effects. This systematic review aimed to... (Review)
Review
BACKGROUND
Oxygen therapy is a common treatment in the intensive care unit (ICU) with both potentially desirable and undesirable long-term effects. This systematic review aimed to assess the long-term outcomes of lower versus higher oxygenation strategies in adult ICU survivors.
METHODS
We included randomised clinical trials (RCTs) comparing lower versus higher oxygen supplementation or oxygenation strategies in adults admitted to the ICU. We searched major electronic databases and trial registers. We included all non-mortality long-term outcomes. Prespecified co-primary outcomes were the long-term cognitive function measures, the overall score of any valid health-related quality of life (HRQoL) evaluation, standardised 6-min walk test, and lung diffusion capacity. The protocol was published and prospectively registered in the PROSPERO database (CRD42021223630).
RESULTS
The review included 17 RCTs comprising 6592 patients, and six trials with 825 randomised patients reported one or more outcomes of interest. We observed no difference in cognitive evaluation via Telephone Interview for Cognitive Status (one trial, 409 patients) (mean score: 30.6 ± 4.5 in the lower oxygenation group vs. 30.4 ± 4.3 in the higher oxygenation group). The trial was judged at overall high risk of bias and the certainty of evidence was very low. Any difference was neither observed in HRQoL measured via EuroQol 5 dimensions 5 level questionnaire and EQ Visual Analogue Score (one trial, 499 patients) (mean score: 70.1 ± 22 in the lower oxygenation group vs. 67.6 ± 22.4 in the higher oxygenation group). The trial was judged as having high risk of bias, the certainty of evidence was very low. No trial reported neither the standardised 6-min walk test nor lung diffusion test.
CONCLUSION
The evidence is very uncertain about the effect of a lower versus a higher oxygenation strategy on both the cognitive function and HRQoL. A lower versus a higher oxygenation strategy may have a little to no effect on both outcomes but the certainty of evidence is very low. No evidence was found for the effects on the standardised 6-min walking test and diffusion capacity test.
Topics: Adult; Humans; Intensive Care Units; Lung; Oxygen Inhalation Therapy; Quality of Life; Survivors
PubMed: 35749059
DOI: 10.1111/aas.14107 -
Respiratory Care Mar 2020The aim of this prospective randomized crossover study was to compare the short-term effects of high-flow nasal cannula (HFNC) therapy and a 45° head-up tilt to the...
BACKGROUND
The aim of this prospective randomized crossover study was to compare the short-term effects of high-flow nasal cannula (HFNC) therapy and a 45° head-up tilt to the short-term effects of conventional oxygen (O) therapy in post-abdominal surgery patients.
METHODS
A total of 18 subjects who were successfully weaned from ventilator support after abdominal surgery were included in the study. The subjects were randomly assigned to 2 groups: conventional O was applied in group A for 15 min, and HFNC (60 L/min) was applied in group B for 15 min. A 15-min washout period with conventional O was performed before the interventions were switched in both groups. Heart rate, blood pressure, breathing frequency, ratio of arterial partial pressure of oxygen to the fraction of inspired oxygen (P /F ), and subject-reported comfort scores were recorded. Changes in end-expiratory lung impedance (EELI) were calculated with electrical impedance tomography.
RESULTS
Results are presented as the percent change in lung volume compared to baseline during volume-controlled continuous mandatory ventilation before extubation. HFNC improved EELI in both the ventral (conventional O vs HFNC, -48.2% ± 41.0 vs -30.0% ± 40.3, < .001) and the dorsal (conventional O vs HFNC, -37.0% ± 75.9 vs -26.5% ± 68.4, = .02) regions of the lungs. Subjective subject-reported scores indicated that HFNC was more comfortable than conventional O (conventional O vs HFNC, 5.8 ± 1.5 vs 6.9 ± 1.9, = .02). No differences were found in the other examined parameters. A head-up tilt position with conventional O improved EELI in the dorsal regions (55.9% ± 100.1, < .001) but not in the ventral regions (-37.9% ± 43.1%, = .38) of the lungs compared to HFNC or conventional O alone.
CONCLUSIONS
In post-abdominal surgery subjects who had been extubated, HFNC improved lung volume and patient comfort. A head-up tilt position introduced a heterogeneous increase in EELI in the dorsal regions of the lungs. HFNC therapy may be beneficial in this patient group. (ChiCTR1900020886, http://chictr.org.cn).
Topics: Aged; Airway Extubation; Cannula; Cross-Over Studies; Electric Impedance; Female; Humans; Lung; Lung Volume Measurements; Male; Middle Aged; Oxygen; Oxygen Inhalation Therapy; Patient Positioning; Prospective Studies; Random Allocation; Respiratory Rate; Tomography
PubMed: 31772064
DOI: 10.4187/respcare.07109 -
Medical Gas Research 2023
Topics: Oxygen Inhalation Therapy; Oxygen; Societies, Medical; Hyperbaric Oxygenation
PubMed: 37077122
DOI: 10.4103/2045-9912.372064 -
Anatolian Journal of Cardiology Oct 2020The aim compares the blood gases, vital signs, mechanical ventilation requirement, and length of hospitalization in patients with hypertensive pulmonary edema treated... (Comparative Study)
Comparative Study
OBJECTIVE
The aim compares the blood gases, vital signs, mechanical ventilation requirement, and length of hospitalization in patients with hypertensive pulmonary edema treated with standard oxygen therapy (SOT) and high-flow oxygen therapy (HFOT).
METHODS
This prospective observational study was conducted in patients with tachypneic, hypoxemic, hypertensive pulmonary edema. The patients' 0th, 1st, and 2nd hour blood gas results; 0th, 1st, and 2nd hour vital signs; requirement of endotracheal intubation, length of hospitalization, and the prognosis were recorded on the study form.
RESULTS
A total of 112 patients were included in this study, of whom 50 underwent SOT and 62 received HFOT. The initial blood gas analysis revealed significantly lower levels of pH, PaO2, and SpO2 and significantly higher levels of PaCO2 in the HFOT group. Patients in the HFOT group had significantly higher respiratory rate and pulse rate and significantly lower SpO2 values. The recovery of vital signs was significantly better in the HFOT group (p<0.05). Similarly, follow-up results of arterial blood gas analysis were better in the HFOT group (p<0.05). Both length of stay in the emergency department (p<0.05) and length of intensive care unit hospitalization s significantly shorter in the HFOT group (p<0.05).
CONCLUSION
HFOT can be much more effective in patients with hypertensive pulmonary edema than SOT as it shortens the length of stay both in the emergency service and in the intensive care unit. HFOT also provides better results in terms of blood gas analysis, heart rate, and respiratory rate in the follow-up period.
Topics: Aged; Aged, 80 and over; Blood Gas Analysis; Female; Humans; Hypertension; Male; Middle Aged; Oxygen Inhalation Therapy; Prospective Studies; Pulmonary Edema
PubMed: 33001049
DOI: 10.14744/AnatolJCardiol.2020.50680