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Pulmonology 2021Thermo-humidified nasal high flow (NHF) oxygen therapy is increasingly used in the management of respiratory failure. This therapy has recently gained attention as an... (Review)
Review
Thermo-humidified nasal high flow (NHF) oxygen therapy is increasingly used in the management of respiratory failure. This therapy has recently gained attention as an alternative non-invasive respiratory support in several clinical scenarios, including acute and chronic settings. NHF enhances the patient's comfort and tolerance when compared with standard oxygen by supplying a heated and humidified mixture of air and oxygen at flows up to 60L/min. It can be delivered through different devices. Although few studies have compared the clinical effects of different NHF systems, the purpose of this paper is to describe the major benefits of NHF and to provide a quick guide on how to implement this therapy in daily practice. We have also included a brief description of the most frequently used NHF systems.
Topics: Acute Disease; Humans; Oxygen Inhalation Therapy; Respiratory Insufficiency
PubMed: 33589403
DOI: 10.1016/j.pulmoe.2021.01.005 -
Medizinische Klinik, Intensivmedizin... Jun 2022Oxygen is essential for energy production and thus for the survival of human cells. If oxygen delivery is disrupted due to illness, injury or changes in environmental... (Review)
Review
Oxygen is essential for energy production and thus for the survival of human cells. If oxygen delivery is disrupted due to illness, injury or changes in environmental factors, the human body is to a certain extent able to activate compensatory mechanisms to ensure adequate delivery of oxygen for the function and integrity of the cells and organ systems. If these compensatory mechanisms are exhausted or overloaded, there is a risk of functional failure of cells and organ systems. In clinical practice, it is often difficult to decide whether the body's own compensation mechanisms are still sufficient or whether more invasive therapy options and their side effects should be used to prevent organ damage. The aim of this review is to reiterate the basic physiological mechanisms of oxygen delivery to cells, to show how insufficient oxygen can be detected, and to highlight the current state of studies and guidelines on target oxygen levels. Although the coronavirus disease 2019 (COVID-19) pandemic has brought recent attention to the pathophysiology and therapeutic strategies of oxygenation disorders, little new knowledge regarding oxygen targets has emerged from this pandemic. Thus, the previously recommended oxygen target values remain unchanged.
Topics: COVID-19; Humans; Hypoxia; Oxygen; Oxygen Inhalation Therapy; Pandemics
PubMed: 35420294
DOI: 10.1007/s00063-022-00914-8 -
Seminars in Fetal & Neonatal Medicine Apr 2020Premature infants undergo a complex postnatal adaptation at birth. For last two centuries, oxygen has been integral to respiratory support of preterm infants at birth.... (Review)
Review
Premature infants undergo a complex postnatal adaptation at birth. For last two centuries, oxygen has been integral to respiratory support of preterm infants at birth. Excess oxygen can cause oxidative stress and tissue injury. Preterm infants due to lung immaturity may need oxygen for successful transition at birth. Although, considerable progress has been made in the last 3 decades, optimum oxygen therapy for preterm delivery room resuscitation remains unknown. In this review, we discuss the history and physiology behind oxygen therapy in the delivery room, evaluate current literature, provide practice points and point out knowledge gaps of oxygen therapy in preterm infant at birth.
Topics: Calibration; Delivery Rooms; Female; Humans; Infant; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Oxygen; Oxygen Inhalation Therapy; Parturition; Pregnancy; Resuscitation
PubMed: 32044281
DOI: 10.1016/j.siny.2020.101081 -
The Journal of International Medical... Jun 2023To evaluate the therapeutic effects of high-flow nasal cannula (HFNC) oxygen therapy in patients with acute exacerbation of chronic obstructive pulmonary disease... (Randomized Controlled Trial)
Randomized Controlled Trial
Effects of high-flow nasal cannula oxygen therapy for patients with acute exacerbation of chronic obstructive pulmonary disease in combination with type II respiratory failure.
OBJECTIVE
To evaluate the therapeutic effects of high-flow nasal cannula (HFNC) oxygen therapy in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and type II respiratory failure.
METHODS
Seventy-two patients with AECOPD and type II respiratory failure were randomly allocated to an HFNC oxygen therapy trial group or a non-invasive positive-pressure ventilator therapy (NIPPV) control group. Their arterial blood gas parameters and comfort, evaluated using a questionnaire, were compared before and after the therapeutic interventions.
RESULTS
The PaCO and blood concentration of both groups were significantly reduced by the treatments, whereas the pH, PaO and PaO/FiO were increased. The PaCO of the experimental group was significantly lower than that of the control group following treatment. The PaO of the experimental group was significantly higher than that of the control group. The tracheal intubation rates of the two groups did not significantly differ. After treatment, all the indices of comfort were rated higher in the HFNC group than in the NIPPV group.
CONCLUSIONS
HFNC has a good therapeutic effect in patients with AECOPD and type II respiratory failure. It improves patient comfort and has clinical value.
Topics: Humans; Cannula; Pulmonary Disease, Chronic Obstructive; Oxygen Inhalation Therapy; Respiratory Insufficiency; Oxygen; Noninvasive Ventilation
PubMed: 37377101
DOI: 10.1177/03000605231182558 -
Seminars in Fetal & Neonatal Medicine Apr 2020Premature neonates <34 weeks gestation can present with early-onset, late-onset and bronchopulmonary dysplasia (BPD) associated pulmonary hypertension (PHT), with... (Review)
Review
Premature neonates <34 weeks gestation can present with early-onset, late-onset and bronchopulmonary dysplasia (BPD) associated pulmonary hypertension (PHT), with clinical, echocardiographic, and histological features similar to term infants with PHT. Changes in pulmonary vascular resistance (PVR) in response to oxygen are diminished in preterm infants compared to term. Studies from preterm lambs and human infants with BPD have shown that PaO > 30-55 mm Hg promotes pulmonary vasodilation. Targeting saturations of 80-85% by 5 min, 85-95% by 10 min during resuscitation and 90-95% during the postnatal course are appropriate targets for routine management of preterm infants. Among preterm infants with PHT, avoiding hypoxia/hyperoxia by titrating supplemental oxygen to maintain saturations in low to mid 90s with alarm limits at 90 and 97% seems to be a reasonable approach pending further studies. Further high-quality evidence generated from randomized trials is required to guide oxygen therapy in preterm PHT.
Topics: Administration, Inhalation; Animals; Gestational Age; Humans; Hypertension, Pulmonary; Infant; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Oxygen; Oxygen Inhalation Therapy; Sheep
PubMed: 31836427
DOI: 10.1016/j.siny.2019.101070 -
Frontiers in Immunology 2022Sepsis-associated encephalopathy (SAE) patients in the intensive care unit (ICU) and perioperative period are administrated supplemental oxygen. However, the correlation...
OBJECTIVES
Sepsis-associated encephalopathy (SAE) patients in the intensive care unit (ICU) and perioperative period are administrated supplemental oxygen. However, the correlation between oxygenation status with SAE and the target for oxygen therapy remains unclear. This study aimed to examine the relationship between oxygen therapy and SAE patients.
METHODS
Patients diagnosed with sepsis 3.0 in the intensive care unit (ICU) were enrolled. The data were collected from the Medical Information Mart for Intensive Care IV (MIMIC IV) database and the eICU Collaborative Research Database (eICU-CRD) database. The generalized additive models were adopted to estimate the oxygen therapy targets in SAE patients. The results were confirmed by multivariate Logistic, propensity score analysis, inversion probability-weighting, doubly robust model, and multivariate COX analyses. Survival was analyzed by the Kaplan-Meier method.
RESULTS
A total of 10055 patients from eICU-CRD and 1685 from MIMIC IV were included. The incidence of SAE patients was 58.43%. The range of PaO (97-339) mmHg, PaO/FiO (189-619), and SO≥93% may reduce the incidence of SAE, which were verified by multivariable Logistic regression, propensity score analysis, inversion probability-weighting, and doubly robust model estimation in MIMIC IV database and eICU database. The range of PaO/FiO (189-619) and SO≥93% may reduce the hospital mortality of SAE were verified by multivariable COX regression.
CONCLUSIONS
SAE patients in ICU, including perioperative period, require conservative oxygen therapy. We should maintain SO≥93%, PaO (97-339) mmHg and PaO/FiO (189-619) in SAE patients.
Topics: Humans; Sepsis-Associated Encephalopathy; Critical Illness; Oxygen; Oxygen Inhalation Therapy; Perioperative Period
PubMed: 36341421
DOI: 10.3389/fimmu.2022.1035298 -
Canadian Journal of Veterinary Research... Oct 2021Dogs with lower airway pathology that present in respiratory distress often receive oxygen therapy as the first line of treatment regardless of the underlying cause.... (Review)
Review
Dogs with lower airway pathology that present in respiratory distress often receive oxygen therapy as the first line of treatment regardless of the underlying cause. Conventional "low-flow" systems deliver oxygen with a maximum flow rate of 15 L/minute. Traditionally, when an animal's respiratory status does not improve with conventional oxygen therapy and treatments for underlying disease, options might be limited to either intubation and mechanical ventilation or humane euthanasia. High-flow oxygen therapy (HFOT) has been gaining popularity in veterinary medicine as an alternative route of oxygen supplementation for animals that require support beyond conventional therapy. High-flow oxygen therapy can supply a mixture of air and oxygen a heated and humidified circuit. It is user friendly and can be used in an environment in which mechanical ventilation is unavailable. This review article is written for emergency doctors and general practitioners who lack access to mechanical ventilation. This article briefly reviews pertinent respiratory physiology, traditional oxygen supplementation techniques, the physiology of HFOT, and the limited evidence available in veterinary medicine regarding the use of HFOT, its applications, and limitations. Guidelines for the use of HFOT are suggested and HFOT is compared to conventional therapy.
Topics: Animals; Dog Diseases; Dogs; Lung Injury; Oxygen; Oxygen Inhalation Therapy
PubMed: 34602728
DOI: No ID Found -
Respiratory Care Mar 2022The delivery of a high and consistent [Formula: see text] is imperative to treat acute hypoxemia. The objective of this study was to analyze the effective inspired...
BACKGROUND
The delivery of a high and consistent [Formula: see text] is imperative to treat acute hypoxemia. The objective of this study was to analyze the effective inspired oxygen concentration delivered by different low-flow oxygen therapy systems challenged with different oxygen flows and respiratory patterns in an experimental lung model.
METHODS
An adult lung model ventilated in volume control mode simulated different respiratory patterns to obtain mean inspiratory flow of 22.5, 30.0, 37.5, or 45.0 L/min. The oxygen concentration sampled inside the lung model by nasal cannula, simple face mask, non-rebreather mask, and double-trunk mask above nasal cannula tested at oxygen flows of 10, 12.5, and 15 L/min was quantified. The 3 masks were sealed tight onto the model's airway opening. They were also tested with standardized leaks to determine their clinical performance.
RESULTS
All oxygen delivery systems delivered higher oxygen concentration with increasing oxygen flows, regardless of the respiratory pattern. Within each device, the increase in inspiratory flow decreased oxygen concentration when using nasal cannula ( = .03), the simple face mask ( = .03), but not the non-rebreather mask ( = .051) nor the double-trunk mask ( = .13). In sealed condition, the double-trunk mask outperformed the non-rebreather mask and simple face mask ( < .001); mean oxygen concentration was 84.2%, 68.5%, and 60.8%, respectively. Leaks amplified oxygen concentration differences between the double-trunk mask and the other masks as the oxygen delivery decreased by 4.6% with simple face mask (95% CI 3.1-6.1%, < .001), 7.8% with non-rebreather mask (95% CI 6.3-9.3%, < .001), and 2.5% with double-trunk mask (95% CI 1-4%, = .002). With leaks, the oxygen concentration provided by the simple face mask and the non-rebreather mask was similar ( = .15).
CONCLUSIONS
Lung oxygen concentration values delivered by the double-trunk mask were higher than those obtained with other oxygen delivery systems, especially when leaks were present.
Topics: Adult; Cannula; Humans; Hypoxia; Oxygen; Oxygen Inhalation Therapy; Respiration, Artificial
PubMed: 34670855
DOI: 10.4187/respcare.09312 -
Respiratory Care Sep 2019Noninvasive respiratory support refers to strategies aimed at providing oxygenation and/or ventilation without the use of an artificial airway. These strategies include... (Review)
Review
Noninvasive respiratory support refers to strategies aimed at providing oxygenation and/or ventilation without the use of an artificial airway. These strategies include the use of standard oxygen delivery devices (face masks, low-flow nasal cannulas), noninvasive ventilation, and high-flow nasal cannula. Considerable interest has been generated recently as to which therapy provides the optimum noninvasive support. This review examined the important literature related to noninvasive respiratory support published in 2018.
Topics: Humans; Noninvasive Ventilation; Oxygen Inhalation Therapy
PubMed: 31467154
DOI: 10.4187/respcare.07170 -
Respiratory Research Sep 2021During flexible fiberoptic bronchoscopy (FOB) the arterial partial pressure of oxygen can drop, increasing the risk for respiratory failure. To avoid desaturation... (Review)
Review
During flexible fiberoptic bronchoscopy (FOB) the arterial partial pressure of oxygen can drop, increasing the risk for respiratory failure. To avoid desaturation episodes during the procedure several oxygenation strategies have been proposed, including conventional oxygen therapy (COT), high flow nasal cannula (HFNC), continuous positive airway pressure (CPAP) and non-invasive ventilation (NIV). By a review of the current literature, we merely describe the clinical practice of oxygen therapies during FOB. We also conducted a pooled data analysis with respect to oxygenation outcomes, comparing HFNC with COT and NIV, separately. COT showed its benefits in patients undergoing FOB for broncho-alveolar lavage (BAL) or brushing for cytology, in those with peripheral arterial oxyhemoglobin saturation < 93% prior to the procedure or affected by obstructive disorder. HFNC is preferable over COT in patients with mild to moderate acute respiratory failure (ARF) undergoing FOB, by improving oxygen saturation and decreasing the episodes of desaturation. On the opposite, CPAP and NIV guarantee improved oxygenation outcomes as compared to HFNC, and they should be preferred in patients with more severe hypoxemic ARF during FOB.
Topics: Bronchoscopy; Humans; Lung Diseases; Noninvasive Ventilation; Observational Studies as Topic; Oxygen Inhalation Therapy; Oxygen Saturation; Pliability; Randomized Controlled Trials as Topic
PubMed: 34563179
DOI: 10.1186/s12931-021-01846-1