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Critical Care Medicine Jan 2024High-flow nasal oxygen (HFNO) therapy is frequently applied outside ICU setting in hypoxemic patients with COVID-19. However, safety concerns limit more widespread use.... (Observational Study)
Observational Study
OBJECTIVE
High-flow nasal oxygen (HFNO) therapy is frequently applied outside ICU setting in hypoxemic patients with COVID-19. However, safety concerns limit more widespread use. We aimed to assess the safety and clinical outcomes of initiation of HFNO therapy in COVID-19 on non-ICU wards.
DESIGN
Prospective observational multicenter pragmatic study.
SETTING
Respiratory wards and ICUs of 10 hospitals in The Netherlands.
PATIENTS
Adult patients treated with HFNO for COVID-19-associated hypoxemia between December 2020 and July 2021 were included. Patients with treatment limitations were excluded from this analysis.
INTERVENTIONS
None.
MEASUREMENTS AND MAIN RESULTS
Outcomes included intubation and mortality rate, duration of hospital and ICU stay, severity of respiratory failure, and complications. Using propensity-matched analysis, we compared patients who initiated HFNO on the wards versus those in ICU. Six hundred eight patients were included, of whom 379 started HFNO on the ward and 229 in the ICU. The intubation rate in the matched cohort ( n = 214 patients) was 53% and 60% in ward and ICU starters, respectively ( p = 0.41). Mortality rates were comparable between groups (28-d [8% vs 13%], p = 0.28). ICU-free days were significantly higher in ward starters (21 vs 17 d, p < 0.001). No patient died before endotracheal intubation, and the severity of respiratory failure surrounding invasive ventilation and clinical outcomes did not differ between intubated ward and ICU starters (respiratory rate-oxygenation index 3.20 vs 3.38; Pa o2 :F io2 ratio 65 vs 64 mm Hg; prone positioning after intubation 81 vs 78%; mortality rate 17 vs 25% and ventilator-free days at 28 d 15 vs 13 d, all p values > 0.05).
CONCLUSIONS
In this large cohort of hypoxemic patients with COVID-19, initiation of HFNO outside the ICU was safe, and clinical outcomes were similar to initiation in the ICU. Furthermore, the initiation of HFNO on wards saved time in ICU without excess mortality or complicated course. Our results indicate that HFNO initiation outside ICU should be further explored in other hypoxemic diseases and clinical settings aiming to preserve ICU capacity and healthcare costs.
Topics: Adult; Humans; Oxygen; COVID-19; Oxygen Inhalation Therapy; Intubation, Intratracheal; Respiratory Insufficiency; Intensive Care Units
PubMed: 37855812
DOI: 10.1097/CCM.0000000000006068 -
European Review For Medical and... Oct 2020Hypoxia is one of the primary causes that leads to multiple organ injuries and death in COVID-19 patients. Aggressive oxygen therapy for the treatment of hypoxia is...
Hypoxia is one of the primary causes that leads to multiple organ injuries and death in COVID-19 patients. Aggressive oxygen therapy for the treatment of hypoxia is important in saving these patients. We have summarized the mechanisms, efficacy, and side effects of various oxygen therapy techniques and their status or the potential to treat hypoxia in COVID-19 patients. The benefit to risk ratio of each oxygen therapy technique and strategy to use them in COVID-19 patients are discussed. High flow nasal cannula oxygen (HFNO) should be considered a better choice as an early stage oxygen therapy. Supraglottic jet oxygenation and ventilation (SJOV) is a promising alternative for HFNO with potential benefits.
Topics: COVID-19; Humans; Hypoxia; Oxygen Inhalation Therapy; Pandemics; SARS-CoV-2
PubMed: 33090435
DOI: 10.26355/eurrev_202010_23248 -
Acta Medica Portuguesa Jun 2022Oxygen therapy remains the cornerstone for managing patients with severe SARS-CoV-2 infection and several modalities of non-invasive ventilation are used worldwide.... (Review)
Review
INTRODUCTION
Oxygen therapy remains the cornerstone for managing patients with severe SARS-CoV-2 infection and several modalities of non-invasive ventilation are used worldwide. High-flow oxygen via nasal canula is one therapeutic option which may in certain cases prevent the need of mechanical ventilation. The aim of this review is to summarize the current evidence on the use of high-flow nasal oxygen in patients with severe SARS-CoV-2 infection.
MATERIAL AND METHODS
We conducted a systematic literature search of the databases PubMed and Cochrane Library until April 2021 using the following search terms: "high flow oxygen and COVID-19" and "high flow nasal and COVID-19".
RESULTS
Twenty-three articles were included in this review, in four of which prone positioning was used as an adjunctive measure. Most of the articles were cohort studies or case series. High-flow nasal oxygen therapy was associated with a reduced need for invasive ventilation compared to conventional oxygen therapy and led to an improvement in secondary clinical outcomes such as length of stay. The efficacy of high-flow nasal oxygen therapy was comparable to that of other non-invasive ventilation options, but its tolerability is likely higher. Failure of this modality was associated with increased mortality.
CONCLUSION
High flow nasal oxygen is an established option for respiratory support in COVID-19 patients. Further investigation is required to quantify its efficacy and utility in preventing the requirement of invasive ventilation.
Topics: Humans; COVID-19; Oxygen; SARS-CoV-2; Respiratory Insufficiency; Noninvasive Ventilation; Oxygen Inhalation Therapy
PubMed: 35029527
DOI: 10.20344/amp.16686 -
Respiratory Care Nov 2020High-flow nasal cannula (HFNC) oxygen therapy is widely used in extubated patients. We aim to evaluate the effect of HFNC compared with conventional oxygen therapy in... (Review)
Review
BACKGROUND
High-flow nasal cannula (HFNC) oxygen therapy is widely used in extubated patients. We aim to evaluate the effect of HFNC compared with conventional oxygen therapy in adults after cardiothoracic surgery.
METHODS
We conducted a literature search in PubMed, Embase, and ClinicalTrials for randomized controlled trials that compared HFNC with conventional oxygen therapy in extubated patients after cardiothoracic surgery.
RESULTS
Eight studies with 1,086 subjects were included. Compared with conventional oxygen therapy, HFNC was associated with a significant reduction in the need for escalation of respiratory support (risk ratio 0.40, 95% CI 0.26-0.61, < .001), re-intubation rate (risk ratio 0.35, 95% CI 0.13-0.96, = .04), and length of hospital stay (mean difference -0.48, 95% CI -0.95 to -0.01, = .05). No significant differences were found for the length of ICU stay (mean difference -0.09, 95% CI -0.21 to -0.04, = .18), pulmonary complications (risk ratio 0.85, 95% CI 0.48-1.48, = .56), or mortality rate (risk ratio 0.54, 95% CI 0.12-2.53, = .44).
CONCLUSIONS
HFNC may significantly reduce the need for the escalation of respiratory support and re-intubation rate, and might reduce the hospital stay. More high-quality randomized controlled trials are needed to further validate our results.
Topics: Airway Extubation; Cannula; Humans; Noninvasive Ventilation; Oxygen; Oxygen Inhalation Therapy; Respiratory Insufficiency
PubMed: 32518086
DOI: 10.4187/respcare.07595 -
PloS One 2022Oxygen (O2) is a mainstay of treatment in acute severe asthma but how it is administered varies widely. The objectives were to examine whether a trial comparing... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Oxygen (O2) is a mainstay of treatment in acute severe asthma but how it is administered varies widely. The objectives were to examine whether a trial comparing humidified O2 to standard O2 in children is feasible, and specifically to obtain data on recruitment, tolerability and outcome measure stability.
METHODS
Heated humidified, cold humidified and standard O2 treatments were compared for children (2-16 years) with acute severe asthma in a multi-centre, open, parallel, pilot randomised controlled trial (RCT). Multiple outcomes were assessed.
RESULTS
Of 258 children screened, 66 were randomised (heated humidified O2 n = 25; cold humidified O2 n = 21; standard O2 n = 20). Median (IQR) length of stay (hours) in hospital was 37.9 (29.1), 52 (35.4) and 49.1 (29.7) for standard, heated humidified and cold humidified respectively and time (hours) on O2 was 15.9 (9.4), 13.6 (14.9) and 13.1 (14.9) for the three groups respectively. The mean (standard deviation) time (hours) taken to step down nebulised to inhaled treatment was 5.6 (14.3), 35.1 (28.2) and 32.7 (20.1). Asthma Severity Score decreased in all three groups similarly, although missing data prevented complete analysis. Humidified O2 was least well tolerated with eight participants discontinuing their randomised treatment early. An important barrier to recruitment was research nurse availability.
CONCLUSION
Although, the results of this pilot study should not be extrapolated beyond the study sample and inferential conclusions should not be drawn from the results, this is the first RCT to compare humidified and standard O2 therapy in acute severe asthmatics of any age. These findings and accompanying screening data show that a large RCT of O2 therapy is feasible. However, challenges associated with randomisation and data collection should be addressed in any future trial design.
Topics: Adolescent; Asthma; Bronchodilator Agents; Child; Child, Preschool; Female; Humans; Male; Nebulizers and Vaporizers; Oxygen; Oxygen Inhalation Therapy; Pilot Projects; Respiratory Therapy
PubMed: 35113903
DOI: 10.1371/journal.pone.0263044 -
Respiratory Care Nov 2019De novo hypoxemic respiratory failure is defined as significant hypoxemia in the absence of chronic lung disease such as COPD, and excluding respiratory failure... (Review)
Review
BACKGROUND
De novo hypoxemic respiratory failure is defined as significant hypoxemia in the absence of chronic lung disease such as COPD, and excluding respiratory failure occurring in the immediate postoperative or postextubation period. We aimed to evaluate the efficacy of various oxygenation strategies including noninvasive ventilation (NIV), high-flow nasal cannula (HFNC), and conventional oxygen therapy in patients with de novo hypoxemic respiratory failure.
METHODS
We performed electronic database searches of PubMed, Cochrane Library, and Embase from inception to December 2018 to include randomized controlled trials that compared various oxygenation strategies in cases of de novo hypoxemic respiratory failure occurring in adult subjects without a preexisting chronic lung disease and excluding respiratory failure in the immediate postoperative or postextubation periods. We performed a Bayesian network meta-analysis to calculate odds ratio (OR) and Bayesian 95% credible intervals (CrI).
RESULTS
16 studies were included, involving 2,180 subjects with a mean age of 61 ± 17 y (66% were male; 46% of the included subjects were treated with conventional oxygen, 27.8% were treated with NIV, and 25.8% were treated with HFNC). Compared to conventional oxygen, NIV was associated with reduced intubation rates (OR 0.42, 95% CrI 0.26-0.62) but no significant reduction in short-term (OR 0.73, 95% CrI 0.47-1.02) or long-term mortality (OR 0.60, 95% CrI 0.29-1.06). There was no significant difference between NIV and HFNC or between HFNC and conventional oxygen regarding all outcomes. In a sensitivity analysis, the results remained consistent after exclusion of studies that included subjects with respiratory failure secondary to cardiogenic pulmonary edema.
CONCLUSION
Among subjects with hypoxemic respiratory failure, NIV was associated with a significant reduction in intubation rates but not short- or long-term mortality when compared to conventional oxygen therapy. There was no significant difference between NIV and HFNC or between HFNC and conventional oxygen regarding all outcomes.
Topics: Humans; Hypoxia; Noninvasive Ventilation; Oxygen Inhalation Therapy; Postoperative Complications; Respiratory Insufficiency; Treatment Outcome
PubMed: 31653763
DOI: 10.4187/respcare.06981 -
Jornal Brasileiro de Pneumologia :... 2022Some chronic respiratory diseases can cause hypoxemia and, in such cases, long-term home oxygen therapy (LTOT) is indicated as a treatment option primarily to improve... (Review)
Review
Some chronic respiratory diseases can cause hypoxemia and, in such cases, long-term home oxygen therapy (LTOT) is indicated as a treatment option primarily to improve patient quality of life and life expectancy. Home oxygen has been used for more than 70 years, and support for LTOT is based on two studies from the 1980s that demonstrated that oxygen use improves survival in patients with COPD. There is evidence that LTOT has other beneficial effects such as improved cognitive function, improved exercise capacity, and reduced hospitalizations. LTOT is indicated in other respiratory diseases that cause hypoxemia, on the basis of the same criteria as those used for COPD. There has been an increase in the use of LTOT, probably because of increased life expectancy and a higher prevalence of chronic respiratory diseases, as well as greater availability of LTOT in the health care system. The first Brazilian Thoracic Association consensus statement on LTOT was published in 2000. Twenty-two years later, we present this updated version. This document is a nonsystematic review of the literature, conducted by pulmonologists who evaluated scientific evidence and international guidelines on LTOT in the various diseases that cause hypoxemia and in specific situations (i.e., exercise, sleep, and air travel). These recommendations, produced with a view to clinical practice, contain several charts with information on indications for LTOT, oxygen sources, accessories, strategies for improved efficiency and effectiveness, and recommendations for the safe use of LTOT, as well as a LTOT prescribing model.
Topics: Humans; Quality of Life; Pulmonary Disease, Chronic Obstructive; Brazil; Oxygen Inhalation Therapy; Hypoxia; Oxygen
PubMed: 36350954
DOI: 10.36416/1806-3756/e20220179 -
Anaesthesia, Critical Care & Pain... Apr 2021
Topics: Humans; Intensive Care Units; Oxygen; Oxygen Inhalation Therapy; Respiratory Distress Syndrome; Respiratory Insufficiency
PubMed: 33798760
DOI: 10.1016/j.accpm.2021.100858 -
JACC. Cardiovascular Interventions Feb 2020The aim of this study was to determine the effect of supplemental oxygen in patients with myocardial infarction (MI) on the composite of all-cause death,... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVES
The aim of this study was to determine the effect of supplemental oxygen in patients with myocardial infarction (MI) on the composite of all-cause death, rehospitalization with MI, or heart failure related to baseline oxygen saturation. A secondary objective was to investigate outcomes in patients developing hypoxemia.
BACKGROUND
In the DETO2X-AMI (Determination of the Role of Oxygen in Suspected Acute Myocardial Infarction) trial, 6,629 normoxemic patients with suspected MI were randomized to oxygen at 6 l/min for 6 to 12 h or ambient air.
METHODS
The study population of 5,010 patients with confirmed MI was divided by baseline oxygen saturation into a low-normal (90% to 94%) and a high-normal (95% to 100%) cohort. Outcomes are reported within 1 year. To increase power, all follow-up time (between 1 and 4 years) was included post hoc, and interaction analyses were performed with oxygen saturation as a continuous covariate.
RESULTS
The composite endpoint of all-cause death, rehospitalization with MI, or heart failure occurred significantly more often in patients in the low-normal cohort (17.3%) compared with those in the high-normal cohort (9.5%) (p < 0.001), and most often in patients developing hypoxemia (23.6%). Oxygen therapy compared with ambient air was not associated with improved outcomes regardless of baseline oxygen saturation (interaction p values: composite endpoint, p = 0.79; all-cause death, p = 0.33; rehospitalization with MI, p = 0.86; hospitalization for heart failure, p = 0.35).
CONCLUSIONS
Irrespective of oxygen saturation at baseline, we found no clinically relevant beneficial effect of routine oxygen therapy in normoxemic patients with MI regarding cardiovascular outcomes. Low-normal baseline oxygen saturation or development of hypoxemia was identified as an independent marker of poor prognosis. (An Efficacy and Outcome Study of Supplemental Oxygen Treatment in Patients With Suspected Myocardial Infarction; NCT01787110).
Topics: Aged; Aged, 80 and over; Biomarkers; Female; Heart Failure; Hospital Mortality; Humans; Hypoxia; Male; Middle Aged; Myocardial Infarction; Oxygen; Oxygen Inhalation Therapy; Patient Readmission; Registries; Risk Factors; Sweden; Time Factors; Treatment Outcome
PubMed: 31838113
DOI: 10.1016/j.jcin.2019.09.016 -
Respiratory Physiology & Neurobiology May 2022Patients admitted to the Intensive Care Unit (ICU) with acute hypoxemic respiratory failure automatically receive oxygen therapy to improve inspiratory oxygen fraction... (Observational Study)
Observational Study
Patients admitted to the Intensive Care Unit (ICU) with acute hypoxemic respiratory failure automatically receive oxygen therapy to improve inspiratory oxygen fraction (FiO). Supplemental oxygen is the most prescribed drug for critically ill patients regardless of altitude of residence. In high altitude dwellers (i.e. in La Paz [≈3,400 m] and El Alto [≈4,150 m] in Bolivia), a peripheral oxygen saturation (SatpO) of 89-95% and an arterial partial pressure of oxygen (PaO) of 50-67 mmHg (lower as altitude rises), are considered normal values for arterial blood. Consequently, it has been suggested that limiting oxygen therapy to maintain SatpO around normoxia may help avoid episodes of hypoxemia, hyperoxemia, intermittent hypoxemia, and ultimately, mortality. In this study, we evaluated the impact of oxygen therapy on the mortality of critically ill COVID-19 patients who permanently live at high altitudes. A multicenter cross-sectional descriptive observational study was performed on 100 patients admitted to the ICU at the "Clinica Los Andes" (in La Paz city) and "Agramont" and "Del Norte" Hospitals (in El Alto city). Our results show that: 1) as expected, fatal cases were detected only in patients who required intubation and connection to invasive mechanical ventilation as a last resort to overcome their life-threatening desaturation; 2) among intubated patients, prolonged periods in normoxia are associated with survival, prolonged periods in hypoxemia are associated with death, and time spent in hyperoxemia shows no association with survival or mortality; 3) the oxygenation limits required to effectively support the intubated patients' survival in the ICU are between 89% and 93%; 4) among intubated patients with similar periods of normoxemic oxygenation, those with better SOFA scores survive; and 5) a lower frequency of observable reoxygenation events is not associated with survival. In conclusion, our findings indicate that high-altitude patients entering an ICU at altitudes of 3,400 - 4,150 m should undergo oxygen therapy to maintain oxygenation levels between 89 and 93 %.
Topics: Adult; Aged; Altitude; Bolivia; COVID-19; Critical Care; Critical Illness; Cross-Sectional Studies; Female; Humans; Male; Middle Aged; Oxygen Inhalation Therapy; Oxygen Saturation
PubMed: 35150939
DOI: 10.1016/j.resp.2022.103868