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Canadian Respiratory Journal 2017
Topics: Extracorporeal Membrane Oxygenation; Humans; Hypoxia; Oxygen Inhalation Therapy; Respiration, Artificial; Respiratory Insufficiency
PubMed: 28588381
DOI: 10.1155/2017/2462818 -
Respiratory Care Jun 2019For hypoxemic respiratory failure, the frontline treatment is supplemental oxygen. Since ARDS was first described, mechanical ventilation via an endotracheal tube... (Review)
Review
For hypoxemic respiratory failure, the frontline treatment is supplemental oxygen. Since ARDS was first described, mechanical ventilation via an endotracheal tube (invasive ventilation) has no doubt saved many patients. During the 1990s, noninvasive ventilation was found to be superior to invasive ventilation for exacerbations of COPD, acute cardiogenic pulmonary edema, and acute respiratory failure in patients who were immunocompromised. In the 2000s, less invasive high-flow nasal cannula (HFNC) therapy gained attention as an alternative means of respiratory support for patients who were critically ill. The HFNC system is simple: it requires only a flow generator, active heated humidifier, single heated circuit, and nasal cannula. While NIV interfaces add to anatomic dead space, HFNC delivery actually decreases dead space. Although the use of HFNC in adults who are critically ill has been dramatically increasing, the advantages and disadvantages of each element have not been well discussed. For now, although functional differences among the different HFNC systems seem to be minor, to avoid adverse clinical events, it is essential to know the advantages and disadvantages of each element.
Topics: Cannula; Equipment Design; Humans; Oxygen Inhalation Therapy; Respiratory Insufficiency
PubMed: 31110041
DOI: 10.4187/respcare.06718 -
Respiratory Care Jun 2018Long-term oxygen therapy (LTOT) at home has been demonstrated to improve survival in patients with COPD and severe resting hypoxemia. Support for LTOT is based on 2... (Review)
Review
Long-term oxygen therapy (LTOT) at home has been demonstrated to improve survival in patients with COPD and severe resting hypoxemia. Support for LTOT is based on 2 landmark trials published nearly 4 decades ago. These results form the basis for reimbursement and prescription of LTOT to this day. Recent work has demonstrated no outcome benefit of LTOT in stable COPD patients with moderate desaturation at rest or during activity. Oxygen therapy during activity and exercise has been shown to alleviate symptoms and maintain arterial oxygen saturation, but not improve long-term outcomes. Oxygen therapy in COPD has a number of physiologic, functional, and biologic effects, not all of which are completely understood. Oxygen therapy in exacerbations of COPD can be both helpful and harmful. New guidance on the use of oxygen therapy during pre-hospital care has been published in the United Kingdom. Technology for LTOT represents a challenge for physicians writing prescriptions, durable medical equipment suppliers, caregivers, and patients. New technology for automated control of LTOT shows promise but is hampered by regulatory processes and cost pressures. Recent changes in government reimbursement for home oxygen therapy also present challenges. This paper will review the current evidence regarding LTOT in COPD and the impact on mortality and functional outcomes as well as reviewing technological challenges.
Topics: Female; Humans; Hypoxia; Male; Oxygen Inhalation Therapy; Pulmonary Disease, Chronic Obstructive; Quality of Life; Treatment Outcome
PubMed: 29794207
DOI: 10.4187/respcare.06312 -
Respiratory Care Apr 2016High-flow nasal cannula (HFNC) oxygen therapy is carried out using an air/oxygen blender, active humidifier, single heated tube, and nasal cannula. Able to deliver... (Review)
Review
High-flow nasal cannula (HFNC) oxygen therapy is carried out using an air/oxygen blender, active humidifier, single heated tube, and nasal cannula. Able to deliver adequately heated and humidified medical gas at flows up to 60 L/min, it is considered to have a number of physiological advantages compared with other standard oxygen therapies, including reduced anatomical dead space, PEEP, constant F(IO2), and good humidification. Although few large randomized clinical trials have been performed, HFNC has been gaining attention as an alternative respiratory support for critically ill patients. Published data are mostly available for neonates. For critically ill adults, however, evidence is uneven because the reports cover various subjects with diverse underlying conditions, such as hypoxemic respiratory failure, exacerbation of COPD, postextubation, preintubation oxygenation, sleep apnea, acute heart failure, and conditions entailing do-not-intubate orders. Even so, across the diversity, many published reports suggest that HFNC decreases breathing frequency and work of breathing and reduces the need for respiratory support escalation. Some important issues remain to be resolved, such as definitive indications for HFNC and criteria for timing the starting and stopping of HFNC and for escalating treatment. Despite these issues, HFNC has emerged as an innovative and effective modality for early treatment of adults with respiratory failure with diverse underlying diseases.
Topics: Adult; Cannula; Critical Illness; Female; Humans; Humidity; Male; Nose; Oxygen; Oxygen Inhalation Therapy; Respiratory Insufficiency; Work of Breathing
PubMed: 27016353
DOI: 10.4187/respcare.04577 -
Monaldi Archives For Chest Disease =... Nov 2022Oxygen is probably the most commonly prescribed drug in the emergency setting and is a life-saving modality as well. However, like any other drug, oxygen therapy may... (Review)
Review
Oxygen is probably the most commonly prescribed drug in the emergency setting and is a life-saving modality as well. However, like any other drug, oxygen therapy may also lead to various adverse effects. Patients with chronic obstructive pulmonary disease (COPD) may develop hypercapnia during supplemental oxygen therapy, particularly if uncontrolled. The risk of hypercapnia is not restricted to COPD only; it has also been reported in patients with morbid obesity, asthma, cystic fibrosis, chest wall skeletal deformities, bronchiectasis, chest wall deformities, or neuromuscular disorders. However, the risk of hypercapnia should not be a deterrent to oxygen therapy in hypoxemic patients with chronic lung diseases, as hypoxemia may lead to life-threatening cardiovascular complications. Various mechanisms leading to the development of oxygen-induced hypercapnia are the abolition of 'hypoxic drive', loss of hypoxic vasoconstriction and absorption atelectasis leading to an increase in dead-space ventilation and Haldane effect. The international guideline recommends a target oxygen saturation of 88% to 92% in patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD) and other chronic lung diseases at risk of hypercapnia. Oxygen should be administered only when oxygen saturation is below 88%. We searched PubMed, EMBASE, and the CINAHL from inception to June 2022. We used the following search terms: "Hypercapnia", "Oxygen therapy in COPD", "Oxygen-associated hypercapnia", "oxygen therapy", and "Hypoxic drive". All types of study are selected. This review will focus on the physiological mechanisms of oxygen-induced hypercapnia and its clinical implications.
Topics: Humans; Oxygen; Hypercapnia; Pulmonary Disease, Chronic Obstructive; Oxygen Inhalation Therapy; Lung Diseases; Hypoxia
PubMed: 36412131
DOI: 10.4081/monaldi.2022.2399 -
Respiratory Care Jun 2017Oxygen is a colorless, odorless, tasteless gas that is utilized by the body for respiration. Oxygen has played a major role in respiratory care. Oxygen therapy is useful... (Review)
Review
Oxygen is a colorless, odorless, tasteless gas that is utilized by the body for respiration. Oxygen has played a major role in respiratory care. Oxygen therapy is useful in treating hypoxemia but is often thought of as a benign therapy. After many years of study, we have learned a great deal of the benefits and potential risk of this powerful drug. Today oxygen gas is cheap, widely available, and easy to administer. Oxygen delivery devices vary in cost from a few cents for a simple nasal cannula to $25-$50 for some humidified systems. Undoubtedly, oxygen therapy is an important tool and has saved many lives and improved others. However, oxygen therapy risk, cost, and benefits should be considered in the same way as other drugs and titrated to a measured end point to avoid excessive or inadequate dosing. Withholding oxygen can have a detrimental effect, yet continuing to provide oxygen therapy when it is no longer indicated can prolong hospitalization and increase the cost of care. This comprehensive review begins with an assessment of need and a review of physiologic effects, potential toxicities, and common delivery devices, and it ends with advances in oxygen therapy with a focus on the pediatric patient.
Topics: Administration, Inhalation; Child; Humans; Hypoxia; Oxygen; Oxygen Inhalation Therapy
PubMed: 28546370
DOI: 10.4187/respcare.05245 -
The New England Journal of Medicine Jun 2015Whether noninvasive ventilation should be administered in patients with acute hypoxemic respiratory failure is debated. Therapy with high-flow oxygen through a nasal... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Whether noninvasive ventilation should be administered in patients with acute hypoxemic respiratory failure is debated. Therapy with high-flow oxygen through a nasal cannula may offer an alternative in patients with hypoxemia.
METHODS
We performed a multicenter, open-label trial in which we randomly assigned patients without hypercapnia who had acute hypoxemic respiratory failure and a ratio of the partial pressure of arterial oxygen to the fraction of inspired oxygen of 300 mm Hg or less to high-flow oxygen therapy, standard oxygen therapy delivered through a face mask, or noninvasive positive-pressure ventilation. The primary outcome was the proportion of patients intubated at day 28; secondary outcomes included all-cause mortality in the intensive care unit and at 90 days and the number of ventilator-free days at day 28.
RESULTS
A total of 310 patients were included in the analyses. The intubation rate (primary outcome) was 38% (40 of 106 patients) in the high-flow-oxygen group, 47% (44 of 94) in the standard group, and 50% (55 of 110) in the noninvasive-ventilation group (P=0.18 for all comparisons). The number of ventilator-free days at day 28 was significantly higher in the high-flow-oxygen group (24±8 days, vs. 22±10 in the standard-oxygen group and 19±12 in the noninvasive-ventilation group; P=0.02 for all comparisons). The hazard ratio for death at 90 days was 2.01 (95% confidence interval [CI], 1.01 to 3.99) with standard oxygen versus high-flow oxygen (P=0.046) and 2.50 (95% CI, 1.31 to 4.78) with noninvasive ventilation versus high-flow oxygen (P=0.006).
CONCLUSIONS
In patients with nonhypercapnic acute hypoxemic respiratory failure, treatment with high-flow oxygen, standard oxygen, or noninvasive ventilation did not result in significantly different intubation rates. There was a significant difference in favor of high-flow oxygen in 90-day mortality. (Funded by the Programme Hospitalier de Recherche Clinique Interrégional 2010 of the French Ministry of Health; FLORALI ClinicalTrials.gov number, NCT01320384.).
Topics: Acute Disease; Adult; Aged; Female; Humans; Hypoxia; Intubation, Intratracheal; Kaplan-Meier Estimate; Male; Middle Aged; Oxygen; Oxygen Inhalation Therapy; Positive-Pressure Respiration; Respiratory Insufficiency
PubMed: 25981908
DOI: 10.1056/NEJMoa1503326 -
Anaesthesiology Intensive Therapy 2019Acute bronchiolitis is a common disease in children below 24 months of age. The most common aetiology of this disease is a respiratory syncytial virus infection. Since... (Review)
Review
Acute bronchiolitis is a common disease in children below 24 months of age. The most common aetiology of this disease is a respiratory syncytial virus infection. Since there is no effective treatment for bronchiolitis, supportive therapy alleviating symptoms and preventing respiratory failure is recommended. Oxygen therapy and appropriate nutrition during the disease are considered effective, particularly in severe cases. The choice of oxygen support is crucial. The present paper discusses oxygen therapy using high-flow nasal cannulas. Moreover, the safety of the method, its adverse side effects and practical pre-treatment guidelines are discussed.
Topics: Acute Disease; Bronchiolitis; Cannula; Humans; Nose; Oxygen Inhalation Therapy
PubMed: 31280552
DOI: 10.5603/AIT.2019.0010 -
Medicina Intensiva Nov 2015Acute respiratory failure represents one of the most common causes of intensive care unit admission and oxygen therapy remains the first-line therapy in the management... (Review)
Review
Acute respiratory failure represents one of the most common causes of intensive care unit admission and oxygen therapy remains the first-line therapy in the management of these patients. In recent years, high-flow oxygen via nasal cannula has been described as a useful alternative to conventional oxygen therapy in patients with acute respiratory failure. High-flow oxygen via nasal cannula rapidly alleviates symptoms of acute respiratory failure and improves oxygenation by several mechanisms, including dead space washout, reduction in oxygen dilution and inspiratory nasopharyngeal resistance, a moderate positive airway pressure effect that may generate alveolar recruitment and an overall greater tolerance and comfort with the interface and the heated and humidified inspired gases. However, the experience in adults is still limited and there are no clinical guidelines to establish recommendations for their use. This article aims to review the existing evidence on the use of high-flow oxygen via nasal cannula in adults with acute respiratory failure and its possible applications, advantages and limitations.
Topics: Acute Disease; Cannula; Heart Failure; Hemodynamics; Humans; Humidity; Hypoxia; Intraoperative Care; Oxygen; Oxygen Inhalation Therapy; Palliative Care; Randomized Controlled Trials as Topic; Respiratory Insufficiency; Rheology; Temperature; Ventilator Weaning; Work of Breathing
PubMed: 26429697
DOI: 10.1016/j.medin.2015.05.009 -
JAMA Dec 2021The effect of high-flow oxygen therapy vs conventional oxygen therapy has not been established in the setting of severe COVID-19. (Randomized Controlled Trial)
Randomized Controlled Trial
Effect of High-Flow Oxygen Therapy vs Conventional Oxygen Therapy on Invasive Mechanical Ventilation and Clinical Recovery in Patients With Severe COVID-19: A Randomized Clinical Trial.
IMPORTANCE
The effect of high-flow oxygen therapy vs conventional oxygen therapy has not been established in the setting of severe COVID-19.
OBJECTIVE
To determine the effect of high-flow oxygen therapy through a nasal cannula compared with conventional oxygen therapy on need for endotracheal intubation and clinical recovery in severe COVID-19.
DESIGN, SETTING, AND PARTICIPANTS
Randomized, open-label clinical trial conducted in emergency and intensive care units in 3 hospitals in Colombia. A total of 220 adults with respiratory distress and a ratio of partial pressure of arterial oxygen to fraction of inspired oxygen of less than 200 due to COVID-19 were randomized from August 2020 to January 2021, with last follow-up on February 10, 2021.
INTERVENTIONS
Patients were randomly assigned to receive high-flow oxygen through a nasal cannula (n = 109) or conventional oxygen therapy (n = 111).
MAIN OUTCOMES AND MEASURES
The co-primary outcomes were need for intubation and time to clinical recovery until day 28 as assessed by a 7-category ordinal scale (range, 1-7, with higher scores indicating a worse condition). Effects of treatments were calculated with a Cox proportional hazards model adjusted for hypoxemia severity, age, and comorbidities.
RESULTS
Among 220 randomized patients, 199 were included in the analysis (median age, 60 years; n = 65 women [32.7%]). Intubation occurred in 34 (34.3%) randomized to high-flow oxygen therapy and in 51 (51.0%) randomized to conventional oxygen therapy (hazard ratio, 0.62; 95% CI, 0.39-0.96; P = .03). The median time to clinical recovery within 28 days was 11 (IQR, 9-14) days in patients randomized to high-flow oxygen therapy vs 14 (IQR, 11-19) days in those randomized to conventional oxygen therapy (hazard ratio, 1.39; 95% CI, 1.00-1.92; P = .047). Suspected bacterial pneumonia occurred in 13 patients (13.1%) randomized to high-flow oxygen and in 17 (17.0%) of those randomized to conventional oxygen therapy, while bacteremia was detected in 7 (7.1%) vs 11 (11.0%), respectively.
CONCLUSIONS AND RELEVANCE
Among patients with severe COVID-19, use of high-flow oxygen through a nasal cannula significantly decreased need for mechanical ventilation support and time to clinical recovery compared with conventional low-flow oxygen therapy.
TRIAL REGISTRATION
ClinicalTrials.gov Identifier: NCT04609462.
Topics: Aged; Aged, 80 and over; COVID-19; Critical Illness; Female; Humans; Intensive Care Units; Intubation, Intratracheal; Male; Middle Aged; Oxygen; Oxygen Inhalation Therapy; Respiration, Artificial; Respiratory Insufficiency; SARS-CoV-2; Time Factors; Treatment Outcome
PubMed: 34874419
DOI: 10.1001/jama.2021.20714