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Original Articles
Pulmonary
Effects of high-flow nasal cannula in patients with mild to moderate hypercapnia: a prospective observational study
Kyung Hun Nam, Hyung Koo Kang, Sung-Soon Lee, So-Hee Park, Sung Wook Kang, Jea Jun Hwang, So Young Park, Won Young Kim, Hee Jung Suh, Eun Young Kim, Ga Jin Seo, Younsuck Koh, Sang-Bum Hong, Jin Won Huh, Chae-Man Lim
Acute Crit Care. 2021;36(3):249-255.   Published online July 26, 2021
DOI: https://doi.org/10.4266/acc.2020.01102
  • 6,202 View
  • 249 Download
  • 3 Web of Science
  • 4 Crossref
AbstractAbstract PDF
Background
Evidence for using high-flow nasal cannula (HFNC) in hypercapnia is still limited. Most of the clinical studies had been conducted retrospectively, and there had been conflicting reports for the effects of HFNC on hypercapnia correction in prospective studies. Therefore, more evidence is needed to understand the effect of the HFNC in hypercapnia.
Methods
We conducted a multicenter prospective observational study after applying HFNC to 45 hospitalized subjects who had moderate hypercapnia (arterial partial pressure of carbon dioxide [PaCO2], 43–70 mm Hg) without severe respiratory acidosis (pH <7.30). The primary outcome was a change in PaCO2 level in the first 24 hours of HFNC use. The secondary outcomes were changes in other parameters of arterial blood gas analysis, changes in respiration rates, and clinical outcomes.
Results
There was a significant decrease in PaCO2 in the first hour of HFNC application (-3.80 mm Hg; 95% confidence interval, -6.35 to -1.24; P<0.001). Reduction of PaCO2 was more prominent in subjects who did not have underlying obstructive lung disease. There was a correction in pH, but no significant changes in respiratory rate, bicarbonate, and arterial partial pressure of oxygen/fraction of inspired oxygen ratio. Mechanical ventilation was not required for 93.3% (42/45) of our study population.
Conclusions
We suggest that HFNC could be a safe alternative for oxygen delivery in hypercapnia patients who do not need immediate mechanical ventilation. With HFNC oxygenation, correction of hypercapnia could be expected, especially in patients who do not have obstructive lung diseases.

Citations

Citations to this article as recorded by  
  • Safety and efficacy of high flow nasal canula in patients with mild hypercapnia
    Mohammed A. Ibrahim, Magdy Emara, Mohammed Shehta
    The Egyptian Journal of Bronchology.2023;[Epub]     CrossRef
  • Current status of treatment of acute respiratory failure in Korea
    Yong Jun Choi, Jae Hwa Cho
    Journal of the Korean Medical Association.2022; 65(3): 124.     CrossRef
  • High-flow nasal cannula: Evaluation of the perceptions of various performance aspects among Chinese clinical staff and establishment of a multidimensional clinical evaluation system
    Ruoxuan Wen, Xingshuo Hu, Tengchen Wei, Kaifei Wang, Zhimei Duan, Zhanqi Zhao, Lixin Xie, Fei Xie
    Frontiers in Medicine.2022;[Epub]     CrossRef
  • The Application Progress of HFNC in Respiratory Diseases
    迪 吴
    Advances in Clinical Medicine.2022; 12(11): 10617.     CrossRef
Pulmonary
Reduction of PaCO2 by high-flow nasal cannula in acute hypercapnic respiratory failure patients receiving conventional oxygen therapy
Hyun Woo Lee, Sun Mi Choi, Jinwoo Lee, Young Sik Park, Chang-Hoon Lee, Chul-Gyu Yoo, Young Whan Kim, Sung Koo Han, Sang-Min Lee
Acute Crit Care. 2019;34(3):202-211.   Published online August 31, 2019
DOI: https://doi.org/10.4266/acc.2019.00563
  • 9,385 View
  • 204 Download
  • 13 Web of Science
  • 13 Crossref
AbstractAbstract PDF
Background
It has been suggested that a high-flow nasal cannula (HFNC) could help to remove carbon dioxide (CO2) from anatomical dead spaces, but evidence to support that is lacking. The objective of this study was to elucidate whether use of an HFNC could reduce the arterial partial pressure of CO2 (PaCO2) in patients with acute hypercapnic respiratory failure who are receiving conventional oxygen (O2) therapy.
Methods
A propensity score-matched observational study was conducted to evaluate patients treated with an HFNC for acute hypercapnic respiratory failure from 2015 to 2016. The hypercapnia group was defined as patients with a PaCO2 >50 mm Hg and arterial pH <7.35.
Results
Eighteen patients in the hypercapnia group and 177 patients in the nonhypercapnia group were eligible for the present study. Eighteen patients in each group were matched by propensity score. Decreased PaCO2 and consequent pH normalization over time occurred in the hypercapnia group (P=0.002 and P=0.005, respectively). The initial PaCO2 level correlated linearly with PaCO2 removal after the use of an HFNC (R2=0.378, P=0.010). The fraction of inspired O2 used in the intensive care unit was consistently higher for 48 hours in the nonhypercapnia group. Physiological parameters such as respiratory rate and arterial partial pressure of O2 improved over time in both groups.
Conclusions
Physiological parameters can improve after the use of an HFNC in patients with acute hypercapnic respiratory failure given low-flow O2 therapy via a facial mask. Further studies are needed to identify which hypercapnic patients might benefit from an HFNC.

Citations

Citations to this article as recorded by  
  • Comparison of preoxygenation with a high-flow nasal cannula and a simple face mask before intubation in patients with head and neck cancer
    Jun-Young Jo, Jungpil Yoon, Heeyoon Jang, Wook-Jong Kim, Seungwoo Ku, Seong-Soo Choi
    Acute and Critical Care.2024; 39(1): 61.     CrossRef
  • Efficacy and safety of high-flow nasal cannula therapy in elderly patients with acute respiratory failure
    J.M. Carratalá, S. Diaz-Lobato, B. Brouzet, P. Más-Serrano, J.L.S. Rocamora, A.G. Castro, A.G. Varela, S.M. Alises
    Pulmonology.2023;[Epub]     CrossRef
  • Successful noninvasive ventilation in a severely acidotic and hypercapnic comatose COVID-19 patient with multiple comorbidities: a case report
    Joseph Abraham Poonuraparampil, Habib Md Reazaul Karim, Manu P Kesavankutty, Porika Prashanth Nayak
    Acute and Critical Care.2022; 37(1): 120.     CrossRef
  • Comparison of Conventional Oxygen Therapy With High-Flow Nasal Oxygenation in the Management of Hypercapnic Respiratory Failure
    Jitendra Pratap Singh, Deepak Malviya, Samiksha Parashar, Soumya Sankar Nath, Archana Gautam, Neha Shrivastava
    Cureus.2022;[Epub]     CrossRef
  • Current Considerations in Emergency Airway Management
    Andrew Pirotte, Vivek Panchananam, Matthew Finley, Austin Petz, Tom Herrmann
    Current Emergency and Hospital Medicine Reports.2022; 10(4): 73.     CrossRef
  • S/F and ROX indices in predicting failure of high‐flow nasal cannula in children
    Ji Hye Kim, Dong In Suh, June Dong Park
    Pediatrics International.2022;[Epub]     CrossRef
  • Nasal High‐flow Oxygen Versus Conventional Oxygen Therapy for Acute Severe Asthma Patients: A Pilot Randomized Controlled Trial
    Onlak Ruangsomboon, Chok Limsuwat, Nattakarn Praphruetkit, Apichaya Monsomboon, Tipa Chakorn, Brian C. Hiestand
    Academic Emergency Medicine.2021; 28(5): 530.     CrossRef
  • Flow Field Analysis of Adult High-Flow Nasal Cannula Oxygen Therapy
    Jingen Xia, Jiaqi Chang, Jixiang Liang, Yixuan Wang, Na Wang, Bo Xiao
    Complexity.2021; 2021: 1.     CrossRef
  • Treatment of Severe Acute on Chronic Liver Failure
    Aarshi Vipani, Christina C. Lindenmeyer, Vinay Sundaram
    Journal of Clinical Gastroenterology.2021; 55(8): 667.     CrossRef
  • Efficacy of High-Flow Nasal Cannula Oxygen Therapy in Patients with Mild Hypercapnia
    Lingling Su, Qinyu Zhao, Taotao Liu, Yujun Xu, Weichun Li, Aiping Zhang
    Lung.2021; 199(5): 447.     CrossRef
  • High-Flow Nasal Cannula Oxygen Therapy Can Be Effective for Patients in Acute Hypoxemic Respiratory Failure with Hypercapnia: a Retrospective, Propensity Score-Matched Cohort Study
    SooHyun Bae, Minkyu Han, Changyoung Kim, Hyeji Lee, Jong-Joon Ahn, Jin Hyoung Kim, Byung Ju Kang
    Journal of Korean Medical Science.2020;[Epub]     CrossRef
  • High-flow nasal cannula oxygen therapy as an emerging option for respiratory failure: the present and the future
    Lucia Spicuzza, Matteo Schisano
    Therapeutic Advances in Chronic Disease.2020; 11: 204062232092010.     CrossRef
  • Impact of High-Flow Nasal Cannula on Arterial Blood Gas Parameters in the Emergency Department
    Emre Şancı, Feride Ercan Coşkun, Basak Bayram
    Cureus.2020;[Epub]     CrossRef
Case Reports
Cardiology/Pulmonary
Successful Rescue Therapy with Pumpless Extracorporeal Carbon Dioxide Removal in a Patient with Persistent Air Leakage due to Empyema
Jaeyoung Cho, Yeon Joo Lee, Jae-Ho Lee, Choon-Taek Lee, Young-Jae Cho
Korean J Crit Care Med. 2017;32(3):284-290.   Published online November 14, 2016
DOI: https://doi.org/10.4266/kjccm.2016.00185
  • 8,520 View
  • 130 Download
AbstractAbstract PDF
A young metastatic lung cancer patient developed empyema due to an infection with carbapenem-resistant Acinetobacter baumannii. Hydropneumothorax was detected and managed by a tube thoracotomy. However, persistent air leakage through the chest tube was observed due to the presence of a bronchopleural fistula (BPF). As hypercapnic respiratory failure had progressed and the large air leak did not diminish by conservative management, a pumpless extracorporeal lung assist (pECLA) device was inserted. The pECLA allowed the patient to be weaned from mechanical ventilation and the BPF to heal. The present case shows the effective application of pECLA in a patient with empyema complicated with BPF and severe hypercapnic respiratory failure. pECLA enabled us to minimize airway pressure to aid in the closure of the BPF in the mechanically ventilated patient.
A Case of Pumpless Extracorporeal Interventional Lung Assist for Severe Respiratory Failure: A Case Report
Young Jae Cho, Ji Yeon Seo, Yu Jung Kim, Jae Ho Lee, Choon Taek Lee
Korean J Crit Care Med. 2012;27(2):120-125.
DOI: https://doi.org/10.4266/kjccm.2012.27.2.120
  • 2,249 View
  • 19 Download
AbstractAbstract PDF
Pumpless extracorporeal interventional lung assist (iLA) is a promising respiratory rescue system permitting protective lung ventilation for severe respiratory failure. Herein, we report a case of prolonged iLA support with regards to a patient exhibiting severe hypercapnic respiratory failure. A 51-year-old female patient with metastatic endometrial carcinoma developed progressive hospital-acquired pneumonia and was intubated in order to restore respiratory failure. Despite maximal mechanical ventilator care, her clinical condition deteriorated due to severe respiratory acidosis. The iLA was performed for the management of refractory hypercapnia. The total duration of iLA support was 23 days without any vascular complications, however, she could not survive because of oxygenation failure.
A Case of iLA Application in a Patient with Refractory Asthma Who Is Nonresponsive to Conventional Mechanical Ventilation: A Case Report
Young Seok Lee, Hyejin Joo, Jae Young Moon, Jin Won Huh, Yeon Mok Oh, Chae Man Lim, Younsuck Koh, Sang Bum Hong
Korean J Crit Care Med. 2012;27(2):108-110.
DOI: https://doi.org/10.4266/kjccm.2012.27.2.108
  • 2,656 View
  • 52 Download
  • 2 Crossref
AbstractAbstract PDF
Refractory asthma with hypercapnia is a near-fatal disease. Pumpless Extracorporeal Interventional Lung Assist (iLA) may be considered as an alternative therapy for the disease as it removes the carbon dioxide effectively. Nevertheless, clinical outcome studies regarding iLA in patients suffering from refractory asthma have rarely been applied. Here, we reported our experience with iLA for the treatment of refractory asthma with hypercapnia. In our case, the patient had refractory asthma which was not controlled with medical treatment or mechanical ventilation. We applied iLA since hypercapnia was not resolved despite mechanical ventilation. After iLA implantation effectively reduced the carbon dioxide, the clinical condition of our patient improved. In conclusion, iLA is a useful tool for patient suffering from refractory asthma with hypercapnia.

Citations

Citations to this article as recorded by  
  • Interventional lung assist and extracorporeal membrane oxygenation in a patient with near-fatal asthma
    Seok Jeong Lee, Yong Sung Cha, Chun Sung Byun, Sang-Ha Kim, Myoung Kyu Lee, Suk Joong Yong, Won-Yeon Lee
    The American Journal of Emergency Medicine.2017; 35(2): 374.e3.     CrossRef
  • Pumpless extracorporeal interventional lung assist for bronchiolitis obliterans after allogenic peripheral blood stem cell transplantation for acute lymphocytic leukemia
    Yeon-Hee Park, Chae-Uk Chung, Jae-Woo Choi, Sang-Ok Jung, Sung-Soo Jung, Jeong-Eun Lee, Ju-Ock Kim, Jae-Young Moon
    Yeungnam University Journal of Medicine.2015; 32(2): 98.     CrossRef
A Case of Severe Acute Exacerbation of Bronchial Asthma Treated with Low Minute Ventilation: A Case Report
Young Joo Han, Dong In Suh, Young Seung Lee, June Dong Park
Korean J Crit Care Med. 2010;25(4):257-262.
DOI: https://doi.org/10.4266/kjccm.2010.25.4.257
  • 3,814 View
  • 168 Download
AbstractAbstract PDF
We report a case of severe status asthmaticus in a 3-year-old boy who required mechanical ventilatory support. He initially presented with rapidly progressing respiratory distress and spontaneous air leaks. Although he was intubated and received mechanical ventilation, dynamic hyperinflation and air leaks were aggravated. We applied the volume control mode, providing sufficient tidal volume (10 ml/kg), a reduced respiratory rate (25/minute), and a prolonged expiratory time (1.8 seconds) to overcome dynamic hyperinflation. After allowing full expiration of trapped air, his over-expanded lung volumes were decreased and the air leaks resolved. He made a complete recovery without sequelae. Dynamic hyperinflation in asthmatic patients occurs from incomplete exhalation throughout narrowed airways. Controlled hypoventilation or permissive hypercapnia is an important lung-protective ventilator strategy and is beneficial in reducing dynamic hyperinflation. We suggest a controlled hypoventilation strategy with a prolonged expiratory time for patients in severe status asthmaticus with dynamic hyperinflation.
Clinical Trial of Tracheal Gas Insufflation to Control Hypercapnia Occured during Laparoscopic Surgery: A Case Report
Seong Sik Kang
Korean J Crit Care Med. 2004;19(1):61-64.
  • 1,508 View
  • 17 Download
AbstractAbstract PDF
Despite numerous benefits of laparoscopic procedures, during carbon dioxide-induced pneumoperitoneum, the serious hypercapnia and respiratory acidosis in hypercapnic patients with decreased pulmonary compliance may be developed. Tracheal gas insufflation (TGI) has been shown to be a useful adjunct to controlled mechanical hypoventilation. However, the utility of TGI in hypercapnic management during laparoscopic surgery was not reported yet. We report a case that TGI superimposed on controlled mechanical ventilation corrected hypercapnia induced by carbon dioxide-induced pneumoperitoneum during laparoscopic salphingo-oophorectomy. There was no specific anesthetic problem during operation, patients was discharged uneventfully.
Original Article
Changes of Heart Rate, Blood Pressure, and Plasma Catecholamine Levels in Rabbits during the Apneic Oxygenation
Seung Eun Oh, Hyun Jeong Kim, Kwang Won Yum
Korean J Crit Care Med. 2001;16(1):30-35.
  • 1,518 View
  • 9 Download
AbstractAbstract PDF
BACKGROUND
Permissive hypercapnia and apneic oxygenation are used to provide oxygen to patient without active ventilation. It is well known that hypercapnia induces the release of endogenous catecholamines. However, it is unclear that how much or what kind of catecholamines are released. The aim of this study was to observe changes of basic hemodynamic parameters and plasma catecholamine concentration during apneic oxygenation.
METHODS
Twenty-one rabbits weighing 2.0~3.0 kg were anesthetized with 100% oxygen and isoflurane. 0.05 mg/kg of atropine was injected and endotracheal intubation was done. 1 mg/kg/hr of vecuronium was infused during the experiment. The anesthesia and apneic oxygenation was maintained with 100% oxygen and 2 vol% isoflurane under 1 cmH2O PEEP using continuous positive airway pressure device. During the apneic oxygenation, blood pressure, heart rate, and plasma catecholamine concentration were measured every 10 min using High Performance Liquid Chromatography.
RESULTS
Systolic blood pressure was significantly increased but diastolic blood pressure was not changed until post-apneic 40 min. After then, both systolic and diastolic blood pressure were significantly decreased. At post-apneic 10 min, heart rate was dramatically decreased and slowly recovered to the level of control data until post-apneic 60 min. Plasma epinephrine level was increased higher than that of norepinephrine by 3 to 4 times.
CONCLUSIONS
Epinephrine may play more important role than norepinephrine to compensate the cardiovascular depressive effects of hypercapnia during the apneic oxygenation in rabbits.

ACC : Acute and Critical Care