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Original Articles
Pulmonary
Comparison of preoxygenation with a high-flow nasal cannula and a simple face mask before intubation in Korean patients with head and neck cancer
Jun-Young Jo, Jungpil Yoon, Heeyoon Jang, Wook-Jong Kim, Seungwoo Ku, Seong-Soo Choi
Acute Crit Care. 2024;39(1):61-69.   Published online January 26, 2024
DOI: https://doi.org/10.4266/acc.2022.01543
  • 1,681 View
  • 141 Download
AbstractAbstract PDFSupplementary Material
Background
Although preoxygenation is an essential procedure for safe endotracheal intubation, in some cases securing sufficient time for tracheal intubation may not be possible. Patients with head and neck cancer might have a difficult airway and need a longer time for endotracheal intubation. We hypothesized that the extended apneic period with preoxygenation via a high-flow nasal cannula (HFNC) is beneficial to patients who undergo head and neck surgery compared with preoxygenation with a simple mask. Methods: The study was conducted as a single-center, single-blinded, prospective, randomized controlled trial. Patients were divided into groups based on one of the two preoxygenation methods: HFNC group or simple facemask (mask group). Preoxygenation was performed for 5 minutes with each method, and endotracheal intubation for all patients was performed using a video laryngoscope. Oxygen partial pressures of the arterial blood were compared at the predefined time points. Results: For the primary outcome, the mean arterial oxygen partial pressure (PaO2 ) immediately after intubation was 454.2 mm Hg (95% confidence interval [CI], 416.9–491.5 mm Hg) in the HFNC group and 370.7 mm Hg (95% CI, 333.7–407.4 mm Hg) in the mask group (P=0.002). The peak PaO2 at 5 minutes after preoxygenation was not statistically different between the groups (P=0.355). Conclusions: Preoxygenation with a HFNC extending to the apneic period before endotracheal intubation may be beneficial in patients with head and neck cancer.
Pulmonary
Combining reservoir mask oxygenation with high-flow nasal cannula in the treatment of hypoxemic respiratory failure among patients with COVID-19 pneumonia: a retrospective cohort study
Ivan Gur, Ronen Zalts, Yaniv Dotan, Khitam Hussain, Ami Neuberger, Eyal Fuchs
Acute Crit Care. 2023;38(4):435-441.   Published online November 23, 2023
DOI: https://doi.org/10.4266/acc.2023.00451
  • 1,706 View
  • 59 Download
  • 1 Web of Science
AbstractAbstract PDFSupplementary Material
Background
Concerns regarding positive-pressure-ventilation for the treatment of coronavirus disease 2019 (COVID-19) hypoxemia led the search for alternative oxygenation techniques. This study aimed to assess one such method, dual oxygenation, i.e., the addition of a reservoir mask (RM) on top of a high-flow nasal cannula (HFNC).
Methods
In this retrospective cohort study, the records of all patients hospitalized with COVID-19 during 2020–2022 were reviewed. Patients over the age of 18 years with hypoxemia necessitating HFNC were included. Exclusion criteria were positive-pressure-ventilation for any indication other than hypoxemic respiratory failure, transfer to another facility while still on HFNC and “do-not-intubate/resuscitate” orders. The primary outcome was mortality within 30 days from the first application of HFNC. Secondary outcomes were intubation and admission to the intensive care unit.
Results
Of 659 patients included in the final analysis, 316 were treated with dual oxygenation and 343 with HFNC alone. Propensity for treatment was estimated based on background diagnoses, laboratories and vital signs upon admission, gender and glucocorticoid dose. Inverse probability of treatment weighted regression including age, body mass index, Sequential Organ Failure Assessment (SOFA) score and respiratory rate oxygenation index showed treatment with dual oxygenation to be associated with lower 30-day mortality (adjusted hazard ratio, 0.615; 95% confidence interval, 0.469–0.809). Differences in the secondary outcomes did not reach statistical significance.
Conclusions
Our study suggests that the addition of RM on top of HFNC may be associated with decreased mortality in patients with severe COVID-19 hypoxemia.
Pulmonary
Comparison of high-flow nasal oxygen therapy and noninvasive ventilation in COVID-19 patients: a systematic review and meta-analysis
Glenardi Glenardi, Febie Chriestya, Bambang J Oetoro, Ghea Mangkuliguna, Natalia Natalia
Acute Crit Care. 2022;37(1):71-83.   Published online February 22, 2022
DOI: https://doi.org/10.4266/acc.2021.01326
  • 8,307 View
  • 464 Download
  • 9 Web of Science
  • 7 Crossref
AbstractAbstract PDFSupplementary Material
Background
Acute respiratory failure (ARF) is a major adverse event commonly encountered in severe coronavirus disease 2019 (COVID-19). Although noninvasive mechanical ventilation (NIV) has long been used in the management of ARF, it has several adverse events which may cause patient discomfort and lead to treatment complication. Recently, high-flow nasal cannula (HFNC) has the potential to be an alternative for NIV in adults with ARF, including COVID-19 patients. The objective was to investigate the efficacy of HFNC compared to NIV in COVID-19 patients. Methods: This meta-analysis was reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria. Literature search was carried out in electronic databases for relevant articles published prior to June 2021. The protocol used in this study has been registered in International Prospective Register of Systematic Reviews (CRD42020225186). Results: Although the success rate of NIV is higher compared to HFNC (odds ratio [OR], 0.39; 95% confidence interval [CI], 0.16–0.97; P=0.04), this study showed that the mortality in the NIV group is also significantly higher compared to HFNC group (OR, 0.49; 95% CI, 0.39–0.63; P<0.001). Moreover, this study also demonstrated that there was no significant difference in intubation rates between the two groups (OR, 1.35; 95% CI, 0.86–2.11; P=0.19). Conclusions: Patients treated with HFNC showed better outcomes compared to NIV for ARF due to COVID-19. Therefore, HFNC should be considered prior to NIV in COVID-19–associated ARF. However, further studies with larger sample sizes are still needed to better elucidate the benefit of HFNC in COVID-19 patients.

Citations

Citations to this article as recorded by  
  • High-flow nasal cannula therapy in patients with COVID-19 in intensive care units in a country with limited resources: a single-center experience
    Anh-Minh Vu Phan, Hai-Yen Thi Hoang, Thanh-Son Truong Do, Trung Quoc Hoang, Thuan Van Phan, Nguyet-Anh Phuong Huynh, Khoi Minh Le
    Journal of International Medical Research.2023;[Epub]     CrossRef
  • Evaluating the use of the respiratory-rate oxygenation index as a predictor of high-flow nasal cannula oxygen failure in COVID-19
    Scott Weerasuriya, Savvas Vlachos, Ahmed Bobo, Namitha Birur Jayaprabhu, Lauren Matthews, Adam R Blackstock, Victoria Metaxa
    Acute and Critical Care.2023; 38(1): 31.     CrossRef
  • Does the variant positivity and negativity affect the clinical course in COVID-19?: A cohort study
    Erkan Yildirim, Levent Kilickan, Suleyman Hilmi Aksoy, Ramazan Gozukucuk, Hasan Huseyin Kilic, Yakup Tomak, Orhan Dalkilic, Ibrahim Halil Tanboga, Fevzi Duhan Berkan Kilickan
    Medicine.2023; 102(9): e33132.     CrossRef
  • The COVID-19 Driving Force: How It Shaped the Evidence of Non-Invasive Respiratory Support
    Yorschua Jalil, Martina Ferioli, Martin Dres
    Journal of Clinical Medicine.2023; 12(10): 3486.     CrossRef
  • Descriptive account of the first use of the LeVe CPAP System, a new frugal CPAP System, in adult patients with COVID-19 Pneumonitis in Uganda
    Anna Littlejohns, Helen Please, Racheal Musasizi, Stuart Murdoch, Gorret Nampiina, Ian Waters, William Davis Birch, Gregory de Boer, Nikil Kapur, Tumwesigye Ambrozi, Ninsiima Carol, Nakigudde Noel, Jiten Parmar, Peter Culmer, Tom Lawton, Edith Namulema
    Tropical Medicine and Health.2023;[Epub]     CrossRef
  • Comparison between high-flow nasal cannula and noninvasive ventilation in COVID-19 patients: a systematic review and meta-analysis
    Yun Peng, Bing Dai, Hong-wen Zhao, Wei Wang, Jian Kang, Hai-jia Hou, Wei Tan
    Therapeutic Advances in Respiratory Disease.2022; 16: 175346662211136.     CrossRef
  • Does High Flow Nasal Cannula avoid intubation and improve the mortality of adult patients in acute respiratory failure in the intensive care setting, when compared to others methods as Conventional Oxygen Therapy or Non-Invasive Ventilation? A narrative r
    P Fosseur, A Renard, P Mateu, J Rosman
    Acta Anaesthesiologica Belgica.2022; 73(Supplement): 97.     CrossRef
Review Article
Pulmonary
High-flow nasal cannula for respiratory failure in adult patients
SeungYong Park
Acute Crit Care. 2021;36(4):275-285.   Published online November 30, 2021
DOI: https://doi.org/10.4266/acc.2021.01571
  • 18,757 View
  • 1,004 Download
  • 9 Web of Science
  • 10 Crossref
AbstractAbstract PDF
The high-flow nasal cannula (HFNC) has been recently used in several clinical settings for oxygenation in adults. In particular, the advantages of HFNC compared with low-flow oxygen systems or non-invasive ventilation include enhanced comfort, increased humidification of secretions to facilitate expectoration, washout of nasopharyngeal dead space to improve the efficiency of ventilation, provision of a small positive end-inspiratory pressure effect, and fixed and rapid delivery of an accurate fraction of inspired oxygen (FiO2) by minimizing the entrainment of room air. HFNC has been successfully used in critically ill patients with several conditions, such as hypoxemic respiratory failure, hypercapneic respiratory failure (exacerbation of chronic obstructive lung disease), post-extubation respiratory failure, pre-intubation oxygenation, and others. However, the indications are not absolute, and much of the proven benefit remains subjective and physiologic. This review discusses the practical application and clinical uses of HFNC in adults, including its unique respiratory physiologic effects, device settings, and clinical indications.

Citations

Citations to this article as recorded by  
  • Asymmetrical high-flow nasal cannula performs similarly to standard interface in patients with acute hypoxemic post-extubation respiratory failure: a pilot study
    Annalisa Boscolo, Tommaso Pettenuzzo, Francesco Zarantonello, Nicolò Sella, Elisa Pistollato, Alessandro De Cassai, Sabrina Congedi, Irene Paiusco, Giacomo Bertoldo, Silvia Crociani, Francesca Toma, Giulia Mormando, Giulia Lorenzoni, Dario Gregori, Paolo
    BMC Pulmonary Medicine.2024;[Epub]     CrossRef
  • Recommendations from The Medical Education Editor
    Mark Lavercombe
    Respirology.2024;[Epub]     CrossRef
  • Liberation from mechanical ventilation in critically ill patients: Korean Society of Critical Care Medicine Clinical Practice Guidelines
    Tae Sun Ha, Dong Kyu Oh, Hak-Jae Lee, Youjin Chang, In Seok Jeong, Yun Su Sim, Suk-Kyung Hong, Sunghoon Park, Gee Young Suh, So Young Park
    Acute and Critical Care.2024; 39(1): 1.     CrossRef
  • Clinical Practice of High-Flow Nasal Cannula Therapy in ARDS Patients: A Cross-Sectional Survey of Respiratory Therapists
    Mohammed Alyami, Abdulelah Aldhahir, Abdullah Alqarni, Khalid Salwi, Abdullah Sarhan, Mohammed Almeshari, Nowaf Alobaidi, Jaber Alqahtani, Rayan Siraj, Abdullah Alsulayyim, Saeed Alghamdi, Ahmed Alasimi, Omar Alqarni, Mansour Majrshi, Hassan Alwafi
    Journal of Multidisciplinary Healthcare.2024; Volume 17: 1401.     CrossRef
  • The Impact of High-Flow Nasal Cannula Therapy on Acute Respiratory Distress Syndrome Patients: A Systematic Review
    Ahmed M Abdelbaky, Wael G Elmasry , Ahmed H. Awad, Sarrosh Khan, Maryam Jarrahi
    Cureus.2023;[Epub]     CrossRef
  • High-Flow Oxygen Therapy in the Perioperative Setting and Procedural Sedation: A Review of Current Evidence
    Lou’i Al-Husinat, Basil Jouryyeh, Ahlam Rawashdeh, Abdelrahman Alenaizat, Mohammad Abushehab, Mohammad Wasfi Amir, Zaid Al Modanat, Denise Battaglini, Gilda Cinnella
    Journal of Clinical Medicine.2023; 12(20): 6685.     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
  • Transnasal High-Flow Oxygen Therapy versus Noninvasive Positive Pressure Ventilation in the Treatment of COPD with Type II Respiratory Failure: A Meta-Analysis
    Wei Liu, Mingli Zhu, Liuqin Xia, Xiangying Yang, Pei Huang, Yanming Sun, Ye Shen, Jianping Ma, Gang Chen
    Computational and Mathematical Methods in Medicine.2022; 2022: 1.     CrossRef
  • Association between timing of intubation and mortality in patients with idiopathic pulmonary fibrosis
    Eunhye Bae, Jimyung Park, Sun Mi Choi, Jinwoo Lee, Sang-Min Lee, Hong Yeul Lee
    Acute and Critical Care.2022; 37(4): 561.     CrossRef
  • Effect of high-flow oxygen versus T-piece ventilation strategies during spontaneous breathing trials on weaning failure among patients receiving mechanical ventilation: a randomized controlled trial
    Hong Yeul Lee, Jinwoo Lee, Sang-Min Lee
    Critical Care.2022;[Epub]     CrossRef
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
  • 6,201 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
Protecting Postextubation Respiratory Failure and Reintubation by High-Flow Nasal Cannula Compared to Low-Flow Oxygen System: Single Center Retrospective Study and Literature Review
Minhyeok Lee, Ji Hye Kim, In Beom Jeong, Ji Woong Son, Moon Jun Na, Sun Jung Kwon
Acute Crit Care. 2019;34(1):60-70.   Published online February 28, 2019
DOI: https://doi.org/10.4266/acc.2018.00311
  • 7,463 View
  • 215 Download
  • 3 Web of Science
  • 2 Crossref
AbstractAbstract PDFSupplementary Material
Background
Use of a high-flow nasal cannula (HFNC) reduced postextubation respiratory failure (PERF) and reintubation rate compared to use of a low-flow oxygen system (LFOS) in low-risk patients. However, no obvious conclusion was reached for high-risk patients. Here, we sought to present the current status of HFNC use as adjunctive oxygen therapy in a clinical setting and to elucidate the nature of the protective effect following extubation.
Methods
The medical records of 855 patients who were admitted to the intensive care unit of single university hospital during a period of 5.5 years were analyzed retrospectively, with only 118 patients ultimately included in the present research. The baseline characteristics of these patients and the occurrence of PERF and reintubation along with physiologic changes were analyzed.
Results
Eighty-four patients underwent HFNC, and the remaining 34 patients underwent conventional LFOS after extubation. Physicians preferred HFNC to LFOS in the face of highrisk features including old age, neurologic disease, moderate to severe chronic obstructive pulmonary disease, a long duration of mechanical ventilation, low baseline arterial partial pressure of oxygen to fraction of inspired oxygen ratio, and a high baseline alveolar–arterial oxygen difference. The reintubation rate at 72 hours after extubation was not different (9.5% vs. 8.8%; P=1.000). Hypoxic respiratory failure was slightly higher in the nonreintubation group than in the reintubation group (31.9% vs. 6.7%; P=0.058). Regarding physiologic effects, heart rate was only stabilized after 24 hours of extubation in the HFNC group.
Conclusions
No difference was found in the occurrence of PERF and reintubation between both groups. It is worth noting that similar PERF and reintubation ratios were shown in the HFNC group in those with certain exacerbating risk factors versus not. Caution is needed regarding delayed reintubation in the HFNC group.

Citations

Citations to this article as recorded by  
  • Predictors and outcomes of high-flow nasal cannula failure following extubation: A multicentre observational study
    Amit Kansal, Shekhar Dhanvijay, Andrew Li, Jason Phua, Matthew Edward Cove, Wei Jun Dan Ong, Ser Hon Puah, Vicky Ng, Qiao Li Tan, Julipie Sumampong Manalansan, Michael Sharey Nocon Zamora, Michael Camba Vidanes, Juliet Tolentino Sahagun, Juvel Taculod, Ad
    Annals of the Academy of Medicine, Singapore.2021; 50(6): 467.     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

ACC : Acute and Critical Care