Heated and humidified high-flow oxygen therapy reduces discomfort during hypoxemic respiratory failure.
ABSTRACT Non-intubated critically ill patients are often treated by high-flow oxygen for acute respiratory failure. There is no current recommendation for humidification of oxygen devices.
We conducted a prospective randomized trial with a final crossover period to compare nasal airway caliber and respiratory comfort in patients with acute hypoxemic respiratory failure receiving either standard oxygen therapy with no humidification or heated and humidified high-flow oxygen therapy (HHFO(2)) in a medical ICU. Nasal airway caliber was measured using acoustic rhinometry at baseline, after 4 and 24 hours (H4 and H24), and 4 hours after crossover (H28). Dryness of the nose, mouth, and throat was auto-evaluated and assessed blindly by an otorhinolaryngologist. After the crossover, the subjects were asked which system they preferred.
Thirty subjects completed the protocol and were analyzed. Baseline median oxygen flow was 9 and 12 L/min in the standard and HHFO(2) groups, respectively (P = .21). Acoustic rhinometry measurements showed no difference between the 2 systems. The dryness score was significantly lower in the HHFO(2) group at H4 (2 vs 6, P = .007) and H24 (0 vs 8, P = .004). During the crossover period, dryness increased promptly after switching to standard oxygen and decreased after switching to HHFO(2) (P = .008). Sixteen subjects (53%) preferred HHFO(2) (P = .01), especially those who required the highest flow of oxygen at admission (P = .05).
Upper airway caliber was not significantly modified by HHFO(2), compared to standard oxygen therapy, but HHFO(2) significantly reduced discomfort in critically ill patients with respiratory failure. The system is usually preferred over standard oxygen therapy.
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ABSTRACT: Oxygen is commonly administered after extubation. Although several devices are available, data about their clinical efficacy are scarce.American Journal of Respiratory and Critical Care Medicine 07/2014; · 11.04 Impact Factor
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ABSTRACT: To demonstrate that heated humidified high-flow nasal cannula (HHHFNC) is superior to inhaled hypertonic saline solution (HSS) in improving respiratory distress in moderate bronchiolitis. In addition, it could improve comfort and reduce length of hospital stay (LOS) and admission to Paediatric Intensive Care Unit (PICU). Randomised Clinical Trial from 1 October 2010 to 31 December 2012. Two urban secondary (no PICU available) paediatric hospitalisation units. Hospitalised children aged up to 6 months with moderate acute bronchiolitis (Respiratory Distress Assessment Instrument, RDAI ≥4). Patients were randomised to HHHFNC or HSS. All of them received epinephrine as bronchodilator. Primary outcome was difference in mean Respiratory Assessment Change Score (RACS) between both groups measured in six previously defined consecutive moments. Secondary outcomes were difference in mean comfort scores in this period, LOS and rate of PICU admission. Seventy-five previously healthy patients were enrolled. Mean age was 2.4 months (95% CI 2.04 to 2.76). 43 were allocated to HSS group and 32 in HHHFNC. Data of 1 patient were lost, and 8 changed group over the study period. Intention-to-treat principle was applied. There were no significant differences in mean RACS and mean comfort scores between groups at the evaluation points. Median LOS or PICU admission rate were similar in both groups. No adverse events were observed. HHHFNC was not superior to HSS in treatment of moderate acute bronchiolitis with respect to severity and comfort scores, LOS or PICU admission rate. NCT01873144.Archives of Disease in Childhood 02/2014; · 2.91 Impact Factor
Article: Oxigenoterapia de alto flujoAnales de Pediatría Continuada 01/2014; 12(1):25–29.