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EditorialEditor's Choice

Physiologic Effects of High-Flow Nasal Cannula Oxygen in Critical Care Subjects

Frederic Vargas, Mélanie Saint-Leger, Alexandre Boyer, Nam H Bui and Gilles Hilbert
Respiratory Care October 2015, 60 (10) 1369-1376; DOI: https://doi.org/10.4187/respcare.03814
Frederic Vargas
Service de Réanimation Médicale, Hôpital Pellegrin-Tripode, Bordeaux, France.
Centre de Recherche Cardio-thoracique, CIC 0005, Université de Bordeaux, Bordeaux, France.
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  • For correspondence: [email protected]
Mélanie Saint-Leger
Service de Réanimation Médicale, Hôpital Pellegrin-Tripode, Bordeaux, France.
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Alexandre Boyer
Service de Réanimation Médicale, Hôpital Pellegrin-Tripode, Bordeaux, France.
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Nam H Bui
Service de Réanimation Médicale, Hôpital Pellegrin-Tripode, Bordeaux, France.
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Gilles Hilbert
Service de Réanimation Médicale, Hôpital Pellegrin-Tripode, Bordeaux, France.
Centre de Recherche Cardio-thoracique, CIC 0005, Université de Bordeaux, Bordeaux, France.
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Abstract

INTRODUCTION: High-flow nasal cannula (HFNC) can deliver heated and humidified gas (up to 100% oxygen) at a maximum flow of 60 L/min via nasal prongs or cannula. The aim of this study was to assess the short-term physiologic effects of HFNC. Inspiratory muscle effort, gas exchange, dyspnea score, and comfort were evaluated.

METHODS: Twelve subjects admitted to the ICU for acute hypoxemic respiratory failure were prospectively included. Four study sessions were performed. The first session consisted of oxygen therapy given through a high-FIO2, non-rebreathing face mask. Recordings were then obtained during periods of HFNC and CPAP at 5 cm H2O in random order, and final measurements were performed during oxygen therapy delivered via a face mask. Each of these 4 periods lasted ∼20 min.

RESULTS: Esophageal pressure signals, breathing pattern, gas exchange, comfort, and dyspnea were measured. Compared with the first session, HFNC reduced inspiratory effort (pressure-time product of 156.0 [119.2–194.4] cm H2O × s/min vs 204.2 [149.6–324.7] cm H2O × s/min, P < .01) and breathing frequency (P < .01). No significant differences were observed between HFNC and CPAP for inspiratory effort and breathing frequency. Compared with the first session, PaO2/FIO2 increased significantly with HFNC (167 [157–184] mm Hg vs 156 [110–171] mm Hg, P < .01). CPAP produced significantly greater PaO2/FIO2 improvement than did HFNC. Dyspnea improved with HFNC and CPAP, but this improvement was not significant. Subject comfort was not different across the 4 sessions.

CONCLUSIONS: Compared with conventional oxygen therapy, HFNC improved inspiratory effort and oxygenation. In subjects with acute hypoxemic respiratory failure, HFNC is an alternative to conventional oxygen therapy. (ClinicalTrials.gov registration NCT01056952.)

  • high-flow nasal cannula
  • continuous positive airway pressure
  • oxygen therapy
  • acute hypoxemic respiratory failure
  • inspiratory effort

Footnotes

  • Correspondence: Frederic Vargas MD PhD, Service de Réanimation Médicale, Centre Hospitalo-Universitaire Pellegrin-Tripode, Place Amélie Raba Léon, 33076 Bordeaux Cedex, France. E-mail: frederic.vargas{at}chu-bordeaux.fr.
  • This study was supported by a research grant from Fisher & Paykel Healthcare. The authors have disclosed no conflicts of interest.

  • See the Related Editorial on Page 1522

  • Copyright © 2015 by Daedalus Enterprises
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Respiratory Care: 60 (10)
Respiratory Care
Vol. 60, Issue 10
1 Oct 2015
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Physiologic Effects of High-Flow Nasal Cannula Oxygen in Critical Care Subjects
Frederic Vargas, Mélanie Saint-Leger, Alexandre Boyer, Nam H Bui, Gilles Hilbert
Respiratory Care Oct 2015, 60 (10) 1369-1376; DOI: 10.4187/respcare.03814

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Physiologic Effects of High-Flow Nasal Cannula Oxygen in Critical Care Subjects
Frederic Vargas, Mélanie Saint-Leger, Alexandre Boyer, Nam H Bui, Gilles Hilbert
Respiratory Care Oct 2015, 60 (10) 1369-1376; DOI: 10.4187/respcare.03814
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Keywords

  • high-flow nasal cannula
  • Continuous Positive Airway Pressure
  • oxygen therapy
  • acute hypoxemic respiratory failure
  • inspiratory effort

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