Beneficial effects of nasal high flow oxygen therapy after weaning from non-invasive ventilation: A prospective observational study
1Department of Anesthesia, Kawasaki Municipal Hospital, Kawasaki, Japan
2Department of Anesthesiology and General Intensive Care Unit, Keio University School of Medicine, Tokyo, Japan
DOI: 10.22514/SV111.052016.11 Vol.11,Issue 1,May 2016 pp.157-171
Published: 02 May 2016
It remains unknown whether application of nasal high flow (NHF) is effective after liberation from non-invasive ventilation (NIV). This study was aimed at investigating the effect of NHF in patients ready for weaning from NIV.
With institutional ethic committee approval, patients receiving NIV due to hypoxemic respiratory failure for more than 24 hours were enrolled. After passing the weaning criteria with continuous positive airway
pressure (CPAP) mode [fraction of inspiratory oxygen (FIO2) ≦0.5,positive end expiratory pressure (PEEP) 4 cmH2O], patients received
NHF (Flow 50 L/min, FIO2 ≦0.5) immediately after liberation from NIV. Before the initiation of the study, eight sequential patients who received oxygen via face mask after NIV treatment, served as the historical control. Respiratory parameters [partial pressure of arterial oxygen
(PaO2) to FIO2 ratio (P/F ratio), respiratory rate (RR)] 1 hour after liberation from NIV were evaluated with those during NIV as the primary outcome. The frequency of rescue NIV therapy, intubation, and respiratory failure were also recorded.
Nine eligible patients received NHF therapy after liberation from NIV. P/F ratio and RR did not change significantly compared with those during NIV (231 ± 43.6 versus 250.7 ± 34.2 mmHg, 20.8 ± 2.3 versus 21± 1.6 /min), while P/F ratio decreased significantly in the historical control group (194.3 ± 20.1 versus 255.9 ± 58.1 mmHg, p=0.013). Rescue NIV therapy, intubation, and respiratory failure never occurred in the NFH group, although two patients received NIV rescue therapy, of whom one was intubated in the historical control.
NHF after liberation from NIV might be effective in patients recovering from hypoxemic respiratory failure.
Registration number: UMIN000014133 (UMIN-CTR)
hypoxemic respiratory failure, weaning, non-invasive ventilation, nasal high flow oxygen therapy, weaning failure, rescue therapy
TAKUYA KURAZUMI,TAKESHI SUZUKI,RIE WAKAMIYA,KIKUKO SUGA,YOSHIHISA MORITA,JUNICHI MASUDA,SHIZUKO KOSUGI,NOBUYUKI KATORI,HIROSHI MORISAKI. Beneficial effects of nasal high flow oxygen therapy after weaning from non-invasive ventilation: A prospective observational study. Signa Vitae. 2016. 11(1);157-171.
1. Brochard L, Mancebo J, Wysocki M, Lofaso F, Conti G, Rauss A, et al.Noninvasive ventilation for acute exacerbation of chronic obstructive pulmonary disease. N Engl J Med 1995;333(13):817-22.
2. Peter JV, Moran JL, Phillips-Hughes J, Graham P, Bersten AD. Effect of non-invasive positive pressure ventilation (NIPPV) on mortality in patients with acute cardiogenic pulmonary oedema: a meta-analysis. Lancet 2006;367(9517):1155-63.
3. Nava S, Navalesi P, Conti G. Time of non-invasive ventilation. Intensive Care Med 2006;32(3):361-70.
4. Ferrer M, Valencia M, Nicolas LM, Bernadich O, Badia JR, Torres A. Early noninvasive ventilation averts extubation failure in patients at risk. Am J Respir Crit Care Med 2006;173(2):164-70.
5. Ferrer M, Esquinas A, Arancibia F, Bauer TT, Gonzalez G, Carrillo A, et al. Noninvasive ventilation during persistent weaning failure. Am J Respir Crit Care Med 2003;168(1):70-6.
6. Gregoretti C, Confalonieri M, Navalesi P, Squadrone V, Frigerio P, Beltrame F, et al. Evaluation of patient skin breakdown and comfort with a new face mask for non-invasive ventilation: a multi-center study. Intensive Care Med 2002;28(3):278-84.
7. Kernick L, Maqarey J. What is the evidence for the use of high flow nasal cannula oxygen in adult patients admitted to critical care units? A systematic review. Aust Crit Care 2010;23(2):53-70.
8. Parke R, McGuinness S, Eccleston M. Nasal high-flow therapy delivers low level positive airway pressure. Br J Anaesth 2009;103(6):886-90.
9. Roca O, Riera J, Torres F, Masclans JR. High-flow oxygen therapy in acute respiratory failure. Respir Care 2010;55(4):408-13.
10. Chatila W, Nugent T, Vance G, Gaughan J, Criner GJ. The effect of high-flow vs low-flow oxygen on exercise in advanced obstructive airways disease. Chest 2004;126(4):1108-15.
11. Rea H, McAuley S, Jayaram L, Garrett J, Hockey H, Storey L, et al. The clinical utility of long-term humidification therapy in chronic airway disease. Respir Med 2010;104(4):525-33.
12. Parke RL, Eccleston ML, McGuinness SP. The effects of flow on airway pressure during nasal high-flow oxygen therapy. Respir Care 2011;56(8):1151-5.
13. Wilkinson D, Andersen C, O’Donnell CP, De Paoli AG. High flow nasal cannula for respiratory support in preterm infants. Cochrane Database Syst Rev 2011;11(5):CD006405.
14. Sztrymf B, Messika J, Bertrand F, Hurel D, Leon R, Dreyfuss D, Ricard DJ. Beneficial effects of humidified high flow nasal oxygen in critical care patients: a prospective pilot study. Intensive Care Med 2011;37(11):1780-6.
15. Parke RL, McGuinness SP, Eccleston ML. A preliminary randomized controlled trial to assess effectiveness of nasal high-flow oxygen in intensive care patients. Respir Care 2011;56(3):265-70.
16. Tiruvoipati R, Lewis D, Haji K, Botha J. High-flow nasal oxygen vs high-flow face mask: A randomized crossover trial in extubated patients. J Crit Care 2010;25(3):463-8.
17. Groves N, Tobin A. High flow nasal oxygen generates positive pressure in adult volunteers. Aust Crit Care 2007;20(4):126-31.
18. Corley A, Caruana LR, Barnett AG, Tronstad O, Fraser JF. Oxygen delivery through high-flow nasal cannulae increase end-expiratory lung volume and reduce respiratory rate in post-cardiac surgical patients. Br J Anaesth 2011;107(6):998-1004.
19. Dysart K, Miller TL, Wolfson MR, Shaffer TH. Research in high flow therapy: mechanisms of action. Respir Med 2009;103(10):1400-5.
20. Sasaki H, Yamakage M, Iwasaki S, Mizuuchi M, Namiki A. Design of oxygen delivery systems influences both effectiveness and comfort in adult volunteers. Can J Anaesth 2003;50(10):1052-5.
21. Manley BJ, Owen LS, Doyle LW, Andersen CC, Cartwright DW, Pritchard MA, et al. High-flow nasal cannulae in very preterm infants after extubation. N Engl J Med 2013;369(15):1425-33.
Table 1. Characteristics of nine patients who received NHF therapy after liberation from NIV.
Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,200 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.
Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.
Chemical Abstracts Service Source Index The CAS Source Index (CASSI) Search Tool is an online resource that can quickly identify or confirm journal titles and abbreviations for publications indexed by CAS since 1907, including serial and non-serial scientific and technical publications.
Index Copernicus The Index Copernicus International (ICI) Journals database’s is an international indexation database of scientific journals. It covered international scientific journals which divided into general information, contents of individual issues, detailed bibliography (references) sections for every publication, as well as full texts of publications in the form of attached files (optional). For now, there are more than 58,000 scientific journals registered at ICI.
Geneva Foundation for Medical Education and Research The Geneva Foundation for Medical Education and Research (GFMER) is a non-profit organization established in 2002 and it works in close collaboration with the World Health Organization (WHO). The overall objectives of the Foundation are to promote and develop health education and research programs.
Scopus: CiteScore 0.5(2021) Scopus is Elsevier's abstract and citation database launched in 2004. Scopus covers nearly 36,377 titles (22,794 active titles and 13,583 Inactive titles) from approximately 11,678 publishers, of which 34,346 are peer-reviewed journals in top-level subject fields: life sciences, social sciences, physical sciences and health sciences.
Embase Embase (often styled EMBASE for Excerpta Medica dataBASE), produced by Elsevier, is a biomedical and pharmacological database of published literature designed to support information managers and pharmacovigilance in complying with the regulatory requirements of a licensed drug.