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.)
KallstromTJ. AARC Clinical Practice Guideline: oxygen therapy for adults in the acute care facility—2002 revision & update. Respir Care, 2002; 47(6):717–720.
2.
WagstaffTA, SoniN. Performance of six types of oxygen delivery devices at varying respiratory rates. Anaesthesia, 2007; 62(5):492–503.
3.
L'HerE, DeyeN, LelloucheF, TailleS, DemouleA, FraticelliA, et al. Physiologic effects of noninvasive ventilation during acute lung injury. Am J Respir Crit Care Med, 2005; 172(9):1112–1118.
4.
RocaO, RieraJ, TorresF, MasclansJR. High-flow oxygen therapy in acute respiratory failure. Respir Care, 2010; 55(4):408–413.
5.
ParkeRL, McGuinnessSP, EcclestonML. A preliminary randomized controlled trial to assess effectiveness of nasal high-flow oxygen in intensive care patients. Respir Care, 2011; 56(3):265–270.
6.
GrovesN, TobinA. High flow nasal oxygen generates positive airway pressure in adult volunteers. Aust Crit Care, 20(4)07;20:126–131.
CorleyA, CaruanaLR, BarnettAG, TronstadO, FraserJF. 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.
9.
ChanquesG, RibouletF, MolinariN, CarrJ, JungB, PradesA, et al. Comparison of three high flow oxygen therapy devices: a clinical physiological cross-over study. Minerva Anestesiol, 2013; 79(12):1344–1355.
10.
ShepardJWJr, BurgerCD. Nasal and oral flow-volume loops in normal subjects and patients with obstructive sleep apnea. Am Rev Respir Dis, 1990; 142(6 Pt 1):1288–1293.
11.
DysartK, MillerTL, WolfsonMR, ShafferTH. Research in high flow therapy: mechanisms of action. Respir Med, 2009; 103(10):1400–1405.
12.
ChatilaW, NugentT, VanceG, GaughanJ, CrinerGJ. The effects of high-flow vs low-flow oxygen on exercise in advanced obstructive airways disease. Chest, 2004; 126(4):1108–1115.
13.
WettsteinRB, ShelledyDC, PetersJI. Delivered oxygen concentrations using low-flow and high-flow nasal cannulas. Respir Care, 2005; 50(5):604–609.
14.
MündelT, FengS, TatkovS, SchneiderH. Mechanisms of nasal high flow on ventilation during wakefulness and sleep. J Appl Physiol, 2013; 114(8):1058–1065.
15.
SztrymfB, MessikaJ, MayotT, LengletH, DreyfussD, RicardJD. Impact of high-flow nasal cannula oxygen therapy on intensive care unit patients with acute respiratory failure: a prospective observational study. J Crit Care, 2012; 27(3):324.e9–324.e913.
16.
SztrymfB, MessikaJ, BertrandF, HurelD, LeonR, DreyfussD, RicardJD. Beneficial effects of humidified high flow nasal oxygen in critical care patients: a prospective pilot study. Intensive Care Med, 2011; 37(11):1780–1786.
17.
ItagakiT, OkudaN, TsunanoY, KohataH, NakatakiE, OnoderaM, et al. Effect of high flow nasal cannula on thoraco-abdominal synchrony in adults critically ill patients. Respir Care, 2014; 59(1):70–74.
18.
MaggioreSM, IdoneFA, VaschettoR, FestaR, CataldoA, AntonicelliF, et al. Nasal high-flow versus Venturi mask oxygen therapy after extubation. Effects on oxygenation, comfort, and clinical outcome. Am J Respir Crit Care Med, 2014; 190(3):282–288.
19.
DelclauxC, L'HerE, AlbertiC, ManceboJ, AbrougF, ContiG, et al. Treatment of acute hypoxemic nonhypercapnic respiratory insufficiency with continuous positive airway pressure delivered by a face mask: a randomized controlled trial. JAMA, 2000; 284(18):2352–2360.
BaydurA, BehrakisPK, ZinWA, JaegerM, Milic-EmiliJ. A simple method for assessing the validity of the esophageal balloon technique. Am Rev Respir Dis, 1982; 126(5):788–791.
22.
VargasF, ThilleA, LyazidiA, CampoFR, BrochardL. Helmet with specific settings versus facemask for noninvasive ventilation. Crit Care Med, 2009; 37(6):1921–1928.
23.
FontanariP, BurnetH, Zattara-HartmannMC, JammesY. Changes in airway resistance induced by nasal inhalation of cold dry, dry, or moist air in normal individuals. J Appl Physiol, 1996; 81(4):1739–1743.
24.
RichardsGN, CistulliPA, UngarRG, Berthon-JonesM, SullivanCE. Mouth leak with nasal continuous positive airway pressure increases nasal airway resistance. Am J Respir Crit Care Med, 1996; 154(1):182–186.
25.
ChikataY, IzawaM, OkudaN, ItagakiT, NakatakiE, OnoderaM, et al. Humidification performances of two high flow nasal cannula devices: a bench study. Respir Care, 2014; 59(8):1186–1190.
26.
ChanquesG, ConstantinJM, SauterM, JungB, SebbaneM, VerzilliD, et al. Discomfort associated with underhumidified high flow oxygen therapy in critically ill patients. Intensive Care Med, 2009; 35(6):996–1003.
27.
FratJP, BrugiereB, RagotS, ChatellierD, VeinsteinA, GoudetV, et al. Sequential application of oxygen therapy via high-flow nasal cannula and noninvasive ventilation in acute respiratory failure: an observational pilot study. Respir Care, 2015; 60(2):170–178.
28.
HinzJ, HahnG, NeumannP, SydowM, MohrenweiserP, HelligeG, BurchardiH. End expiratory lung impedance change enables bedside monitoring of end-expiratory lung volume change. Intensive Care Med, 2003; 29(1):37–43.
29.
van GenderingenHR, van VughtAJ, JansenJR. Estimation of regional lung volume changes by electrical impedance pressures tomography during a pressure-volume maneuver. Intensive Care Med, 2003; 29(2):233–240.
30.
KatzJA, MarksJD. Inspiratory work with and without continuous positive airway pressure in patients with acute respiratory failure. Anesthesiology, 1985; 63(6):598–607.
31.
LinM, YangYF, ChiangHT, ChangMS, ChiangBN, CheitlinMD. Reappraisal of continuous positive airway pressure therapy in acute cardiogenic pulmonary oedema: short-term results and long-term follow-up. Chest, 1995; 107(5):1379–1386.
32.
LeniqueF, HabisM, LofasoF, Dubois-RandéJL, HarfA, BrochardL. Ventilatory and hemodynamic effects of continuous positive airway pressure in left heart failure. Am J Respir Crit Care Med, 1997; 155(2):500–505.
33.
RicardJD. High flow nasal oxygen in acute respiratory failure. Minerva Anestesiol, 2012; 78(7):836–841.
