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humidified high flow oxygen

L A Hermez, C J Spence, M J Payton, S A R Nouraei, A Patel, T H Barnes
Clinical observations suggest that compared with standard apnoeic oxygenation, transnasal humidified rapid-insufflation ventilatory exchange using high-flow nasal oxygenation reduces the rate of carbon dioxide accumulation in patients who are anaesthetised and apnoeic. This suggests that active gas exchange takes place, but the mechanisms by which it may occur have not been described. We used three laboratory airway models to investigate mechanisms of carbon dioxide clearance in apnoeic patients. We determined flow patterns using particle image velocimetry in a two-dimensional model using particle-seeded fluorescent solution; visualised gas clearance in a three-dimensional printed trachea model in air; and measured intra-tracheal turbulence levels and carbon dioxide clearance rates using a three-dimensional printed model in air mounted on a lung simulator...
February 15, 2019: Anaesthesia
Frank J Lodeserto, Thomas M Lettich, Salim R Rezaie
The use of the heated and humidified high-flow nasal cannula has become increasingly popular in the treatment of patients with respiratory failure through all age groups. This article will examine the main mechanisms of actions attributed to the use of the high-flow nasal cannula and review the indications in adult and pediatric populations (outside of the neonatal period). It is unclear which of the mechanisms of action is the most important, but it may depend on the cause of the patient's respiratory failure...
November 26, 2018: Curēus
Mutsuo Onodera, Emiko Nakataki, Nobuto Nakanishi, Taiga Itagaki, Masami Sato, Jun Oto, Masaji Nishimura
BACKGROUND: During high-flow oxygen therapy, heated humidified gas is delivered at high flow. Although the warmth and humidity of this gas facilitates mucociliary function in the lower airway, warm and humid conditions also promote bacterial growth. Bacterial contamination of high-flow oxygen therapy circuits has not been well investigated. We examined the incidence of bacterial contamination in high-flow oxygen therapy circuits. METHODS: This was a prospective observational study in a university hospital 10-bed general ICU...
February 5, 2019: Respiratory Care
Jean-Luc Hanouz, David Lhermitte, Jean-Louis Gérard, Marc Olivier Fischer
BACKGROUND: High-flow nasal oxygen (HFNO) therapy has been proposed for pre-oxygenation before intubation, but the end-tidal fraction of oxygen (ETO2) obtained remains unknown. OBJECTIVE(S): To compare the ETO2 following a 3 min pre-oxygenation with HFNO and face mask. SETTING: Operating room in a primary university hospital. DESIGN: A prospective, randomised crossover study. PARTICIPANTS: Fifty healthy volunteers...
January 18, 2019: European Journal of Anaesthesiology
P C F Tan, O J Millay, L Leeton, A T Dennis
BACKGROUND: Obstetric airway guidelines recommend preoxygenation in preparation for general anaesthesia to achieve end-tidal oxygen concentrations (etO2 ) of ≥90%, and mention the potential use of high-flow humidified nasal oxygen (HFNO). We investigated the new HFNO technique (Optiflow™) in term pregnant women. METHODS: Seventy-three term participants underwent a 3 min HFNO protocol (30 L min-1 for 30 s, and then 50 L min-1 for 150 s). The etO2 was assessed for the first four breaths after simulated preoxygenation...
January 2019: British Journal of Anaesthesia
Matti Korppi
Bronchiolitis in infancy is the most common infectious reason for hospitalization of infants without any chronic underlying illness. Areas covered: This review focuses on the role of racemic epinephrine, systemic corticosteroids, hypertonic saline and high-flow oxygen therapy (HFOT) in the treatment of infants with bronchiolitis. Literature was searched from Pubmed covering the years 2009-2018 using the entries of bronchiolitis or viral bronchiolitis, and epinephrine, adrenaline, racemic epinephrine, racemic adrenaline, corticosteroids, hypertonic saline, high-flow oxygen therapy or high-flow oxygen cannula...
November 29, 2018: Expert Review of Respiratory Medicine
Callie Gittemeier Ebeling, Christina Anne Riccio
Three patients underwent laryngeal and tracheal surgeries under apneic conditions using transnasal humidified rapid-insufflation ventilatory exchange. Transcutaneous carbon dioxide (CO2) levels were recorded throughout the apneic period to detect rates of CO2 rise. Conventional airway management was initiated after 15 minutes of apnea with either tracheal intubation or jet ventilation. No patient experienced oxygen desaturation <97%. The average rate of transcutaneous CO2 rise (1.7 mm Hg/min) was higher than previously reported using this technique...
November 20, 2018: A&A practice
Amélie O Von Saint André-Von Arnim, Bob Okeyo, Nathan Cook, Mardi Steere, Joan Roberts, Christopher R A Howard, Larissa I Stanberry, Grace C John-Stewart, Arianna Shirk
BACKGROUND: High-flow nasal cannula (HFNC) is a well-established respiratory support device in high-income countries, but to our knowledge, its use in sub-Saharan Africa has not been reported. This feasability study describes the implementation process of HFNC in rural Kenya. METHODS: HFNC was implemented in intensive care and high dependency units at Kijabe Hospital, Kenya for children with acute lower respiratory disease. Rate of intubation was compared with historical controls and challenges of implementation described...
November 19, 2018: Paediatrics and International Child Health
David Kotwinski, Laura Paton, Roger Langford
The delivery of oxygen is a key component of anaesthetic practice. High flow nasal oxygen therapy is a relatively new addition to more traditional means of oxygenation which provides heated and humidified flows of controlled oxygen/air mixes achieving rates of up to 120 litres/min. The physiological benefits include nasopharyngeal dead space washout, reduced work of breathing, alveolar recruitment, maintained mucociliary function and the ability to provide apnoeic oxygenation. This article considers the current evidence for high flow nasal oxygen therapy in perioperative anaesthetic care during pre-oxygenation and intubation, management of the difficult airway, oxygenation for shared airway surgery, extubation and postoperative support, obstetric and paediatric anaesthesia...
November 2, 2018: British Journal of Hospital Medicine
Elinor Charles, Katie A Hunt, Gerrard F Rafferty, Janet L Peacock, Anne Greenough
Our aim was to compare the work of breathing (WOB) during synchronised nasal intermittent positive pressure ventilation (SNIPPV) and heated humidified high flow nasal cannula (HHHFNC) when used as post-extubation support in preterm infants. A randomised crossover study was undertaken of nine infants with a median gestational age of 27 (range 24-31) weeks and post-natal age of 7 (range 2-50) days. Infants were randomised to either SNIPPV or HHHFNC immediately following extubation. They were studied for 2 h on one mode and then switched to the other modality and studied for a further 2-h period...
January 2019: European Journal of Pediatrics
(no author information available yet)
The Food and Drug Administration (FDA or we) is classifying the high flow humidified oxygen delivery device into class II (special controls). The special controls that apply to the device type are identified in this order and will be part of the codified language for the high flow humidified oxygen delivery device's classification. We are taking this action because we have determined that classifying the device into class II (special controls) will provide a reasonable assurance of safety and effectiveness of the device...
October 26, 2018: Federal Register
C J Lai, K C Yeh, M L Wang, W H Tai, Ya-Jung Cheng
PURPOSE: In patients receiving non-intubated video-assisted thoracic surgery (NIVATS), transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) has been applied instead of oxygen mask for better oxygenation. However, the THRIVE effects on intraoperative temperature decrease have not been investigated. METHODS: Pre- and postoperative temperatures, measured by an infrared tympanic ear thermometer, taken before sending patients to the operation room and immediately upon their arrival in the postoperative anesthesia unit, were collected from medical records of patients who received NIVATS either with oxygen mask or THRIVE...
December 2018: Journal of Anesthesia
Chieko Mitaka, Masahiko Odoh, Daizoh Satoh, Tadasuke Hashiguchi, Eiichi Inada
BACKGROUND: Weaning from prolonged mechanical ventilation is extremely difficult in tracheostomized patients with restrictive pulmonary dysfunction. High-flow oxygen via tracheostomy supplies heated and humidified oxygen gas at > 10 L/minute. However, little has been reported on the use of high-flow oxygen via tracheostomy during weaning from ventilators in patients with restrictive pulmonary dysfunction. We report successful weaning from ventilators in patients with restrictive pulmonary dysfunction using high-flow oxygen via tracheostomy...
October 12, 2018: Journal of Medical Case Reports
Jean-Damien Ricard, Fadia Dib, Marina Esposito-Farese, Jonathan Messika, Christophe Girault
INTRODUCTION: This study protocol describes a trial designed to investigate whether high-flow heated and humidified nasal oxygen (HFHO) therapy in patients with hypercapnic acute respiratory failure (ARF) reduces the need of non-invasive ventilation (NIV). METHODS AND ANALYSIS: This is an open-label, superiority, international, parallel-group, multicentre randomised controlled two-arm trial, with an internal feasibility pilot phase. 242 patients with hypercapnic ARF requiring NIV admitted to an intensive care unit, an intermediate care or a respiratory care unit will be randomised in a 1:1 ratio to receive HFHO or standard oxygen in between NIV sessions...
September 19, 2018: BMJ Open
Zhu Wang, Jian-Wen Xiang, Wei-Wei Gao, Yong-Zhen Shen, Wen-Ji Zhou, Jia Chen, Fang Xu, Jie Yang
OBJECTIVE: To compare the clinical efficacy of nasal intermittent positive pressure ventilation (NIPPV) and heated humidified high flow nasal cannula (HHHFNC) in the treatment of respiratory distress syndrome (RDS) among very low birth weight (VLBW) preterm infants. METHODS: A total of 89 very low birth weight premature infants with respiratory distress syndrome (RDS) who were randomly administered with NIPPV (n=46) and HHHFNC (n=43) as an initial respiratory support...
August 2018: Zhongguo Dang Dai Er Ke za Zhi, Chinese Journal of Contemporary Pediatrics
Verna M Aykanat, Desmond P McGlade
This case demonstrates a novel preoxygenation technique in a patient with difficult access to the airway after a traumatic facial injury. To find a solution, a fusion of oxygenation equipment was trialed by altering and combining a tracheostomy mask and the tubing of an Optiflow circuit from which the nasal cannula component had been removed. This novel combination delivered high-flow humidified oxygen (60 L/min) orally, avoided further facial injury, and was well tolerated by the patient. Effective preoxygenation was confirmed by arterial gas measurements...
July 16, 2018: A&A practice
I Ng, R Krieser, P Mezzavia, K Lee, C Tseng, Nwr Douglas, R Segal
This study explored the use of high-flow nasal oxygen (HFNO) in both pre-oxygenation and apnoeic oxygenation in adults who were intubated following a non-rapid sequence induction. Fifty patients were randomised to receive pre-oxygenation via a standard facemask or the Transnasal Humidified Rapid-Insufflation Ventilatory Exchange (THRIVE) device. After five minutes of pre-oxygenation, induction and muscle relaxant agents were given. While waiting for complete paralysis, patients in the standard facemask group received bag-mask ventilation (BMV), whereas patients in the HFNO group received apnoeic oxygenation via the THRIVE device...
July 2018: Anaesthesia and Intensive Care
Tommaso Mauri, Alessandro Galazzi, Filippo Binda, Laura Masciopinto, Nadia Corcione, Eleonora Carlesso, Marta Lazzeri, Elena Spinelli, Daniela Tubiolo, Carlo Alberto Volta, Ileana Adamini, Antonio Pesenti, Giacomo Grasselli
BACKGROUND: The high-flow nasal cannula (HFNC) delivers up to 60 l/min of humidified air/oxygen blend at a temperature close to that of the human body. In this study, we tested whether higher temperature and flow decrease patient comfort. In more severe patients, instead, we hypothesized that higher flow might be associated with improved comfort. METHODS: A prospective, randomized, cross-over study was performed on 40 acute hypoxemic respiratory failure (AHRF) patients (PaO2 /FiO2  ≤ 300 + pulmonary infiltrates + exclusion of cardiogenic edema) supported by HFNC...
May 9, 2018: Critical Care: the Official Journal of the Critical Care Forum
Line Hust Storgaard, Hans-Ulrich Hockey, Birgitte Schantz Laursen, Ulla Møller Weinreich
Background: This study investigated the long-term effects of humidified high-flow nasal cannula (HFNC) in COPD patients with chronic hypoxemic respiratory failure treated with long-term oxygen therapy (LTOT). Patients and methods: A total of 200 patients were randomized into usual care ± HFNC. At inclusion, acute exacerbation of COPD (AECOPD) and hospital admissions 1 year before inclusion, modified Medical Research Council (mMRC) score, St George's Respiratory Questionnaire (SGRQ), forced expiratory volume in 1 second (FEV1 ), 6-minute walk test (6MWT) and arterial carbon dioxide (PaCO2 ) were recorded...
2018: International Journal of Chronic Obstructive Pulmonary Disease
Steve Cunningham
Acute viral lower respiratory tract infection is frequently associated with hypoxemia and respiratory distress, sometimes progressing to hypercarbia and respiratory failure. In recent years, trials have assessed the effects of oxygen supplementation and respiratory support with high-flow oxygen therapy. An oxygen saturation target of 90% is as safe and clinically effective as 94% in infants with bronchiolitis. Trials of high-flow humidified oxygen have demonstrated safety, but as yet poorly demarcated an appropriate place for use within the clinical course of the disease...
May 2018: American Journal of Perinatology
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