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Nasal high-flow oxygen therapy in patients with hypoxic respiratory failure: effect on functional and subjective respiratory parameters compared to conventional oxygen therapy and non-invasive ventilation (NIV).

Schwabbauer N, Berg B, Blumenstock G, Haap M, Hetzel J, Riessen R - BMC Anesthesiol (2014)

Bottom Line: PaO2 was highest under NIV (129 ± 38 mmHg) compared to HFNC (101 ± 34 mmHg, p <0.01 vs.In contrast, dyspnea was significantly better using a HFNC (2.9 ± 2.1, 10-point Borg scale) compared to NIV (5.0 ± 3.3, p <0.05), whereas dyspnea rating under HFNC and VM (3.3 ± 2.3) was not significantly different.A similar pattern was found when patients rated their overall discomfort on the 10 point scale: HFNC 2.7 ± 1.8, VM 3.1 ± 2.8 (ns vs.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Internal Medicine, Medical Intensive Care Unit, University of Tübingen, Otfried-Müller-Str, 10, Tübingen 72076, Germany.

ABSTRACT

Background: Aim of the study was to compare the short-term effects of oxygen therapy via a high-flow nasal cannula (HFNC) on functional and subjective respiratory parameters in patients with acute hypoxic respiratory failure in comparison to non-invasive ventilation (NIV) and standard treatment via a Venturi mask.

Methods: Fourteen patients with acute hypoxic respiratory failure were treated with HFNC (FiO2 0.6, gas flow 55 l/min), NIV (FiO2 0.6, PEEP 5 cm H2O Hg, tidal volume 6-8 ml/kg ideal body weight,) and Venturi mask (FiO2 0.6, oxygen flow 15 l/min,) in a randomized order for 30 min each. Data collection included objective respiratory and circulatory parameters as well as a subjective rating of dyspnea and discomfort by the patients on a 10-point scale. In a final interview, all three methods were comparatively evaluated by each patient using a scale from 1 (=very good) to 6 (=failed) and the patients were asked to choose one method for further treatment.

Results: PaO2 was highest under NIV (129 ± 38 mmHg) compared to HFNC (101 ± 34 mmHg, p <0.01 vs. NIV) and VM (85 ± 21 mmHg, p <0.001 vs. NIV, p <0.01 vs. HFNC, ANOVA). All other functional parameters showed no relevant differences. In contrast, dyspnea was significantly better using a HFNC (2.9 ± 2.1, 10-point Borg scale) compared to NIV (5.0 ± 3.3, p <0.05), whereas dyspnea rating under HFNC and VM (3.3 ± 2.3) was not significantly different. A similar pattern was found when patients rated their overall discomfort on the 10 point scale: HFNC 2.7 ± 1.8, VM 3.1 ± 2.8 (ns vs. HFNC), NIV 5.4 ± 3.1 (p <0.05 vs. HFNC). In the final evaluation patients gave the best ratings to HFNC 2.3 ± 1.4, followed by VM 3.2 ± 1.7 (ns vs. HFNC) and NIV 4.5 ± 1.7 (p <0.01 vs. HFNC and p <0.05 vs. VM). For further treatment 10 patients chose HFNC, three VM and one NIV.

Conclusions: In hypoxic respiratory failure HFNC offers a good balance between oxygenation and comfort compared to NIV and Venturi mask and seems to be well tolerated by patients.

Trial registration: GERMAN CLINICAL TRIALS REGISTER: DRKS00005132.

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Related in: MedlinePlus

Flowchart. During the intervention patients were treated in a randomized order with either high-flow nasal cannula (HFNC), Venturi-mask (VM) or with none - invasive ventilation (NIV).
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Figure 1: Flowchart. During the intervention patients were treated in a randomized order with either high-flow nasal cannula (HFNC), Venturi-mask (VM) or with none - invasive ventilation (NIV).

Mentions: The order of the experimental protocol was randomly assigned (Figure 1). The assignment of patients to the sequence in which the three oxygen applicators were applied was randomized. Each intervention was preceded by a 15-minute baseline period, in which oxygen was administered via conventional nasal prongs. The gas flow was set to achieve a peripheral oxygen saturation (SpO2) of ≥ 88%. This gas flow was used in all subsequent baseline phases. The interventions themselves had a duration of 30 min. The patients were allowed to stop an intervention prematurely (e.g. if they did not tolerate an oxygen applicator).


Nasal high-flow oxygen therapy in patients with hypoxic respiratory failure: effect on functional and subjective respiratory parameters compared to conventional oxygen therapy and non-invasive ventilation (NIV).

Schwabbauer N, Berg B, Blumenstock G, Haap M, Hetzel J, Riessen R - BMC Anesthesiol (2014)

Flowchart. During the intervention patients were treated in a randomized order with either high-flow nasal cannula (HFNC), Venturi-mask (VM) or with none - invasive ventilation (NIV).
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4126617&req=5

Figure 1: Flowchart. During the intervention patients were treated in a randomized order with either high-flow nasal cannula (HFNC), Venturi-mask (VM) or with none - invasive ventilation (NIV).
Mentions: The order of the experimental protocol was randomly assigned (Figure 1). The assignment of patients to the sequence in which the three oxygen applicators were applied was randomized. Each intervention was preceded by a 15-minute baseline period, in which oxygen was administered via conventional nasal prongs. The gas flow was set to achieve a peripheral oxygen saturation (SpO2) of ≥ 88%. This gas flow was used in all subsequent baseline phases. The interventions themselves had a duration of 30 min. The patients were allowed to stop an intervention prematurely (e.g. if they did not tolerate an oxygen applicator).

Bottom Line: PaO2 was highest under NIV (129 ± 38 mmHg) compared to HFNC (101 ± 34 mmHg, p <0.01 vs.In contrast, dyspnea was significantly better using a HFNC (2.9 ± 2.1, 10-point Borg scale) compared to NIV (5.0 ± 3.3, p <0.05), whereas dyspnea rating under HFNC and VM (3.3 ± 2.3) was not significantly different.A similar pattern was found when patients rated their overall discomfort on the 10 point scale: HFNC 2.7 ± 1.8, VM 3.1 ± 2.8 (ns vs.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Internal Medicine, Medical Intensive Care Unit, University of Tübingen, Otfried-Müller-Str, 10, Tübingen 72076, Germany.

ABSTRACT

Background: Aim of the study was to compare the short-term effects of oxygen therapy via a high-flow nasal cannula (HFNC) on functional and subjective respiratory parameters in patients with acute hypoxic respiratory failure in comparison to non-invasive ventilation (NIV) and standard treatment via a Venturi mask.

Methods: Fourteen patients with acute hypoxic respiratory failure were treated with HFNC (FiO2 0.6, gas flow 55 l/min), NIV (FiO2 0.6, PEEP 5 cm H2O Hg, tidal volume 6-8 ml/kg ideal body weight,) and Venturi mask (FiO2 0.6, oxygen flow 15 l/min,) in a randomized order for 30 min each. Data collection included objective respiratory and circulatory parameters as well as a subjective rating of dyspnea and discomfort by the patients on a 10-point scale. In a final interview, all three methods were comparatively evaluated by each patient using a scale from 1 (=very good) to 6 (=failed) and the patients were asked to choose one method for further treatment.

Results: PaO2 was highest under NIV (129 ± 38 mmHg) compared to HFNC (101 ± 34 mmHg, p <0.01 vs. NIV) and VM (85 ± 21 mmHg, p <0.001 vs. NIV, p <0.01 vs. HFNC, ANOVA). All other functional parameters showed no relevant differences. In contrast, dyspnea was significantly better using a HFNC (2.9 ± 2.1, 10-point Borg scale) compared to NIV (5.0 ± 3.3, p <0.05), whereas dyspnea rating under HFNC and VM (3.3 ± 2.3) was not significantly different. A similar pattern was found when patients rated their overall discomfort on the 10 point scale: HFNC 2.7 ± 1.8, VM 3.1 ± 2.8 (ns vs. HFNC), NIV 5.4 ± 3.1 (p <0.05 vs. HFNC). In the final evaluation patients gave the best ratings to HFNC 2.3 ± 1.4, followed by VM 3.2 ± 1.7 (ns vs. HFNC) and NIV 4.5 ± 1.7 (p <0.01 vs. HFNC and p <0.05 vs. VM). For further treatment 10 patients chose HFNC, three VM and one NIV.

Conclusions: In hypoxic respiratory failure HFNC offers a good balance between oxygenation and comfort compared to NIV and Venturi mask and seems to be well tolerated by patients.

Trial registration: GERMAN CLINICAL TRIALS REGISTER: DRKS00005132.

Show MeSH
Related in: MedlinePlus