High-flow oxygen therapy versus noninvasive ventilation: a randomised physiological crossover study of alveolar recruitment in acute respiratory failure.
Artaud-Macari, Elise; Bubenheim, Michael; Le Bouar, Gurvanet al.
[en] High-flow nasal cannula (HFNC) oxygen therapy has recently shown clinical benefits in hypoxaemic acute respiratory failure (ARF) patients, while the value of noninvasive ventilation (NIV) remains debated. The primary end-point was to compare alveolar recruitment using global end-expiratory electrical lung impedance (EELI) between HFNC and NIV. Secondary end-points compared regional EELI, lung volumes (global and regional tidal volume variation (V (T))), respiratory parameters, haemodynamic tolerance, dyspnoea and patient comfort between HFNC and NIV, relative to face mask (FM). A prospective randomised crossover physiological study was conducted in patients with hypoxaemic ARF due to pneumonia. They received alternately HFNC, NIV and FM. 16 patients were included. Global EELI was 4083 with NIV and 2921 with HFNC (p=0.4). Compared to FM, NIV and HFNC significantly increased global EELI by 1810.5 (95% CI 857-2646) and 826 (95% CI 399.5-2361), respectively. Global and regional V (T) increased significantly with NIV compared to HFNC or FM, but not between HFNC and FM. NIV yielded a significantly higher pulse oxygen saturation/inspired oxygen fraction ratio compared to HFNC (p=0.03). No significant difference was observed between HFNC, NIV and FM for dyspnoea. Patient comfort score with FM was not significantly different than with HFNC (p=0.1), but was lower with NIV (p=0.001). This study suggests a potential benefit of HFNC and NIV on alveolar recruitment in patients with hypoxaemic ARF. In contrast with HFNC, NIV increased lung volumes, which may contribute to overdistension and its potentially deleterious effect in these patients.
Disciplines :
Anesthesia & intensive care
Author, co-author :
Artaud-Macari, Elise
Bubenheim, Michael
Le Bouar, Gurvan
Carpentier, Dorothée
Grangé, Steven
Boyer, Déborah
Béduneau, Gaëtan
Misset, Benoît ; Université de Liège - ULiège > Département des sciences cliniques > Soins intensifs
Cuvelier, Antoine
Tamion, Fabienne
Girault, Christophe
Language :
English
Title :
High-flow oxygen therapy versus noninvasive ventilation: a randomised physiological crossover study of alveolar recruitment in acute respiratory failure.
Publication date :
2021
Journal title :
ERJ Open Research
eISSN :
2312-0541
Publisher :
European Respiratory Society, Sheffield, United Kingdom
Rochwerg B, Brochard L, Elliott MW, et al. Official ERS/ATS clinical practice guidelines: noninvasive ventilation for acute respiratory failure. Eur Respir J 2017; 50: 1602426.
Frat JP, Thille AW, Mercat A, et al. High-flow oxygen through nasal cannula in acute hypoxemic respiratory failure. N Engl J Med 2015; 372: 2185–2196.
Carteaux G, Millán-Guilarte T, De Prost N, et al. Failure of noninvasive ventilation for de novo acute hypoxemic respiratory failure: role of tidal volume. Crit Care Med 2016; 44: 282–290.
Frat JP, Ragot S, Coudroy R, et al. Predictors of intubation in patients with acute hypoxemic respiratory failure treated with a noninvasive oxygenation strategy. Crit Care Med 2018; 46: 208–215.
Spoletini G, Alotaibi M, Blasi F, et al. Heated humidified high-flow nasal oxygen in adults: mechanisms of action and clinical implications. Chest 2015; 148: 253–261.
Papazian L, Calfee CS, Chiumello D, et al. Diagnostic workup for ARDS patients. Intensive Care Med 2016; 42: 674–685.
Frat JP, Brugiere B, Ragot S, 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: 170–178.
Groves N, Tobin A. High flow nasal oxygen generates positive airway pressure in adult volunteers. Aust Crit Care 2007; 20: 126–131.
Parke RL, Eccleston ML, McGuinness SP. The effects of flow on airway pressure during nasal high-flow oxygen therapy. Respir Care 2011; 56: 1151–1155.
Chanques G, Riboulet F, Molinari N, et al. Comparison of three high flow oxygen therapy delivery devices: a clinical physiological cross-over study. Minerva Anestesiol 2013; 79: 1344–1355.
Kunst PW, Vazquez de Anda G, Böhm SH, et al. Monitoring of recruitment and derecruitment by electrical impedance tomography in a model of acute lung injury. Crit Care Med 2000; 28: 3891–3895.
Hinz J, Moerer O, Neumann P, et al. Effect of positive end-expiratory-pressure on regional ventilation in patients with acute lung injury evaluated by electrical impedance tomography. Eur J Anaesthesiol 2005; 22: 817–825.
Hinz J, Hahn G, Neumann P, et al. End-expiratory lung impedance change enables bedside monitoring of end-expiratory lung volume change. Intensive Care Med 2003; 29: 37–43.
Lindgren S, Odenstedt H, Olegård C, et al. Regional lung derecruitment after endotracheal suction during volume-or pressure-controlled ventilation: a study using electric impedance tomography. Intensive Care Med 2007; 33: 172–180.
Riera J, Pérez P, Cortés J, et al. Effect of high-flow nasal cannula and body position on end-expiratory lung volume: a cohort study using electrical impedance tomography. Respir Care 2013; 58: 589–596.
Corley A, Caruana LR, Barnett AG, et al. 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: 998–1004.
Corley A, Sharpe N, Caruana LR, et al. Lung volume changes during cleaning of closed endotracheal suction catheters: a randomized crossover study using electrical impedance tomography. Respir Care 2014; 59: 497–503.
Metlay JP, Waterer GW, Long AC, et al. Diagnosis and treatment of adults with community-acquired pneumonia. An official clinical practice guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med 2019; 200: e45–e67.
Frat JP, Ricard JD, Coudroy R, et al. Preoxygenation with non-invasive ventilation versus high-flow nasal cannula oxygen therapy for intubation of patients with acute hypoxaemic respiratory failure in ICU: the prospective randomised controlled FLORALI-2 study protocol. BMJ Open 2017; 7: e018611.
Bilan N, Dastranji A, Ghalehgolab Behbahani A. Comparison of the SpO2/FiO2 ratio and the PaO2/FiO2 ratio in patients with acute lung injury or acute respiratory distress syndrome. J Cardiovasc Thorac Res 2015; 7: 28–31.
Mauri T, Turrini C, Eronia N, et al. Physiologic effects of high-flow nasal cannula in acute hypoxemic respiratory failure. Am J Respir Crit Care Med 2017; 195: 1207–1215.
Mauri T, Alban L, Turrini C, et al. Optimum support by high-flow nasal cannula in acute hypoxemic respiratory failure: effects of increasing flow rates. Intensive Care Med 2017; 43: 1453–1463.
Lehmann EL. Nonparametrics. Upper Saddle River, Prentice-Hall, 2018.
Eronia N, Mauri T, Maffezzini E, et al. Bedside selection of positive end-expiratory pressure by electrical impedance tomography in hypoxemic patients: a feasibility study. Ann Intensive Care 2017; 7: 76.
Futier E, Constantin JM, Pelosi P, et al. Noninvasive ventilation and alveolar recruitment maneuver improve respiratory function during and after intubation of morbidly obese patients: a randomized controlled study. Anesthesiology 2011; 114: 1354–1363.
Brochard L, Isabey D, Piquet J, et al. Reversal of acute exacerbations of chronic obstructive lung disease by inspiratory assistance with a face mask. N Engl J Med 1990; 323: 1523–1530.
Brochard L, Slutsky A, Pesenti A. Mechanical ventilation to minimize progression of lung injury in acute respiratory failure. Am J Respir Crit Care Med 2017; 195: 438–442.
Pérez-Terán P, Marin-Corral J, Dot I, et al. Aeration changes induced by high flow nasal cannula are more homogeneous than those generated by non-invasive ventilation in healthy subjects. J Crit Care 2019; 53: 186–192.
Grieco DL, Menga LS, Raggi V, et al. Physiological comparison of high-flow nasal cannula and helmet noninvasive ventilation in acute hypoxemic respiratory failure. Am J Respir Crit Care Med 2020; 201: 303–312.
Schwabbauer N, Berg B, Blumenstock G, et al. 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). BMC Anesthesiol 2014; 14: 66.
Rice TW, Wheeler AP, Bernard GR, et al. Comparison of the SpO2/FiO2 ratio and the PaO2/FiO2 ratio in patients with acute lung injury or ARDS. Chest 2007; 132: 410–417.
Grivans C, Lundin S, Stenqvist O, et al. Positive end-expiratory pressure-induced changes in end-expiratory lung volume measured by spirometry and electric impedance tomography. Acta Anaesthesiol Scand 2011; 55: 1068–1077.
van der Burg PS, Miedema M, de Jongh FH, et al. Cross-sectional changes in lung volume measured by electrical impedance tomography are representative for the whole lung in ventilated preterm infants. Crit Care Med 2014; 42: 1524–1530.