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1.
Isr Med Assoc J ; 22(3): 173-177, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32147983

RESUMO

BACKGROUND: The use of a high flow nasal cannula (HFNC) was examined for different clinical indications in the critically ill. OBJECTIVES: To describe a single center experience with HFNC in post-extubation critical care patients by using clinical indices. METHODS: In this single center study, the authors retrospectively evaluated the outcome of patients who were connected to the HFNC after their extubation in the intensive care unit (ICU). At 48 hours after the extubation, the patients were divided into three groups: the group weaned from HFNC, the ongoing HFNC group, and the already intubated group. RESULTS: Of the 80 patients who were included, 42 patients were without HFNC support at 48 hours after extubation, 22 and 16 patients were with ongoing HFNC support and already intubated by this time frame, respectively. The mean ROX index (the ratio of SpO2 divided by fraction of inspired oxygen to respiratory rate) at 6 hours of the weaned group was 12.3 versus 9.3 in the ongoing HFNC group, and 8.5 in the reintubated group (P = 0.02). The groups were significantly different by the ICU length of stay, tracheostomy rate, and mortality. CONCLUSIONS: Among patients treated with HFNC post-extubation of those who had a higher ROX index were less likely to undergo reintubation.


Assuntos
Extubação , Cuidados Críticos/métodos , Oxigenoterapia/métodos , Oxigenoterapia/estatística & dados numéricos , Insuficiência Respiratória/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Cânula , Estado Terminal , Feminino , Humanos , Unidades de Terapia Intensiva , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Oxigenoterapia/instrumentação , Estudos Retrospectivos , Tempo , Adulto Jovem
2.
Med. infant ; 26(4): 364-367, dic. 2019. ilus, Tab
Artigo em Espanhol | LILACS | ID: biblio-1047049

RESUMO

Introducción: La Oxigenoterapia de Alto Flujo (OAF) es una técnica de soporte respiratorio no invasiva, que ofrece un flujo de aire y oxígeno, caliente y humidificado, por encima del flujo pico inspiratorio del paciente, a través de una cánula nasal. En este artículo se presenta la experiencia con OAF en una sala de pediatría de mediana y baja complejidad para el tratamiento de bronquiolitis/ infección respiratoria aguda baja (IRAB). Materiales y métodos: Se diseñó un protocolo para la implementación de OAF. Criterios de inclusión: Pacientes cursando bronquiolitis/ IRAB con: Score de Tal modificado ≥6, Sat O2 < 92% y/o mala mecánica ventilatoria, a pesar de recibir más de 2 lt/ min de O2 por cánula nasal ó FiO2 >40%. Criterios de exclusión, pCO2 ≥55 mmHg; pH: < 7,20; Apneas ≥20 segundos; Glasgow ≤10; Peso >15 kg. Inestabilidad hemodinámica; Alteraciones craneofaciales. Resultados: En el periodo 2017- 2018 se internaron 441 pacientes con infección respiratoria aguda baja. Se administró OAF a 54 pacientes (12%). La mediana de edad mediana 7,4 meses (r: 27 días-36 meses). Los pacientes ingresados no presentaban comorbilidades asociadas. El 22,2% (12/54) fueron trasladados a UTIP (2,7% del total de los internados). El 64.8% de los pacientes que permanecieron en sala de internación, mostró mejoría en FC y FR a las 4 hs. Por el contrario, en el 75% de los pacientes que requirieron UTIP no se evidenció mejoría en estos parámetros. Conclusiones: La OAF es una alternativa terapéutica que podría disminuir el ingreso a UTIP en pacientes con dificultad respiratoria moderada. En nuestra experiencia resultó fácil de implementar, sin efectos adversos graves (AU)


Introduction: High-flow oxygen (HFO) therapy is a non-invasive oxygen support technique that provides hot and humidified air and oxygen flow above the peak inspiratory flow of the patient through a nasal cannula. In this study we present our experience with HFO on a intermediate and low complexity ward for the treatment of bronchiolitis/acute lower respiratory tract infection (LRTI). Material and methods: A protocol for the implementation of HFO was designed. Inclusion criteria: Patients with bronchiolitis/ALRI with: Modified Tal score ≥6, Sat O2 < 92%, and/or poor ventilatory mechanism, in spite of receiving more than 2 L/ min O2 by nasal cannula or FiO2 >40%. Exclusion criteria: pCO2 ≥55 mmHg; pH: < 7.20; Apnea ≥20 seconds; Glasgow score ≤10; Peso >15 kg. Hemodynamic instability; Craniofacial abnormalities. Results: During 2017- 2018, 441 patients were admitted with LRTI. HFO was administered to 54 patients (12%). Median age was 7.4 months (r: 27 days-36 months). The patients that were included in the study did not have associated morbidities. Overall, 22.2% (12/54) were transferred to the PICU (2.7% of all hospitalized patients). Of the patients who remained on the ward, 64.8% improved FC and FR after 4 hours. On the other hand, in 75% of the patients that required PICU admission these parameters did not improve. Conclusions: HFO is a therapeutic option to decrease PICU admission of patients with moderate respiratory difficulties. The protocol was easy to implement and was not associated with severe adverse effects (AU)


Assuntos
Humanos , Recém-Nascido , Lactente , Pré-Escolar , Oxigenoterapia/instrumentação , Oxigenoterapia/métodos , Infecções Respiratórias/terapia , Bronquiolite/terapia , Estudos Retrospectivos , Cânula
4.
Respir Res ; 20(1): 149, 2019 Jul 12.
Artigo em Inglês | MEDLINE | ID: mdl-31299963

RESUMO

BACKGROUND: Supplemental oxygen therapy is widely used in hospitals and in the home for chronic care. However, there are several fundamental problems with the application of this therapy such that patients are often exposed to arterial oxygen concentrations outside of the intended target range. This paper reports volume-averaged tracheal oxygen concentration measurements (FtO2) from in vitro experiments conducted using a physiologically realistic upper airway model. The goal is to provide data to inform a detailed discussion of the delivered oxygen dose. METHODS: A baseline FtO2 dataset using a standard, straight adult nasal cannula was established by varying tidal volume (Vt), breathing frequency (f), and continuous oxygen flow rate (QO2) between the following levels to create a factorial design: Vt = 500, 640, or 800 ml; f = 12, 17, or 22 min- 1; QO2 = 2, 4, or 6 l/min. Further experiments were performed to investigate the influence on FtO2 of variation in inspiratory/expiratory ratio, inclusion of an inspiratory or expiratory pause, patient interface selection (e.g. nasal cannula versus a facemask), and rapid breathing patterns in comparison with the baseline measurements. RESULTS: Oxygen concentration measured at the trachea varied by as much as 60% (i.e. from 30.2 to 48.0% of absolute oxygen concentration) for the same oxygen supply flow rate due to variation in simulated breathing pattern. Among the baseline cases, the chief reasons for variation were 1) the influence of variation in tidal volume leading to variable FiO2 and 2) variation in breathing frequency affecting volume of supplemental oxygen delivered through the breath. CONCLUSION: For oxygen administration using open patient interfaces there was variability in the concentration and quantity of oxygen delivered to the trachea over the large range of scenarios studied. Of primary importance in evaluating the oxygen dose is knowledge of the breathing parameters that determine the average inhalation flow rate relative to the oxygen flow rate. Otherwise, the oxygen dose cannot be determined.


Assuntos
Pulmão/fisiologia , Modelos Biológicos , Oxigenoterapia/instrumentação , Oxigenoterapia/métodos , Mecânica Respiratória/fisiologia , Humanos , Volume de Ventilação Pulmonar/fisiologia
5.
Int J Chron Obstruct Pulmon Dis ; 14: 1229-1237, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31239658

RESUMO

Background: High-flow nasal cannula (HFNC) oxygen therapy in acute hypoxic respiratory failure is becoming increasingly popular. However, evidence to support the use of HFNC in acute respiratory failure (ARF) with hypercapnia is limited. Methods: Chronic obstructive pulmonary disease (COPD) patients with moderate hypercapnic ARF (arterial blood gas pH 7.25-7.35, PaCO2>50 mmHg) who received HFNC or non-invasive ventilation (NIV) in the intensive care uint from April 2016 to March 2018 were analyzed retrospectively. The endpoint was treatment failure, defined as either invasive ventilation, or a switch to the other study treatment (NIV for patients in the NFNC group, and vice-versa), and 28-day mortality. Results: Eighty-two COPD patients (39 in the HFNC group and 43 in the NIV group) were enrolled in this study. The mean age was 71.8±8.2 and 54 patients (65.9%) were male. The treatment failed in 11 out of 39 patients with HFNC (28.2%) and in 17 of 43 patients with NIV (39.5%) (P=0.268). No significant differences were found for 28-day mortality (15.4% in the HFNC group and 14% in the NIV group, P=0.824). During the first 24 hrs of treatment, the number of nursing airway care interventions in the HFNC group was significantly less than in the NIV group, while the duration of device application was significantly longer in the HFNC group (all P<0.05). Skin breakdown was significantly more common in the NIV group (20.9% vs 5.1%, P<0.05). Conclusion: Among COPD patients with moderate hypercarbic ARF, the use of HFNC compared with NIV did not result in increased rates of treatment failure, while there were fewer nursing interventions and skin breakdown episodes reported in the HFNC group.


Assuntos
Cânula , Hipercapnia/terapia , Pulmão/fisiopatologia , Ventilação não Invasiva , Oxigenoterapia/instrumentação , Doença Pulmonar Obstrutiva Crônica/terapia , Insuficiência Respiratória/terapia , Administração Intranasal , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Hipercapnia/diagnóstico , Hipercapnia/mortalidade , Hipercapnia/fisiopatologia , Masculino , Pessoa de Meia-Idade , Ventilação não Invasiva/efeitos adversos , Ventilação não Invasiva/mortalidade , Oxigenoterapia/efeitos adversos , Oxigenoterapia/mortalidade , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/mortalidade , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Insuficiência Respiratória/diagnóstico , Insuficiência Respiratória/mortalidade , Insuficiência Respiratória/fisiopatologia , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Falha de Tratamento
6.
Trials ; 20(1): 336, 2019 Jun 08.
Artigo em Inglês | MEDLINE | ID: mdl-31176375

RESUMO

BACKGROUND: The benefit of pulmonary rehabilitation (PR) in symptomatic chronic obstructive pulmonary disease (COPD) is well known. However, advanced patients with chronic respiratory failure (CRF), a category excluded from most studies, are frequently unable to sustain a work-load sufficiently high to obtain the full benefit of PR on exercise tolerance. Recent studies involving heated and humidified high flow oxygen therapy (HFOT) showed positive effects on breathing pattern and ventilatory efficiency during effort. We thus plan to compare, in COPD patients with CRF undergoing a high-intensity exercise programme, the effect of using HFOT versus standard oxygen delivery via Venturi Mask (V-mask), at the same inspiratory oxygen fraction, on improving exercise endurance. METHODS/DESIGN: This is a multicentre randomised controlled trial that will involve 156 COPD inpatients with CRF recruited from seven PR hospitals. Patients will be randomised to one of two groups - V-mask versus HFOT. All patients will undergo the same high-intensity exercise programme using either of the oxygen delivery devices as per their group allocation. Training will consist of 20 sessions, over 1 month (5 sessions per week) within the hospitalisation period. Anthropometric and clinical data, including body mass index, diagnosis, spirometry and comorbidities (Cumulative Rating Scale) will be collected at baseline. At baseline and at the end of the exercise programme (primary assessment time) evaluation will include exercise tolerance (Constant Work Rate Exercise Test) (primary outcome), functional capacity (6-min walk test), maximal inspiratory pressure/maximal expiratory pressure, peripheral muscle strength (biceps and quadriceps) by manual dynamometer, respiratory exchanges (blood gases analysis), disability (Barthel Index and Barthel Dyspnoea Index), impact of disease (COPD Assessment test), and quality of life (Maugeri Respiratory Failure Scale-26). At the end of the training period, patient satisfaction will be evaluated. DISCUSSION: This study will add knowledge about the exercise response in advanced COPD with CRF and verify if an alternative tool, namely HFOT, can increase the benefit obtained from PR. TRIAL REGISTRATION: ClinicalTrials.gov ID NET03322787 Registered: 6 November 2017.


Assuntos
Cânula , Terapia por Exercício , Tolerância ao Exercício , Pulmão/fisiopatologia , Oxigenoterapia/instrumentação , Doença Pulmonar Obstrutiva Crônica/terapia , Respiração , Insuficiência Respiratória/terapia , Administração Intranasal , Humanos , Itália , Estudos Multicêntricos como Assunto , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Recuperação de Função Fisiológica , Insuficiência Respiratória/diagnóstico , Insuficiência Respiratória/fisiopatologia , Fatores de Tempo , Resultado do Tratamento
8.
Crit Care ; 23(1): 180, 2019 05 17.
Artigo em Inglês | MEDLINE | ID: mdl-31101127

RESUMO

BACKGROUND: The effect of high-flow nasal cannula (HFNC) therapy in patients after planned extubation remains inconclusive. We aimed to perform a rigorous and comprehensive systematic meta-analysis to robustly quantify the benefits of HFNC for patients after planned extubation by investigating postextubation respiratory failure and other outcomes. METHOD: We searched MEDLINE, EMBASE, Web of Science, and the Cochrane Library from inception to August 2018. Two researchers screened studies and collected the data independently. Randomized controlled trials (RCTs) and crossover studies were included. The main outcome was postextubation respiratory failure. RESULTS: Ten studies (seven RCTs and three crossover studies; HFNC group: 856 patients; Conventional oxygen therapy (COT) group: 852 patients) were included. Compared with COT, HFNC may significantly reduce postextubation respiratory failure (RR, 0.61; 95% CI, 0.41, 0.92; z = 2.38; P = 0.02) and respiratory rates (standardized mean differences (SMD), - 0.70; 95% CI, - 1.16, - 0.25; z = 3.03; P = 0.002) and increase PaO2 (SMD, 0.30; 95% CI, 0.04, 0.56; z = 2.23; P = 0.03). There were no significant differences in reintubation rate, length of ICU and hospital stay, comfort score, PaCO2, mortality in ICU and hospital, and severe adverse events between HFNC and COT group. CONCLUSIONS: Our meta-analysis demonstrated that compared with COT, HFNC may significantly reduce postextubation respiratory failure and respiratory rates, increase PaO2, and be safely administered in patients after planned extubation. Further large-scale, multicenter studies are needed to confirm our results.


Assuntos
Cânula/normas , Oxigenoterapia/instrumentação , Oxigênio/administração & dosagem , Extubação/métodos , Humanos , Ventilação não Invasiva/instrumentação , Ventilação não Invasiva/métodos , Ventilação não Invasiva/normas , Oxigênio/uso terapêutico , Oxigenoterapia/métodos , Recidiva , Desmame do Respirador/métodos
9.
S Afr Med J ; 109(4): 272-277, 2019 Mar 29.
Artigo em Inglês | MEDLINE | ID: mdl-31084694

RESUMO

BACKGROUND: High-flow nasal cannula (HFNC) oxygen is a non-invasive alternative to nasal continuous positive airway pressure (CPAP) therapy for infants and children requiring respiratory support. There is a paucity of data to support its use in children, with no published data from sub-Saharan Africa. OBJECTIVES: To describe the outcomes of and adverse events related to HFNC in the first year of its use in a level 2 (L2) general paediatric ward, and to compare these outcomes with those of a historical cohort when this intervention was unavailable. METHODS: This retrospective descriptive study included children aged <13 years who received HFNC in the first 12 months after its introduction (HFNC-availability group, n=66). Demographic data, clinical characteristics and outcomes (death, treatment failure, length of HFNC and HFNC-related adverse events) were assessed. A comparative description of children who required transfer to level 3 (L3) for any form of respiratory support (other than the available standard low-flow oxygen) during the 12-month period prior to HFNC availability (pre-HFNC group, n=54) was made. All analyses were performed in the paediatric wards, New Somerset Hospital, Cape Town, South Africa. Outcomes were compared using standard descriptive and comparative statistics. RESULTS: The median age of the cohort was 5 months (interquartile range (IQR) 1.9 - 14.6). Sixteen children (13.3%) were malnourished, 10 (8.3%) were HIV-infected, and 30 (25.0%) had been born prematurely. The most common diagnoses were pneumonia, bronchiolitis and asthma. Asthma, anaemia and cardiac abnormalities were the most prevalent underlying comorbidities. Two children died in each group. All 54 children in the pre-HFNC group were transferred to L3; 38 (70.4%) needed CPAP or invasive ventilation. In the HFNC-availability period, 85 children were assessed as needing more than standard low-flow oxygen therapy: of the 19 immediately transferred to L3, 17 (89.4%) received CPAP or invasive ventilation; of the 66 who received HFNC at L2, 16 (24.2%) subsequently required transfer to L3 for CPAP or invasive ventilation. The median duration of HFNC was 46.3 hours (IQR 19.5 - 93.5) overall, and it was 12 hours (IQR 4 - 28) and 58.5 hours (IQR 39.5 - 106) for those who failed or were successfully managed on HFNC, respectively. No HFNC-related serious adverse events were recorded. CONCLUSIONS: HFNC is a safe, effective, feasible option for non-invasive ventilation of children with respiratory illnesses in a resource-limited L2 setting. A greater proportion of children with lower respiratory tract infections in the HFNC-availability group than in the pre-HFNC group required support, but the intervention reduced the bed pressure on L3. Improved ways to identify HFNC failures would be beneficial.


Assuntos
Oxigenoterapia/métodos , Doenças Respiratórias/terapia , Adolescente , Cânula , Criança , Pré-Escolar , Pressão Positiva Contínua nas Vias Aéreas , Feminino , Hospitalização , Humanos , Lactente , Recém-Nascido , Masculino , Oxigenoterapia/instrumentação , Doenças Respiratórias/mortalidade , Estudos Retrospectivos , África do Sul , Resultado do Tratamento
10.
Trials ; 20(1): 195, 2019 Apr 04.
Artigo em Inglês | MEDLINE | ID: mdl-30947740

RESUMO

BACKGROUND: Maintaining adequate oxygenation during rapid sequence intubation (RSI) is imperative to prevent peri-intubation adverse events that can lead to increased duration of hospital and intensive care unit stay, or a prolonged vegetative state requiring long-term institutionalisation. Despite employing current best practices during RSI, desaturation during intubation still occurs. High-flow nasal cannula (HFNC) oxygenation may potentially improve oxygenation during pre- and apnoeic oxygenation to allow a longer safe apnoeic time for RSI. OBJECTIVE: We aim to test the hypothesis that the use of humidified high-flow oxygenation via nasal cannula at 60 L/min maintains higher oxygen saturation compared with current usual care of non-rebreather mask and standard nasal cannula at an oxygen flow rate of 15 L/min for pre- and apnoeic oxygenation. METHODS: This is a multi-centre randomised controlled trial enrolling adult patients aged 21 years and older who require rapid sequence intubation due to medical, surgical, or traumatic conditions in the Emergency Departments (EDs) of the National University Hospital and the Ng Teng Fong General Hospital. Eligible patients will undergo randomisation at an equal ratio into intervention or control arms. The primary endpoint will be the lowest oxygen saturation achieved during the first intubation attempt from time of administration of paralytic agent until quantitative end-tidal carbon dioxide is detected if the first intubation attempt is successful, or until the start of the second attempt if it is not. DISCUSSION: Prolongation of safe apnoea time through maintenance of oxygen saturation above 90% using HFNC oxygenation during RSI could potentially change current clinical practice, improve standard of care, and translate to better outcomes for patients. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03396094 . Registered on 10 January 2018.


Assuntos
Apneia/fisiopatologia , Intubação Intratraqueal/métodos , Pulmão/fisiopatologia , Oxigenoterapia/métodos , Respiração Artificial , Cânula , Estado Terminal , Serviço Hospitalar de Emergência , Feminino , Humanos , Intubação Intratraqueal/efeitos adversos , Masculino , Estudos Multicêntricos como Assunto , Oxigenoterapia/efeitos adversos , Oxigenoterapia/instrumentação , Ensaios Clínicos Controlados Aleatórios como Assunto , Respiração Artificial/efeitos adversos , Singapura , Fatores de Tempo , Resultado do Tratamento
11.
BMJ Case Rep ; 12(3)2019 Mar 05.
Artigo em Inglês | MEDLINE | ID: mdl-30842134

RESUMO

Intubating a neonate under non-emergent conditions may be quite stressful, even for experienced providers, due to the potential for rapid oxygen desaturation. Pulmonary physiology and increased metabolic oxygen demand in this patient population contribute to accelerated oxygen desaturation during induction of anaesthesia and intubation. Using a nasal cannula, placed prior to induction of anaesthesia and left in place until the airway is secured, is a simple and effective way to provide apneic oxygenation and may help maintain adequate oxygen saturation. This technique may be particularly useful for patients who require additional time for intubation, including those with suspected difficult airways.


Assuntos
Manuseio das Vias Aéreas/métodos , Apneia/terapia , Cânula , Hipóxia/prevenção & controle , Intubação Intratraqueal/instrumentação , Oxigenoterapia/instrumentação , Anormalidades Múltiplas , Apneia/fisiopatologia , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Intubação Intratraqueal/métodos , Oxigenoterapia/métodos , Resultado do Tratamento
12.
J Vet Emerg Crit Care (San Antonio) ; 29(3): 246-255, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30861261

RESUMO

OBJECTIVE: To determine the feasibility, degree of respiratory support, and safety of high flow nasal cannula (HFNC) oxygen therapy in sedated and awake healthy dogs, when compared to traditional nasal cannula (TNC) oxygen administration. DESIGN: Randomized experimental crossover study. SETTING: University research facility. ANIMALS: Eight healthy dogs. INTERVENTIONS: Variable flow rates (L/kg/min) were assessed, TNC: 0.1, 0.2, and 0.4 and HFNC: 0.4, 1.0, 2.0, and 2.5. HFNC was assessed in sedated and awake dogs. MEASUREMENTS: Variables measured included: inspiratory/expiratory airway pressures, fraction of inspired oxygen (FiO2 ), end-tidal oxygen (ETO2 ), end-tidal carbon dioxide (ETCO2 ), partial pressure of oxygen (PaO2 ), partial pressure of carbon dioxide (PaCO2 ), temperature, heart/respiratory rate, arterial blood pressure, and pulse oximetry. Sedation status, complications, and predefined tolerance and respiratory scores were recorded. MAIN RESULTS: Using HFNC, continuous positive airway pressure (CPAP) was achieved at 1 and 2 L/kg/min. CPAP was not higher at 2.5 than 2 L/kg/min, with worse tolerance scores. Expiratory airway pressures were increased when sedated (P = 0.006). FiO2 at 0.4 L/kg/min for both methods was 72%. FiO2 with TNC 0.1 L/kg/min was 27% and not different from room air. The FiO2 at all HFNC flow rates ≥1 L/kg/min was 95%. PaO2 for HFNC 0.4 L/kg/min was lower than at other flow rates (P = 0.005). The only noted complication was aerophagia. PaCO2 was increased with sedation and use of HFNC when compared to baseline (P = 0.006; P < 0.01). CONCLUSIONS: Use of HFNC in dogs is feasible and safe, provides predictable oxygen support and provides CPAP, but may cause a mild increase in PaCO2 . Flow rates of 1-2 L/kg/min are recommended. If using TNC, flow rates above 0.1 L/kg/min may attain higher FiO2 .


Assuntos
Cânula/veterinária , Cães/fisiologia , Oxigenoterapia/veterinária , Oxigênio/administração & dosagem , Animais , Pressão Positiva Contínua nas Vias Aéreas/veterinária , Cuidados Críticos/métodos , Estudos Cross-Over , Feminino , Masculino , Oximetria/veterinária , Oxigenoterapia/instrumentação , Estudos Prospectivos , Troca Gasosa Pulmonar/fisiologia , Distribuição Aleatória , Valores de Referência , Resultado do Tratamento
13.
Can Respir J ; 2019: 4901049, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30863468

RESUMO

Background and Objectives: Despite its' proven benefits, oxygen therapy may be complicated with potential adverse events such as hypoxemia or hyperoxia-driven hypercapnia. Automated oxygen delivery systems may aid in avoiding these complications. The scope of the present study is to test the efficacy and safety of a new automated oxygen delivery device. Methods: This study included 23 patients with acute respiratory failure (ARF) hospitalized in the Respiratory Medicine Department of the University Hospital of Larissa. Both patients with purely hypoxemic or hypercapnic ARF were included. Automated oxygen administration was performed with Digital Oxygen Therapy, a new closed-loop system designed to automatically adjust oxygen flow according to target oxygen saturation (SpO2) of 88-92% for hypercapnic patients and 92-96% for purely hypoxemic patients with ARF. The device was applied for 4 hours. Arterial blood gas analysis was performed at 1 hour and 3 hours following the device application. Results: Mean age was 72.91 ± 13.91 years. Twelve patients were male, and 11 were female. The majority of patients suffered from hypercapnic respiratory failure (n=13, 56.5%). At 1 hour and 3 hours, SpO2 and PaO2 displayed excellent correlation (p < 0.001, r = 0.943, and p < 0.001, r = 0.954, respectively). We did not observe any adverse events associated with the device. Conclusions: Our results indicate that automated oxygen treatment is feasible and safe in hospitalized patients with acute respiratory failure. Further studies are required in order to assess the long-term effects of automated oxygen delivery systems.


Assuntos
Oxigenoterapia/instrumentação , Oxigênio/administração & dosagem , Insuficiência Respiratória/terapia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Pacientes Internados , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Estudos Prospectivos
14.
Crit Care ; 23(1): 68, 2019 Feb 28.
Artigo em Inglês | MEDLINE | ID: mdl-30819227

RESUMO

BACKGROUND: Data on high-flow nasal oxygen after thoracic surgery are limited and confined to the comparison with low-flow oxygen. Different from low-flow oxygen, Venturi masks provide higher gas flow at a predetermined fraction of inspired oxygen (FiO2). We conducted a randomized trial to determine whether preemptive high-flow nasal oxygen reduces the incidence of postoperative hypoxemia after lung resection, as compared to Venturi mask oxygen therapy. METHODS: In this single-center, randomized trial conducted in a teaching hospital in Italy, consecutive adult patients undergoing thoracotomic lung resection, who were not on long-term oxygen therapy, were randomly assigned to receive high-flow nasal or Venturi mask oxygen after extubation continuously for two postoperative days. The primary outcome was the incidence of postoperative hypoxemia (i.e., ratio of the partial pressure of arterial oxygen to FiO2 (PaO2/FiO2) lower than 300 mmHg) within four postoperative days. RESULTS: Between September 2015 and April 2018, 96 patients were enrolled; 95 patients were analyzed (47 in high-flow group and 48 in Venturi mask group). In both groups, 38 patients (81% in the high-flow group and 79% in the Venturi mask group) developed postoperative hypoxemia, with an unadjusted odds ratio (OR) for the high-flow group of 1.11 [95% confidence interval (CI) 0.41-3] (p = 0.84). No inter-group differences were found in the degree of dyspnea nor in the proportion of patients needing oxygen therapy after treatment discontinuation (OR 1.34 [95% CI 0.60-3]), experiencing pulmonary complications (OR 1.29 [95% CI 0.51-3.25]) or requiring ventilatory support (OR 0.67 [95% CI 0.11-4.18]). Post hoc analyses revealed that PaO2/FiO2 during the study was not different between groups (p = 0.92), but patients receiving high-flow nasal oxygen had lower arterial pressure of carbon dioxide, with a mean inter-group difference of 2 mmHg [95% CI 0.5-3.4] (p = 0.009), and were burdened by a lower risk of postoperative hypercapnia (adjusted OR 0.18 [95% CI 0.06-0.54], p = 0.002). CONCLUSIONS: When compared to Venturi mask after thoracotomic lung resection, preemptive high-flow nasal oxygen did not reduce the incidence of postoperative hypoxemia nor improved other analyzed outcomes. Further adequately powered investigations in this setting are warranted to establish whether high-flow nasal oxygen may yield clinical benefit on carbon dioxide clearance. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02544477 . Registered 9 September 2015.


Assuntos
Pulmão/cirurgia , Oxigenoterapia/instrumentação , Oxigenoterapia/métodos , Idoso , Gasometria/estatística & dados numéricos , Feminino , Humanos , Itália , Masculino , Máscaras/normas , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Troca Gasosa Pulmonar/fisiologia , Procedimentos Cirúrgicos Torácicos/métodos , Resultado do Tratamento
15.
Curr Opin Anaesthesiol ; 32(2): 150-155, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30817387

RESUMO

PURPOSE OF REVIEW: High-flow nasal cannula oxygen therapy (HFOT) is becoming an alternative to noninvasive ventilation (NIV) and standard oxygen in management of patients with acute respiratory failure. RECENT FINDINGS: Patients with de novo acute respiratory failure should be managed with HFOT rather than NIV. Indeed, the vast majority of patients with de novo respiratory failure meet the criteria for ARDS, and NIV does not seem protective, as patients generate overly high tidal volume that may worsen underlying lung injury. However, NIV remains the first-line oxygenation strategy in postoperative patients and those with acute hypercapnic respiratory failure when pH is equal to or below 7.35. During preoxygenation, NIV also seems to be more efficient than standard oxygen using valve-bag mask to prevent profound oxygen desaturation. In postoperative cardiothoracic patients, HFOT could be an alternative to NIV in the management of acute respiratory failure. SUMMARY: Recent recommendations for managing patients with acute respiratory failure have been established on the basis of studies comparing NIV with standard oxygen. Growing use of HFOT will lead to new studies comparing NIV versus HFOT in view of more precisely defining the appropriate indications for each treatment.


Assuntos
Lesão Pulmonar Aguda/prevenção & controle , Cuidados Críticos/métodos , Ventilação não Invasiva/efeitos adversos , Oxigenoterapia/métodos , Síndrome do Desconforto Respiratório do Adulto/terapia , Lesão Pulmonar Aguda/etiologia , Lesão Pulmonar Aguda/fisiopatologia , Cânula , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Ventilação não Invasiva/instrumentação , Ventilação não Invasiva/métodos , Nariz , Oxigenoterapia/efeitos adversos , Oxigenoterapia/instrumentação , Seleção de Pacientes , Síndrome do Desconforto Respiratório do Adulto/fisiopatologia , Volume de Ventilação Pulmonar/fisiologia , Resultado do Tratamento
19.
Arch Dis Child Fetal Neonatal Ed ; 104(4): F360-F365, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30154236

RESUMO

OBJECTIVE: To assess the efficacy of a newly developed system for closed loop control of the fraction of inspired oxygen (FiO2) on variation of arterial (SpO2) and on regional tissue oxygen saturation (StO2) in preterm infants with fluctuations in SpO2. DESIGN: Randomised crossover trial comparing automated (auto) to manual FiO2 adjustment (manual) during two consecutive 24 hours periods using a Sophie infant ventilator (SPO2C). SETTING: Tertiary university medical centre. PATIENTS: Twelve very low birthweight infant (VLBWI) (gestational age (median; IQR): (25; 23-26 weeks); birth weight (mean±SD): (667±134 g); postnatal age (mean±SD): (31.5±14 days)). MAIN OUTCOME MEASURE: Time within SpO2 target range. RESULTS: There was an increase in time within the intended SpO2 target range (88%-96%) during auto as compared with manual mode (77.8%±7.1% vs 68.5%±7.7% (mean±SD), p<0.001) and a decrease in time below the SpO2 target during the auto period (18.1%±6.4% vs 25.6%±7.6%; p<0.01). There was a dramatic reduction in events with an SpO2 <88% with >180 s duration: (2 (0-10) vs 10 (0-37) events, p<0.001) and the need for manual adjustments. The time the infants spent above the intended arterial oxygen range (4.1%±3.8% vs 5.9%±3.6%), median FiO2, mean SpO2 over time and StO2 in the brain, liver and kidney did not differ significantly between the two periods. CONCLUSIONS: Closed-loop FiO2 using SPO2C significantly increased time of arterial SpO2 within the intended range in VLBWI and decreased the need for manual adjustments when compared with the routine adjustment by staff members. StO2 was not significantly affected by the mode of oxygen control.


Assuntos
Hipóxia Encefálica/terapia , Doenças do Prematuro/terapia , Recém-Nascido de muito Baixo Peso , Oxigenoterapia/instrumentação , Oxigênio/uso terapêutico , Respiração Artificial/métodos , Estudos Cross-Over , Feminino , Humanos , Unidades de Terapia Intensiva Neonatal , Masculino
20.
Arch Dis Child Fetal Neonatal Ed ; 104(3): F321-F323, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30232093

RESUMO

High flow therapy works partly by washout of airway dead space, the volume of which has not been quantified in newborns. This observational study aimed to quantify airway dead space in infants and to compare efficacy of washout between high flow devices in three-dimensional (3D) printed airway models of infants weighing 2.5-3.8 kg. Nasopharyngeal airway dead space volume was 1.5-2.0 mL/kg in newborns. A single cannula device produced lower carbon dioxide (CO2) levels than a dual cannula device (33.7, 31.2, 23.1, 15.9, 10.9 and 6.3 mm Hg vs 36.8, 35.5, 32.1, 26.8, 23.1 and 18.8 mm Hg at flow rates of 1, 2, 3, 4, 6 and 8 L/min, respectively; p<0.0001 at all flow rates). Airway pressure was 1 mm Hg at all flow rates with the single cannula but increased at higher flow rates with the dual cannula.Relative nasopharyngeal airway dead space volume is increased in newborns. In 3D-printed airway models, a single cannula high flow device produces improved CO2 washout with lower airway pressure.


Assuntos
Modelos Anatômicos , Oxigenoterapia/instrumentação , Impressão Tridimensional , Espaço Morto Respiratório/fisiologia , Dióxido de Carbono/análise , Pressão Positiva Contínua nas Vias Aéreas/efeitos adversos , Pressão Positiva Contínua nas Vias Aéreas/instrumentação , Pressão Positiva Contínua nas Vias Aéreas/métodos , Humanos , Recém-Nascido , Cavidade Nasal , Nasofaringe/diagnóstico por imagem , Nasofaringe/fisiologia , Oxigenoterapia/efeitos adversos , Oxigenoterapia/métodos , Respiração por Pressão Positiva Intrínseca/etiologia , Volume de Ventilação Pulmonar/fisiologia , Tomografia Computadorizada por Raios X
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