High flow nasal cannula combined with non-invasive ventilation versus high flow nasal cannula alone in patients with acute hypoxemic respiratory failure due to pneumonia: a randomized controlled trial

Submitted: 15 December 2022
Accepted: 14 February 2023
Published: 28 March 2023
Abstract Views: 963
PDF: 442
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

Authors

In this monocentric, open label, randomized controlled trial we aimed to compare the efficacy of combined High Flow Nasal Cannula (HFNC) and Non invasive Ventilation (NIV) versus HFNC alone in acute hypoxemic respiratory failure (hARF) in patients affected by Community Acquired Pneumonia (CAP). We enrolled 49 patients affected by CAP with moderate to severe hypoxemic respiratory failure (P/F < 300). The patients were randomized into two groups: one has been treated with HFNC alone (group A) while the other received NIV alternated to HFNC every 3 hours (group B). The primary outcome was P/F change from baseline to 21 hours. Secondary outcomes included variation of pH and pCO2, need to continue HFNC or NIV/HFNC after 45 hours, orotracheal intubation, mortality rate, and the devices comfort. Not statistical significant differences between the two arms were shown in the P/F change at 21 hours since baseline, in pCO2 and pH variation, mortality at hospital and at follow-up. We emphasize the importance of combined HFNC with NIV as a first step for severe pneumonia treatment whereas HFNC might represent as the first step treatment in less severe patients and during the NIV intervals.

Dimensions

Altmetric

PlumX Metrics

Downloads

Download data is not yet available.

Citations

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. DOI: https://doi.org/10.1183/13993003.02426-2016
Carrillo A, Gonzalez-Diaz G, Ferrer M, et al. Non-invasive ventilation in community-acquired pneumonia and severe acute respiratory failure. Intensive care Med 2012;38:458-66. DOI: https://doi.org/10.1007/s00134-012-2475-6
Confalonieri M, Potena A, Carbone G, et al. Acute respiratory failure in patients with severe community-acquired pneumonia: a prospective randomized evaluation of noninvasive ventilation. Am J Respir Crit Care Med 1999;160:1585-91. DOI: https://doi.org/10.1164/ajrccm.160.5.9903015
Holleman-Duray D, Kaupie D, Weiss MG. Heated humidified high-flow nasal cannula: use and a neonatal early extubation protocol. J Perinatol 2007;27:776–81. DOI: https://doi.org/10.1038/sj.jp.7211825
Spentzas T, Minarik M, Patters AB et al. Children with respiratory distress treated with high-flow nasal cannula. J Intensive Care Med 2009;24:323–28. DOI: https://doi.org/10.1177/0885066609340622
Drake MG. High-flow nasal cannula oxygen in adults: an evidence-based assessment. Ann Am Thorac Soc 2008;15:145-55. DOI: https://doi.org/10.1513/AnnalsATS.201707-548FR
Bottani G, Centurioni, F, Veronese G, et al. Current application of high flow oxygen nasal cannula in acute hypoxemic respiratory failure in the emergency department. Emerg Care J 2018;13:7036. DOI: https://doi.org/10.4081/ecj.2017.7036
Nishimura M. High-flow nasal cannula oxygen therapy in adults: physiological benefits, indication, clinical benefits, and adverse effects. Respir Care 2016;61:529-41. DOI: https://doi.org/10.4187/respcare.04577
Parke, RL. Pressures delivered by nasal high flow oxygen during all phases of the respiratory cycle. Respir Care 2013;10:1621-24. DOI: https://doi.org/10.4187/respcare.02358
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. DOI: https://doi.org/10.1093/bja/aer265
Nuttapol R, Tscheikuna J, Praphruetkit N, Kijpinyochai S. Use of high-flow nasal cannula for acute dyspnea and hypoxemia in the emergency department. Resp Care 2015;60:1377-82. DOI: https://doi.org/10.4187/respcare.03837
Nava S, Hill N. Non-invasive ventilation in acute respiratory failure. Lancet 2009;374:250-59. DOI: https://doi.org/10.1016/S0140-6736(09)60496-7
Lari F, Scandellari N, De Maria, et al. Non-invasive mechanic ventilation in treating acute respiratory failure. Emerg Care J 2009;5:8-20. DOI: https://doi.org/10.4081/ecj.2009.6.8
Carron M, Freo U, Zorzi M, Ori C. Predictors of failure of noninvasive ventilation in patients with severe community-acquired pneumonia. J Crit Care 2010;25:540-e9-14. DOI: https://doi.org/10.1016/j.jcrc.2010.02.012
Grieco D L, Maggiore S M, Roca O, et al. Non-invasive ventilatory support and high-flow nasal oxygen as first-line treatment of acute hypoxemic respiratory failure and ARDS. Intensive Care Med 2021;47:851-66. DOI: https://doi.org/10.1007/s00134-021-06459-2
Ricard JC. High flow nasal oxygen in acute respiratory failure. Minerva Anestesiol 2012;78:836-41.
Greene KE, Peters JL. Pathophysiology of acute respiratory failure. Clinics Chest Med 1994;15:1-12. DOI: https://doi.org/10.1016/S0272-5231(21)01052-2
Parke R, McGuinnes S, Eccleston M. Nasal high-flow therapy delivers low level positive airway pressure. Br J Anaesth 2009;103:886-90. DOI: https://doi.org/10.1093/bja/aep280
Ritchie J E, Williams A B, Gerard C, Hockey H. Evaluation of a humidified nasal high-flow oxygen system, using oxygraphy, capnography and measurement of upper airway pressures. Anaesth Intensive Care 2011;39:1103-10 DOI: https://doi.org/10.1177/0310057X1103900620
Paolini V, Faverio P, Aliberti S, et al. Positive end expiratory pressure in acute hypoxemic respiratory failure due to community acquired pneumonia: do we need a personalized approach? Peer J 2018;30;6:e4211 DOI: https://doi.org/10.7717/peerj.4211
MacIntyre, Neil R. Physiologic effects of noninvasive ventilation. Respir Care 2019;64:617-28. DOI: https://doi.org/10.4187/respcare.06635
Frat JP, Thille AW, Mercat A, et al. High-flow oxygen through nasal cannula in acute hypoxemic respiratory failure. N Engl J Med 2015;372:2185-96. DOI: https://doi.org/10.1056/NEJMoa1503326

How to Cite

Ghezzi, L., Graziano, F., Bottani, G., Marullo, G., Capsoni, N., Forni, E., Vincenti, F., Rebora, P., & Bellone, A. (2023). High flow nasal cannula combined with non-invasive ventilation versus high flow nasal cannula alone in patients with acute hypoxemic respiratory failure due to pneumonia: a randomized controlled trial. Emergency Care Journal, 19(1). https://doi.org/10.4081/ecj.2023.11088