High Flow Oxygen Therapy In Respiratory Failure

Year 2018, Volume: 10 Issue: 3, 12 - 18, 08.05.2018

Uzm. Dr. Seçil Kezer

Abstract

Abstract

High-flow nasal cannula oxygen therapy is one of the new treatment modalities thatreduce to need for invasive mechanical ventilation in moderate hypoxemic respiratoryfailure. High flow oxygen therapy was performed in three patients with acute bronchiolitis, one patient with severe left ventricular outflow tract obstruction and pulmonary edema and one patient with chemical pneumonia secondary to paraffin oil ingestion. The ages of the patients were between 3 months to 3 years. At the beginning oftherapy, the flow rate was generally set as 8-10 L per min (maximum: 15 L per min)and the fraction inspiratory oxygen concentration was set as 40%. At the second hourof high flow oxygen therapy heart rate and respiratory rate was decreased 20% and 27%,respectively. There was 93% improvement in SpO2/FiO2 at the second hour of therapy.Duration of treatment was 3.6 days.

Conclusions:High flow oxygen therapy should safely consider in the management of moderate hypoxemic respiratory failure. The most important approach during high flow oxygen therapy is monitoring the improvement in vital signs and SpO2/FiO2ratio especially atthe first hours of treatment.

Keywords

High Flow Oxygen, NasalCannula, Hypoxemic Respiratory Failure

Solunum Yetersizliğinde Yüksek Akım Oksijen Tedavisi

Abstract

Öz

Yüksek akımlı oksijen tedavisi, orta ciddiyetteki solunum yetersizliğinde invazif mekanik ventilasyon gereksinimini azaltan yeni tedavi yaklaşımlarındandır. Yaşları 3 ay ile 3 yaş arasında değişen akut solunum yetersizliği tanılı beş hastada yüksek akımlı oksijen tedavisi uyguladık. Üç olgu bronşiyolit, bir olgu gazyağı alımı sonrası gelişen şimik pnömoni ve bir olgu da sol ventrikül çıkım yolu darlığı ve akciğer ödemi tablosunda idi. Tedavi başlangıcında ortalama akım hızı 8-10 L/dakika (maksimum 15 L/dakika) ve fraksiyone inspiratuvar oksijen konsantrasyonu %40 olarak uygulandı. Tedavi ikinci saatinde kalp hızı ve solunum hızında sırasıyla %20, %27azalma, SpO2/FiO2 oranında %93 artış oldu. Yüksek akımlı oksijen tedavisi ortalama 3.6 gün uygulandı.

Sonuçlar:Yüksek akımlı oksijen tedavisi orta ciddiyetteki hipoksemik solunum yetersizliğinde güvenle uygulanabilir. Tedavi etkinliğini gösteren önemli değişkenler, kalp tepe atımı ve dakika solunum sayısında azalma ve SpO2/FiO2oranında artıştır.

Keywords

Yüksek Akım Oksijen, NazalKanül, Hipoksemik SolunumYetersizliği

References

• Kaynaklar 1. Pham TM, O'Malley L, Mayfield S, Martin S, SchiblerA. The effect of high flow nasal cannula therapy on thework of breathing in infants with bronchiolitis. PediatrPulmonol. 2014 May 21. doi: 10.1002/ppul.23060. 2.Mayfield S, Jauncey-Cooke J, Hough JL, Schibler A, Gib-bons K, Bogossian F. High-flow nasal cannula therapy for respiratory support in children. Cochrane Databa-se Syst Rev. 2014; 3: CD009850. 3.Courtney SE, Pyon KH, Saslow JG, Arnold GK, PanditPB, Habib RH. Lung recruitment and breathing patternduring variable versus continuous flow nasal continu-ous positive airway pressure in premature infants: an eva-luation of three devices. Pediatrics 2001; 107: 304-308. 4.Richardson CP, Jung AL. Effects of continuous positi-ve airway pressure on pulmonary function and blood ga-ses of infants with respiratory distress syndrome. Pedi-atr Res 1978; 12: 771-74. 5.Saunders RA, Milner AD, Hopkin IE. The effects of conti-nuous positive airway pressure on lung mechanics and lungvolumes in the neonate. Biol Neonate 1976; 29: 178-86. 6.Milési C, Boubal M, Jacquot A, et al. High-flow nasalcannula: recommendations for daily practice in pediat-rics. Ann Intensive Care 2014; 4: 29. 7.Wilkinson DJ, Andersen CC, Smith K, Holberton J.Pharyngeal pressure with high-flow nasal cannulae inpremature infants. J Perinatol 2008; 28: 42-47. 8.Matthay MA. Saving lives with high-flow nasal oxygen.N Engl J Med 2015; 372: 2225-26. 9.Milési C, Baleine J, Matecki S, et al. Is treatment witha high flow nasal cannula effective in acute viralbronchiolitis? A physiologic study. Intensive Care Med2013; 39: 1088-94. 10.Fontanari P, Burnet H, Zattara-Hartmann MC, JammesY. Changes in airway resistance induced by nasal inha-lation of cold dry, dry, or moist air in normal individu-als. J Appl Physiol 1996; 81: 1739-43. 11.Spentzas T, Minarik M, Patters AB, Vinson B, StidhamG. Children with respiratory distress treated with high-flow nasal cannula. J Intensive Care Med 2009; 24: 323-28. 12.Dysart K, Miller TL, Wolfson MR, Shaffer TH. Researchin high flow therapy: mechanisms of action. Respir Med2009; 103: 1400-405. 13.Roca O, Riera J, Torres F, Masclans JR. High-flow oxy-gen therapy in acute respiratory failure. Respir Care2010; 55: 408-13. 14.Yong S, Chen S, Boo N. Incidence of nasal trauma as-sociated with nasal prong versus nasal mask during con-tinuous positive airway pressure treatment in very lowbirthweight infants: a randomised control study. ArchDis Child Fetal Neonatal Ed 2005; 90: 480-83. 15.Ward JJ. High-flow oxygen administration by nasalcannula for adult and perinatal patients. Respir Care 2013;58: 98-122. 16.Patel A, Nouraei SAR. Transnasal humidified rapid-in-sufflation ventilatory exchange (THRIVE): a physiolo-gical method of increasing apnoea time in patients withdifficult airways. Anaesthesia 2015; 70: 323-29. 17.Nuckton TJ, Alonso JA, Kallet RH, et al. Pulmonary de-adspace fraction as a risk factor for death in the acuterespiratory distress syndrome. N Engl J Med 2002; 346:1281-86. 18.Lee JH, Rehder KJ, Williford L, Cheifetz IM, Turner DA.Use of high flow nasal cannula in critically ill infants,children, and adults: a critical review of the literature.Intensive Care Med 2013; 39: 247-57. 19.Frat JP, Thille AW, Mercat A, et al. High-flow oxygenthrough nasal cannula in acute hypoxemic respiratoryfailure. N Engl J Med 2015; 372: 2185-96. 20.Frizzola M, Miller TL, Rodriguez ME, et al. High-flownasal cannula: impact on oxygenation and ventilationin an acute lung injury model. Pediatr Pulmonol 2011;46: 67–74. 21.Dassieu G, Brochard L, Agudze E, Patkai J, Janaud JC,Danan C. Continuous tracheal gas insufflation enablesa volume reduction strategy in hyaline membrane disea-se: technical aspects and clinical results. Intensive CareMed 1998; 24: 1076–82. 22.Masip J, Roque M, Sánchez B, Fernández R, SubiranaM, Expósito JA. Noninvasive ventilation in acute cardio-genic pulmonary edema: systematic review and meta-analysis. JAMA 2005; 294: 3124-30. 23.Schibler A, Pham TM, Dunster KR, et al. Reduced in-tubation rates for infants after introduction of high-flownasal prong oxygen delivery. Intensive Care Med 2011;37: 847-52. 24.Arora B, Mahajan P, Zidan MA, Sethuraman U. Nasop-haryngeal airway pressures in bronchiolitis patients trea-ted with high-flow nasal cannula oxygen therapy. Pedi-atr Emerg Care 2012; 28: 1179-84. 25.Mayfield S, Bogossian F, O’Malley L, Schibler A.High-flow nasal cannula oxygen therapy for infants withbronchiolitis: pilot study. J Paediatr Child Health2014; 50: 373–78. 26.Mc Kiernan C, Chua LC, Visintainer PF, Allen H. Hıghflow nasal cannulae therapy in infants with bronchıoli-tis. J Pediatr 2010; 156: 634-38. 27.Kelly GS, Simon HK, Sturm JJ. HFNC use in childrenwith respiratuvar distress in the emergency department:predicting the need for subsequent intubation PediatrEmerg Care 2013; 29: 888-92. 28.Knudsen N, Fulkerson WF. Ventilator induced lung in-jury. In: MacIntyre NR, Branson R, eds. Mechanical Ven-tilation. WB Saunders: Philadelphia, 2000; The ARDSNetwork 2000. 29.Beggs S, Wong ZH, Kaul S, Ogden KJ, Walters JA. High flow nasal cannula therapy for infants with bronchioli-tis. Cochrane Database Syst Rev 2014; 1: CD009609. 30.Dahlem P, Van Aalderen WM, Hamaker ME, Dijkfra-af MG, Bos AP. Incidence and short-term outcome of acu-te lung injury in mechanically ventilated children. EurRespir J 2003; 22: 980–85. 31.Abboud PA, Roth PJ, Skiles CL, Stolfi A, Rowin ME. Pre-dictors of failure in infants with viral bronchiolitis trea-ted with high-flow, high-humidity nasal cannula therapy.Pediatr Crit Care Med 2012; 13: 343-49. 32.Sztrymf B, Messika J, Mayot T, Lenglet H, Dreyfuss D,Ricard JD. Impact of high-flow nasal cannula oxygen the-rapy on intensive care unit patients with acute respira-tory failure: a prospective observational study. J CritCare 2012; 27: 324.e9-324.e13. 33.Sztrymf B, Messika J, Bertrand F, et al. Beneficial effectsof humidified high flow nasal oxygen in critical care pa-tients: a prospective pilot study. Intensive Care Med 2011;37: 1780-86. 34.Wang EE, Milner R, Allen U, Maj H. Bronchodilatorsfor treatment of mild bronchiolitis: a factorial randomi-sed trial. Arch Dis Child 1992; 67: 289-93. 35.Hegde S, Prodhan P. Serious air leak syndrome compli-cating high-flow nasal cannula therapy: a report of 3 ca-ses. Pediatrics 2013; 131: 939-44.