ABSTRACT
Objective:To compare the predictive ability of SpO 2/FiO 2(S/F) and ROX index on the failure of high-flow nasal cannula(HFNC)therapy in children with acute respiratory failure after congenital heart disease surgery, and to identify the best cut-off point. Methods:Through a case-control study, the clinical data of 371 children with acute respiratory failure after congenital heart surgery treated with HFNC admitted to Guangzhou Women and Children′s Medical Center from January 2018 to December 2021 were retrospectively analyzed.The primary outcome was the need for re-intubation within 48 h after extubation of invasive ventilation.The ability of S/F and ROX index to predict HFNC failure was compared, and the optimal cut-off point was determined based on the area under the curve (AUC) of receiver operating characteristic curve.Results:A total of 371 children were included, of whom 27 (7.3%) eventually required mechanical ventilation within 48 h. The S/F prediction accuracy was highest after 6 h of HFNC treatment(AUC=0.712, 95% CI 0.599-0.825, P=0.001), and the best cut-off point for S/F was 178 mmHg(1 mmHg=0.133 kPa)(sensitivity 74.9%, specificity 69.6%). Whereas the prediction accuracy of the ROX index was highest after 12 hours of HFNC treatment, the AUC was 0.737(95% CI 0.623-0.851, P=0.002), and the best cut-off point of the ROX index was 5.865(sensitivity 72.4% specificity 66.7%). The difference in AUC between S/F after 6 h of HFNC treatment and ROX after 12 h was not statistically significant ( P=0.444), with higher sensitivity and specificity, and earlier prediction time(6 hours) in the former. Conclusion:Children with acute respiratory failure after congenital heart surgery have a strong predictive ability of S/F after 6 h of HFNC treatment, and the risk of HFNC treatment failure is higher in children with S/F <178 mmHg.
ABSTRACT
Objective:To systematically review and evaluate the safety and efficacy of high-flow nasal oxygen (HFNO) for pre-oxygenation before anesthesia induction.Methods:Pubmed, Cochrane Library, Embase, China National Knowledge Infrastructure, Wanfang Database, China Science and Technology Journal Database and China Biomedical Literature Database were searched from inception to March 2022.All randomized controlled trials comparing HFNO and facemask ventilation for pre-oxygenation before anesthesia induction were collected.Two researchers independently assessed the quality of trials and extracted data.The primary outcome was the safe apnea time, the secondary outcomes were the lowest SpO 2 during intubation, oxygenation-related complications, patient comfort, PaO 2 and PaCO 2 before and after pre-oxygenation and after intubation.Meta-analysis was performed using RevMan 5.4 software. Results:Seventeen randomized controlled trials involving 843 patients were included in this meta-analysis.The results of meta-analysis showed that the safe apnea time was significantly longer ( MD=67.61, 95% CI 5.94-129.28, P=0.03), the lowest SpO 2 was higher during tracheal intubation ( MD=3.27, 95% CI 2.25-4.29, P<0.01), and PaO 2 was higher after pre-oxygenation ( MD=54.39, 95% CI 9.32-99.46, P=0.02) in the patients using HFNO than those using facemask ventilation.There were no statistically significant differences in the other outcomes ( P>0.05). Conclusions:HFNO for pre-oxygenation before anesthesia induction can significantly prolong the safe apnea time, increase the lowest SpO 2 during tracheal intubation, and improve the levels of PaO 2 after pre-oxygenation, and HFNO does not affect the patient′s comfort or increase the development of preoxygenation-related complications when compared with facemask ventilation.
ABSTRACT
BACKGROUND: Continuous positive airway pressure (CPAP) therapy is the gold standard treatment for obstructive sleep apnea (OSA), although, associated with poor patient compliance. Conversely, high flow, humidified, temperature-regulated nasal insufflation of oxygen or air is well tolerated.CASE: We describe our experience of three patients with known or suspected moderate to severe OSA who were poorly compliant to CPAP therapy and received high flow nasal insufflation (HFNI) postoperatively. None had significant episodes of desaturation (SpO₂ < 95%) and all patients uniformly reported superior comfort levels than with the CPAP therapy. HFNI generates small amounts of positive end-expiratory pharyngeal pressure, increases inspiratory airflow and decreases dead space ventilation. Due to the open system, less difficulty with the patient-mask interface and improved patient comfort is experienced. These factors help prevent hypopnea and lead to enhanced sleep continuity.CONCLUSIONS: HFNI may be a promising alternative to CPAP therapy in the perioperative setting.
Subject(s)
Humans , Continuous Positive Airway Pressure , Insufflation , Oxygen , Patient Compliance , Sleep Apnea, Obstructive , VentilationABSTRACT
High-flow nasal cannula oxygenation (HFNC) characterized as a new non-invasive respiratory support technology, has been widely used in recent years. Compared with conventional oxygen therapy (COT), non-invasive ventilation (NIV), HFNC can offset patient discomforts, and effectively arrest the deterioration of acute respiratory failure (ARF) in immunosuppressed patients. Although there is no benefit of HFNC over COT on reducing mortality in immunocompromised patients with ARF, HFNC is associated with a lower intubation rate and the improved prognosis of transplant recipients and solid cancer patients. Although the association between the prognosis of HFNC treatment and the pathogenic differences of ARF patients remains unknown, HFNC has, as one of the alternative methods for treating ARF in immunosuppressed patients, outstanding clinical significance. The treatment of HFNC in immunosuppressed patients with ARF, such as transplantation, malignancy, pneumocystis pneumonia, and interstitial pneumonia are reviewed in this article, in order to guide the clinical application of HFNC in such patients.
ABSTRACT
Objective To systematically evaluate the effect of high-flow nasal cannula oxygen (HFNC) on improving the atelectasis and respiratory function in adults after cardiac surgeries.Methods All randomized controlled trials (RCTs) about HFNC therapy for adults after cardiac surgeries published from January 2000 to March 2018 were searched through CNKI, CBM, VIP, Wanfang, PubMed, Springer Link, Embase, Web of Science, Cochrane Library. The references from relevant articles were searched. The experimental group was treated with HFNC while the control group treated with conventional oxygen therapy (COT). The outcome measurements included radiological atelectasis score (RAS), endotracheal reintubation rate and the length of intensive care unit (ICU) stay. Two researchers were responsible for literature screening, data extraction and quality evaluation respectively. Meta-analysis was performed with RevMan 5.2 software. Funnel plot was used to analyze the publication bias.Results A total of 4 RCTs were enrolled and 643 patients were included (325 in experimental group and 318 in control group). Meta-analysis showed that the tracheal reintubation rate in experimental group was lower than that in control group [odds ratio (OR) = 0.26, 95％ confidence interval (95％CI) = 0.09-0.74,P = 0.01], but there was no significant difference in RAS [mean difference (MD) = -0.15, 95％CI = -0.50-0.21,P = 0.41] and the length of ICU stay (MD= 0.09, 95％CI =-0.09-0.26,P = 0.33) between experimental group and control group. Sensitivity analysis was performed in two trials with low risk of bias, which demonstrated that there was no significant difference in RAS between the two groups (MD =0.06, 95％CI = -0.26-0.37,P = 0.73). It was shown by the funnel analysis that there was bias in the study of the length of ICU stay in the literature, while the bias of RAS and tracheal reintubation rate was low.Conclusion Compared with COT, HFNC could reduce the rate of tracheal reintubation in adults after cardiac surgeries, but no difference was found in improving atelectasis or reducing the length of ICU stay.