Résumé
High-flow nasal cannula oxygen therapy (HFNC) in palliative care is mentioned in several guidelines, however, the indication for this procedure has not been established yet. At our department, HFNC has increasingly been adopted for end-stage cancer patients when their dyspnea needs to be alleviated. This is a case report on three patients treated with this procedure at our department. Although they had severe dyspnea with respiratory failure, their daily activities, such as enjoying meals and conversation with their families, were improved with HFNC. It can be a treatment of choice to maintain and improve patients’ quality of life (QOL) in palliative setting, where benefits and risks should be considered for each patient.
Résumé
Objective T o analyze the influence of high flow nasal cannula (HFNC) on trespiratory mechanical parameters of the patient with acute respiratory distress syndrome (ARDS) based on ventilation experiment, and investigate the therapeutic and side effects of the HFNC. Methods The HFNC ventilation system model based on MATLAB and the physical experiment platform based on active simulated lung ASL5000 were developed to simulate the respiratory movement of ARDS patients with different lung compliance, and a series of the HFNC ventilation experiments were carried out. Both experimental results in MATLAB and physical platform were compared and analyzed. Results The results from the Matlab model-based simulation experiment and physical platform based-physical experiment uniformly showed that increasing the output flow of HFNC would decrease the relevant respiratory mechanical parameters of respiratory flow and tidal volume, but increase the intrapulmonary pressure and the functional residual capacity (FRC). Under the condition of small flow, the output flow from HFNC might be smaller than the inspiratory flow required by the patient, and an inspiratory compensation flow was necessary to make up for the inspiratory flow. Conclusions The necessary reliable compensation flow in inspiration will promote the security of HFNC. Understanding the changes in respiratory mechanical parameters of ARDS patient will be beneficial to pre-evaluate the HFNC, improve the ventilation effect and reduce the ventilation risks.
Résumé
Objective To compare the clinical effects of high flow nasal cannula (HFNC) and non-rebreathing oxygen face mask (NRB) in post-extubation patients.Methods 88 critically ill patients with machinery ventilations were divided into HFNC group and NRB group randomly.Blood gas analysis and hemodynamic parameters were assessed 1 hour prior to extubation and 6 hours after extubation.The primary clinical outcomes measured were ventilation-free days,re-intubation patient numbers,length of stay in ICU (Intensive Care Unite),total duration of hospitalization and mortality.The scant of breath degree and comfortableness of patient were recorded according to the Visual analogue scale.The measurement data were described by mean ± standard deviation ((x) ± s) and analyzed with t test,enumeration data were described by number of cases and composition ratio and analyzed with X2test,P ＜ 0.05 was considered to have statistical difference.Results There was no significant difference in clinical features between the two groups,The oxygenation index of HFNC group is significantly higher than that of NRB group after extubation [(251.4 ±43.9) vs.(201.7 ±60.7),P =0.037)].There were more ventilator-free days in the HFNC group than NRB group [(4.2 ± 2.1) vs.(3.4 ± 2.8),P =0.037)] and fewer patients required reintubation (P =0.028).The rate of ventilator associated pneumonia is also lower than NRB group (P =0.024).The patients' scant of breath feeling were obviously allevated comparing with the NRB group [(2.9 ± 1.1) vs.(3.7 ± 1.8),P =0.042)].The oxygenation index of NRB group significantly decreased after extubation [(242.9 ±68.4vs.201.7 ±60.7 P =0.048)].The two groups demonstrated similar hemodynamic patterns before and after extubation.And there were no statistically significant clinical differences in PaCO2,length of ICU stay,total duration of hospitalization or mortality.Conclusions Compared with NRB,HFNC is a more safe and effective clinical tool in the prevention and treatment of critical adult patients with extubation failure.