High-flow nasal oxygen in acute hypoxemic respiratory failure: A narrative review of the evidence before and after the COVID-19 pandemic.

High-flow nasal oxygen (HFNO) is a type of non-invasive advanced respiratory support that allows the delivery of high-flow and humidified air through a nasal cannula. It can deliver a higher inspired oxygen fraction than conventional oxygen therapy (COT), improves secretion clearance, has a small positive end-expiratory pressure, and exhibits a washout effect on the upper air space that diminishes dead space ventilation. HFNO has been shown to reduce the work of breathing in acute hypoxemic respiratory failure (AHRF) and has become an interesting option for non-invasive respiratory support. Evidence published before the COVID-19 pandemic suggested a possible reduction of the need for invasive mechanical ventilation compared to COT. The COVID-19 pandemic has resulted in a substantial increase in AHRF worldwide, overwhelming both acute and intensive care unit capacity in most countries. This triggered new trials, adding to the body of evidence on HFNO in AHRF and its possible benefits compared to COT or non-invasive ventilation. We have summarized and discussed this recent evidence to inform the best supportive strategy in AHRF both related and unrelated to COVID-19.

Short-Term Continuous Positive Air Pressure Treatment: Effects on Quality of Life and Sleep in Patients with Obstructive Sleep Apnea.

Background and Objectives: The aim of this study was to evaluate short-term continuous positive air pressure (CPAP) treatment for health-related quality of life (HRQL) in patients with obstructive sleep apnea. Materials and Methods: Our subjects were 18-65 years old, diagnosed with moderate-to-severe obstructive sleep apnea and treated with CPAP between January 2020 and June 2021 in Hospital of Lithuanian University of Health Sciences Kaunas clinics. All the patients completed the Epworth Sleepiness Scale (ESS), the 36-Item Short Form Health Survey (SF-36), the and Pittsburgh Sleep Quality Index (PSQI) before and after 3 months of treatment. Polysomnography was also repeated. Statistical analyses were performed using SPSS 27.0 software. The value of p < 0.05 was considered as statistically significant. Results: The active-treatment group comprised 17 subjects with a mean age of 51.9 ± 8.9 years. The total SF-36 questionnaire score improved from 499.8 ± 122.3 to 589.6 ± 124.7 (p = 0.012). The SF-36 role limitations due to emotional problems (p = 0.021), energy (fatigue) (p = 0.035), and general health (p = 0.042) domains score significantly improved after CPAP treatment for 3 months. The PSQI mean score at baseline was 12.6 ± 2.9 and in the post-treatment group, it was -5.5 ± 2.3 (p = 0.001). The ESS also changed significantly from a pretreatment mean score of 10.9 ± 5.7 to -5.3 ± 3.2 (p = 0.002) after 3 months. Conclusions: Improvement in HRQL is seen even after a short treatment period with CPAP. Questionnaires are a good tool to evaluate CPAP treatment efficacy.

Time-Variant Positive Air Pressure in Drainage Stacks as a Pathogen Transmission Pathway of COVID-19.

Time-variant positive air pressure in a drainage stack poses a risk of pathogenic virus transmission into a habitable space, however, the excessive risk and its significance have not yet been sufficiently addressed for drainage system designs. This study proposes a novel measure for the probable pathogenic virus transmission risk of a high-rise drainage stack with the occurrence of positive air pressure. The proposed approach is based on time-variant positive air pressures measured in a 38 m high drainage stack of a full-scale experimental tower under steady flow conditions of flow rate 1-4 Ls-1 discharging at a height between 15 m to 33 m above the stack base. The maximum pressure and probabilistic positive air pressures in the discharging stack ventilation section with no water (Zone A of the discharging drainage stack) were determined. It was demonstrated that the positive air pressures were lower in frequency as compared with those in other stack zones and could propagate along the upper 1/3 portion of the ventilation pipe (H' ≥ 0.63) towards the ventilation opening at the rooftop. As the probabilistic positive pressures at a stack height were found to be related to the water discharging height and flow rate, a risk model of positive air pressure is proposed. Taking the 119th, 124th, 140th and 11,547th COVID-19 cases of an epidemiological investigation in Hong Kong as a baseline of concern, excessive risk of system overuse was evaluated. The results showed that for a 20-80% increase in the frequency of discharge flow rate, the number of floors identified at risk increased from 1 to 9 and 1 to 6 in the 34- and 25-storey residential buildings, respectively. The outcome can apply to facilities planning for self-quarantine arrangements in high-rise buildings where pathogenic virus transmission associated with drainage system overuse is a concern.