Traumatic air myelogram

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 (±s) and analyzed with t test, enumeration data were described by number of cases and composition ratio and analyzed with χ2test, 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 re-intubation(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. Key words: High flow nasal cannula (HFNC); Non-rebreathing oxygen face mask (NRB); Post-extubation respiratory failure; Mechanical ventilation; Extubation; Curative effect

Can We Finally Take the "VE" Out of THRIVE?

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High-flow nasal oxygen alone or alternating with non-invasive ventilation in critically ill immunocompromised patients with acute respiratory failure: a randomised controlled trial

Background: High-flow nasal cannula (HFNC) oxygen therapy is carried out using an air/oxygen blender, active humidifier, single heated tube, and nasal cannula. It is an oxygen delivery system which uses air blender to deliver accurate oxygen concentration to the patient from 21% to 100% at desired temperature. It can be administered via wide bore nasal cannula or to the tracheostomy tube via connector. It can give upto 60L/min flow hence can generate positive end expiratory pressure between 2 to 7 cmH20. By providing humidified oxygen along with the high flow rates it satisfies air hunger and reduces work of breathing for the patient.Methods: This is a retrospective observational study. Patients with persistent hypoxia in spite of conventional oxygen therapy were treated with HFNC. Patients with possible need for immediate invasive ventilator support were excluded. Clinical respiratory parameters and oxygenation were compared under conventional and HFNC oxygen therapy.Results: Thirty patients, aged more than 18 years admitted in intensive respiratory care unit with acute hypoxemic respiratory failure from June 2017 to January 2018 were included in the study. Study period was of 6 months. Etiology of acute respiratory failure (ARF) was mainly pneumonia (n = 17), interstitial lung disease (n = 5), bronchial asthma (n=3) and others (n = 5). There was statistically significant reduction in respiratory rate (29.40 before Vs 23.50 after; P- &lt;0.0001) and significant improvement in comfort level of the patient after HFNC therapy. Median duration of HFNC was 48 hrs (24-360) hours. Five patients were intubated later on and 4 died in the intensive care unit.Conclusions: Use of HFNC in patients with persistent ARF was associated with significant and sustained improvement of clinical parameters (respiratory rate). It can be used comfortably for prolonged periods.

Effect of high-flow oxygen therapy on regional oxygen saturation during vaso-occlusive pain crisis: An observational study.

Bronchiolitis remains the single most common cause of hospitalization during the first year of life.1 Although supportive treatment is the cornerstone of bronchiolitis therapy, with excellent recovery in the majority of children,2 clinicians continue to search for new and better treatment strategies. As reflected in the most recent American Academy of Pediatrics clinical practice guidelines for bronchiolitis,1 previously embraced treatment strategies such as ribavirin, chest physiotherapy, systemic glucocorticoids, epinephrine, and β-agonist therapy are not recommended for children with bronchiolitis. Even the stance emphasizing continuous pulse oximetry has been prudently revisited (clinicians may choose not to use it for patients who do not require supplemental oxygen or if oxygen saturation is >90%). However, treatment guidelines have not yet confronted the putative benefits of high-flow nasal cannula (HFNC) in the more severely ill component of the population. There is also no consensus surrounding the propriety of enteral nutrition in infants with bronchiolitis being treated with HFNC.Despite the absence of data showing the efficacy of HFNC in the context of bronchiolitis, the strategy is increasingly being used. For children with accelerating illness, and who display respiratory distress and hypoxemia despite nasal cannula support, HFNC is generally more well tolerated than nasal continuous positive airway pressure devices. In a small trial (N = 14), HFNC had a demonstrably favorable effect on diaphragmatic contraction in children with bronchiolitis, thereby decreasing the work of breathing.3 Although it is tempting to ascribe a lower rate of intubation4,5 with the use of HFNC, these studies involved historical control subjects, which confounds data interpretation. The first randomized controlled trial to include children with moderate bronchiolitis receiving HFNC compared with low-flow nasal cannula was recently published.6 It found no reduction in the duration of supplemental oxygen therapy between the 2 groups. Notwithstanding these constraints, use of HFNC continues to proliferate.The issue of whether to feed infants who have bronchiolitis possesses significant clinical implications. In infants with bronchiolitis, caloric intake (either enteral or parenteral) correlates inversely with length of stay,7,8 arguably because providers are more hesitant to provide enteral nutrition to more symptomatic children.9 The hesitancy is likely derived from concerns regarding the risk of aspiration.Whether and how to feed children with bronchiolitis while being treated with HFNC remains unknown. Practices diverge widely, both within and between institutions. The present issue of Hospital Pediatrics includes 2 articles that address the question of whether infants with bronchiolitis being treated with HFNC can be safely fed via an enteral route.In the first article, entitled “Oral Nutrition in Children With Bronchiolitis on High Flow Nasal Cannula Is Well Tolerated,” Sochet and October10 conducted a prospective observational cohort study at a single center over the course of 1 year (2015) in a university-affiliated PICU in children aged between 1 month and 2 years. Patients with a diagnosis of viral bronchiolitis receiving HFNC and concurrent enteral nutrition were included. The primary outcome measures were the incidence of aspiration-related respiratory failure and nutrition interruptions. Respiratory failure was defined as secondary to aspiration in the presence of clinical or radiographic evidence of aspiration and the initiation of invasive ventilation after introduction of either enteral feedings or clinician-observed emesis. Nutrition interruptions were defined as a pause in nutrition of >8 hours. A total of 132 children were included; 97% were fed by mouth and 3% by nasogastric tube, with HFNC flows between 4 and 13 L/min at onset of nutrition. One (0.8%) patient had aspiration-related respiratory failure, and nutrition was interrupted in 12 (9.1%) patients. The nutritional interruptions were primarily due to tachypnea, and not emesis, aspiration, or feeding intolerance.The second article, written by Slain et al11 and entitled “Nutrition and High Flow Nasal Cannula Respiratory Support in Children With Bronchiolitis,” addresses a similar issue by analyzing data derived from the medical records of children admitted to the PICU of an academic children’s hospital between September 2013 and April 2014. The hospital course of children aged <2 years with a primary diagnosis of bronchiolitis, who were treated with HFNC and enteral nutrition after initiation of HFNC, was reviewed to determine the incidence of feeding-related adverse events (AEs). Feeding-related AEs were defined retrospectively based on nursing and physician documentation of “respiratory distress” or “emesis.” Of the 70 children who met inclusion criteria, 89% received nutrition orally, 7% via nasogastric or nasoduodenal tube, and 4% by gastrostomy tube. HFNC flows at initiation of nutrition ranged between 2 and >7 L/min. The data were analyzed in 8-hour epochs, with feeding-related AEs occurring in 29 (6%) of 501 shifts in 18 distinct patients. Of the 29 events, emesis comprised 20 and respiratory distress comprised 9. In this relatively small range of HFNC flow rates, the incidence of AEs did not differ with flow rates.The notion of feeding infants while they are being treated with HFNC is highly compelling, and the present articles10,11 address a topic of meaningful clinical significance. Being able to safely feed severely ill infants who have bronchiolitis while receiving HFNC is especially attractive. Both articles carefully approach the issue and add meaningful information to the medical literature. Although the present articles argue in favor of the practice, there is considerable reason to view the evidence with some amount of skepticism.First, both studies included relatively small sample sizes, which, as the authors note,10,11 limit the ability to make claims surrounding safety. Given that thousands of infants are hospitalized annually, the implications of a change in the commonly accepted practice of withholding oral feeding in infants with significant respiratory distress are significant. Hence, data derived from randomized controlled trials would be preferred before advocating for enteral feeding in this population. Indeed, a determination to alter practice should be tempered by the recognition that bronchiolitis is, in general, a self-limited illness, one from which the overwhelming majority make a full recovery.1 Moreover, from a physiologic perspective, there is meaningful risk associated with feeding. Certainly, carefully balancing risk and reward, relative to feeding in children with respiratory distress wherein suck–swallow coordination is under some amount of duress,12 is essential.Interpretation of both of these investigations10,11 may be complicated by a component of selection bias. Neither study included an assessment of the respiratory severity of illness at baseline. The decisions to initiate HFNC, and the flow and fraction of inspired oxygen, were provider-determined and not protocol-driven. Furthermore, criteria for the initiation of enteral feedings were subjective. Based on the study designs, it is possible that providers opted to initiate enteral nutrition in infants on HFNC with a less severe clinical presentation, while withholding nutrition in more overtly ill children.Identifying aspiration in infants and children remains an important, albeit complicated, consideration. Clinical and radiographic features of bronchiolitis can mimic aspiration,13 both in acute aspiration events leading to respiratory failure or repeated small volume “microaspiration” episodes that increase airway inflammation. The definition of the primary outcomes of feeding-related AEs or aspiration-related respiratory failure each address severe acute aspiration events; they may not capture microaspiration events, which could have an impact on disease course.Although it is important to consider the safety of feeding while on HFNC, it may be worthwhile to consider whether use of HFNC possesses clinical utility. With HFNC, infants are receiving an indeterminate amount of positive airway pressure. Airway pressure delivery varies widely between patients, contingent on factors such as size of nares, upper airway inflammation, mouth closure, and cannulae fit.14–18 The questions of whether HFNC alters hospital course, decreases length of stay, or influences the incidence of mechanical ventilation remain insufficiently addressed.6,19 Moreover, even the fundamental physiology of HFNC remains incompletely understood.The incidence of bronchiolitis continues to motivate the search for novel treatments to mitigate the burden of illness. If HFNC proves effective in decreasing severity or length of stay, the questions asked in these investigations10,11 will need to be definitively addressed. These articles are an excellent first step in that direction. However, many previous therapies designed to improve care for children with bronchiolitis have been warmly embraced but failed to withstand the scrutiny of randomized controlled trials. Whether the therapeutic benefit of HFNC will be accepted or rejected has yet to be determined.

High flow nasal cannula (HFNC) is increasingly used for children hospitalized with bronchiolitis. We aimed to validate identification of HFNC use in a national database, then compare resource utilization among children treated with and without HFNC. In this cross-sectional, multicenter study, we obtained clinical and resource utilization data from the Pediatric Health Information System (PHIS) database for healthy children aged 1 to 24 months admitted for bronchiolitis. We assessed HFNC use based on a combination of billing codes and reviewed charts at 2 hospitals to determine their accuracy. We compared costs, length of stay, and readmissions between the HFNC and no HFNC groups at hospitals utilizing the HFNC codes. The PHIS codes demonstrated 90.4% sensitivity and 99.3% specificity to detect HFNC use as verified by chart review at 2 hospitals. However, only 24 of 51 PHIS hospitals used these codes for ≥1% of patients with bronchiolitis. Within those hospitals, children treated with HFNC had greater total costs ($7054 vs $4544; P < .001), greater daily costs ($2922 vs $2613; P < .001), and longer length of stay (57.6 vs 41.6 hours; P < .001). Those treated with HFNC were less likely to be readmitted at 3 and 7 days (P < .001), but by 14 days, readmissions were similar in the 2 groups. Billing codes for HFNC are inconsistently applied across PHIS hospitals; however, among those hospitals that routinely apply these codes, HFNC was associated with more intense resource utilization. Standardization of billing practices for HFNC would allow future study to more broadly describe the value of HFNC.

Background: Acute hypoxemic respiratory failure (AHRF) is a common reason to be admitted and die in the intensive care unit (ICU). Traditional Oxygen therapy might be unable to reverse hypoxemia and early intubation may be needed. High-flow nasal cannula (HFNC) therapy provides high flow rates of warmed, humidified oxygen and has possible physiologic and clinical advantages. Albeit there have been several randomized controlled trials (RCTs) devoted to its role, the outcomes have not been reported consistently. Objectives: To conduct a systematic review and quantitative analysis of the effects of high-flow nasal cannula versus conventional oxygen therapy on mortality, intubation rate and mortality in the ICU, in adult patients with acute hypoxemic respiratory failure. Methodology: The present systematic review and meta-analysis have been conducted in accordance with PRISMA. A search of PubMed, Scopus and Cochrane CENTRAL was conducted in full until October 2025. A total of six large RCTs were incorporated: FLORALI (Frat et al., 2015), HiFLo-COVID (Ospina-Tascgon et al., 2021), HENIVOT (Grieco et al., 2021), RECOvery-RS (Perkins et al., 2022), SOHO-COVID (Frat et al., 2022) and Covid-High (Crimi et al., 2023). Data were abstracted on mortality, intubation, and ICU related outcomes. Pooled risk ratios (RRs) were computed by means of a random-effects model [DerSimonian- Laird] with 95% confidence intervals (CIs). Results: There were six RCTs (HFNC: 1,267; Control: 1,313) that included 2,580 patients. The probability of endotracheal intubation was much lower in HFNC compared with standard oxygen therapy (RR = 0.861; 95% CI, 0.751-0.987; p = 0.032; I2 = 36%). No meaningful tendency towards a decrease in mortality was observed with HFNC (RR = 0.786; 95% CI, 0.591-1.045; p = 0.097; I2 = 31%). Outcomes associated with the ICU (escalation of respiratory support or length of stay) were positive (though not homogeneous). Conclusion: Compared to standard oxygen therapy, high-flow nasal cannula therapy reduces endotracheal intubation use in patients with acute hypoxemic respiratory failure and has a no significant possible mortality reduction. The findings of this research help to support the early use of HFNC as one of the strategies of choice in noninvasive oxygenation. More extensive studies are justified to establish its impact on outcome in the long run and in ICU.

High-flow nasal oxygen administration during apnoea was first described in a case series of 25 adults in Anaesthesia in 2015 1. Subsequently, case series by other groups 2, 3, randomised trials 4-6 and widespread international experience have confirmed beyond doubt that this is a highly effective approach to apnoeic oxygenation. However, the data surrounding the concept of carbon dioxide clearance during apnoea with high-flow nasal oxygen is more limited, raising the possibility that recent modelling 7 and simulation 8 exercises are premature, and that appropriately conducted randomised trials in adults are still required. It is thus timely to re-examine the strengths and weaknesses of the carbon dioxide data during apnoea, in contrast to the more established benefits associated with high-flow nasal oxygen. The extensive apnoeic oxygenation benefits with high-flow nasal oxygen were recently summarised by Lyons and Callaghan in an article highlighting the evidence supporting use during airway management, especially in high-risk groups, and for tubeless anaesthesia 9. Other physiological benefits of high-flow nasal oxygen are apparent in spontaneously-breathing patients, including: reduction of functional dead space; generation of flow-dependent positive end-expiratory pressure; and decreased work of breathing. These diverse spontaneous ventilation benefits may be more accurately described as high-flow nasal therapy, and show promise in improving patient-centred outcomes when applied postoperatively 10. Overall, it is clear that the development of this technology represents a significant advance in a myriad of settings, and further applications are likely to be discovered. In their original case series, Patel et al. measured end-tidal (n = 20) and arterial (n = 4) carbon dioxide levels during surgery performed under apnoea of varying duration 1. The median apnoea time without significant arterial oxygen desaturation was 14 min and ranged from 5 to 65 min. Carbon dioxide at the end of apnoea was plotted against the apnoeic time, and the slope of the linear regression line was used to calculate an average rate of carbon dioxide increase of 0.15 kPa.min−1. This carbon dioxide accumulation rate appeared low in comparison with a selection of trials published in 1959 (0.45 kPa.min−1) 11, 1961 (0.4 kPa.min−1) 12, 1973 (0.43 kPa.min−1) 13, 1989 (0.45 kPa.min−1) 14 and 2013 (0.24 kPa.min−1) 15. Thus, the concept of transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) was born. The carbon dioxide data obtained by Patel et al. have several limitations. First, the majority of carbon dioxide estimates were based on end-tidal levels after placement of a definitive airway. This approach does not account for the increasing arterial-to-alveolar gradient with progressive apnoea and is vulnerable to error 9. Indeed, Gustaffson et al. have since shown in a similar case series that end-tidal measurements underestimate the true arterial carbon dioxide accumulation rate by approximately 50% (0.12 kPa.min−1 vs. 0.24 kPa.min−1), whereas transcutaneous carbon dioxide measurements serve as an excellent and preferred non-invasive surrogate 2. Second, the use of historical controls, rather than contemporaneous controls as in a randomised trial setting, introduces significant confounding. Varying patient populations undergoing anaesthesia with varying drug regimens under varying conditions may well have varying rates of carbon dioxide accumulation during apnoea, irrespective of the apnoeic oxygenation technique used. For example, many of the historical controls cited above used suxamethonium as a bolus and infusion to prevent spontaneous ventilation, and this exposure in itself is known to increase carbon dioxide production 16. Perhaps most importantly, the rate of carbon dioxide increase during apnoea is non-linear 12. Therefore, the varying durations of the apnoeic period being tested in different trials can confound the average carbon dioxide accumulation rate reported. The non-linear rise of carbon dioxide during apnoea was first described by Eger and Severinghaus in 1961 12 and is a finding replicated by multiple other groups 2, 14 including our own 17. This non-linearity leads to a slowing of carbon dioxide accumulation as the apnoeic period progresses and has a significant impact on the 'average' rate of carbon dioxide increase reported for a given period. In our recent evaluation study of buccal oxygenation, we illustrated this by reporting a carbon dioxide accumulation rate of 0.42 kPa.min−1 during the first 4 min of apnoea and 0.29 kPa.min−1 during the complete 12.5 min of apnoea 17. Thus, if a given apnoeic oxygenation device undergoes a short apnoeic test, it will report a relatively higher carbon dioxide accumulation rate than if it undergoes longer apnoeic tests. The average or median apnoeic periods varied considerably between the original case series describing THRIVE (14 min) and the historical control studies used as comparators (Frumin et al., 45 min; Eger et al., 16.4 min; Fraioli et al., 15 min; Stock et al., 3.7 min; and Rudlof et al., 25 min). Clearly, to test the hypothesis that the rate of carbon dioxide accumulation is lower during apnoea with high-flow nasal oxygen, a randomised trial is required where the influence of the apnoeic period is controlled or adjusted for. In contrast to the other clinically available apnoeic oxygenation devices (low flow nasal prongs 18, insufflating laryngoscopes 19, buccal oxygen 20) it is remarkable that high-flow nasal oxygen during apnoea in adults became established into practice on the basis of several case series alone. The first randomised controlled trial in adults with a prescribed apnoeic test has only just been published 6. This confirmed an oxygenation benefit in morbidly obese patients, extending the safe apnoea time from 180 to 261 s, but reported no difference in plateau end-tidal carbon dioxide at the end of apnoea (5.11 kPa vs. 4.99 kPa). The only two randomised trials of high-flow nasal oxygen with arterial or transcutaneous carbon dioxide measurements have been conducted in paediatric populations 4, 5. Humphreys et al. compared high-flow nasal oxygen against a control arm and found no difference in carbon dioxide accumulation rates (0.32 kPa.min−1 vs. 0.32 kPa.min−1). Similarly, Riva et al. in a three-arm trial evaluated high-flow nasal oxygen with 100% oxygen vs. high-flow nasal oxygen with 30% oxygen vs. low-flow nasal prongs with 100% oxygen, and again found no difference in the rate of carbon dioxide increase (0.55 kPa.min−1 vs. 0.60 kPa.min−1 vs. 0.57 kPa.min−1, p = 0.25). The almost two-fold difference in overall carbon dioxide accumulation rates reported in these two trials further demonstrates the point that variations in trial protocols can influence carbon dioxide values greatly, even when the same apnoeic oxygenation technique is used. The lack of impact of high-flow nasal oxygen on carbon dioxide accumulation rates in paediatric populations may be explained by differences in anatomy and physiology that prevent the purported mechanisms of carbon dioxide clearance from applying 21. Equally, these findings are consistent with the concept that high-flow nasal oxygen does not impact on carbon dioxide accumulation in children or adults, and the original observation of 'ventilatory exchange' was an epiphenomenon arising from the limitations discussed above. The hypothesis that high-flow nasal oxygen leads to carbon dioxide clearance from the airway during apnoea in adults and therefore a lower rate of carbon dioxide accumulation can only be tested in an appropriately designed randomised trial. Such a trial must use a robust measure of carbon dioxide (arterial or transcutaneous) and set out to achieve the same apnoeic period in the high-flow nasal oxygen arm and the comparator arm, or to adjust for observed differences. This is perhaps best accomplished by comparing high-flow nasal oxygen to another available apnoeic oxygenation device to avoid premature arterial oxygen desaturation. Using prior studies to estimate data variability, a randomised trial would require a sample size of approximately 20 participants to detect a difference of 0.32 kPa.min−1 vs. 0.24 kPa.min−1 (80% power, p < 0.05). At the time of writing, a search of the trial registries in the USA, Australia and Europe revealed several trials in the active recruitment phase that are appropriately designed and powered to address the carbon dioxide hypothesis (www.clinicaltrials.gov: NCT03478774 22; NCT03550924; both due to complete end-2019). Although the proven oxygenation benefits of high-flow nasal oxygen will continue to be captured and refined by anaesthetists, evidence that can reliably guide practice with respect to ventilatory exchange during apnoea is eagerly awaited. AT has been an investigator on two randomised controlled trials of apnoeic oxygenation with a buccal device in the oral cavity. There are no commercial interests or intellectual property associated with these studies. No external funding or competing interests declared.

Background: High flow nasal cannula (HFNC) is increasingly used during a post-extubation period. Its interface allows patients to drink or eat but there are limited data of HFNC’s effects on patient’s swallowing. Objectives: Our study aimed to compare swallowing latency time in post-extubated patients using HFNC 50 LPM and oxygen cannula 5 LPM. We hypothesized that a positive pressure effect of HFNC might decrease the latency time and improve swallowing function. Additionally, we analyzed factors affecting the latency time. Methods: We performed a crossover study in the post-extubated patients within a 48-hour period. We randomly assigned the patients to receive HFNC 50 LPM or oxygen cannula 5 LPM. The oxygen therapy lasted for 5 minutes. Then the patients swallowed 3 ml. of water. The latency times were recorded three times using surface electromyography and were interpreted by blinded assessors. Subsequently, the patients were switched into the other treatment and the tests were repeated. After the crossover phase, we also measured the latency times in patients using HFNC 30 and 40 LPM. Results: Totally, 20 patients were included. The mean swallowing latency time in the HFNC 50 LPM group was significantly shorter than the latency time in simple oxygen group (1.11 (0.56) VS 1.29 (0.70) seconds, p = 0.027). The mean latency times in patients using HFNC 30 LPM (1.24 (0.80) seconds) and HFNC 40 LPM (1.23 (0.70) seconds) were not different from the simple oxygen group. According to multivariate analysis, diabetes mellitus was the only factor affecting the swallowing latency time. Conclusion: The post-extubated patients using HFNC 50 LPM had better swallowing reflex.

To assess the effects of in-bed cycling (IBC) combined with high flow nasal cannula (HFNC) on arterial oxygen and respiratory dynamics in patients with severe respiratory failure (RF). We retrospectively collected clinical data of 103 patients with severe RF, admitted to the intensive care unit (ICU) of The Second Affiliated Hospital of Harbin Medical University from March 2021 to March 2023. Among them, 50 patients had HFNC alone (control group), and 53 patients did IBC in addition to HFNC (observation group). We compared arterial oxygen index, lung function, respiratory dynamics, and clinical efficacy between the two groups. There was no significant difference in the basic data between the two groups (P>0.05). After the treatment, the improvement of the partial pressure of oxygen (PaO2), PaO2/fraction of inspired oxygen (FiO2), arterial oxygen saturation (SaO2), and oxygen delivery (DO2) in the observation group was significantly better than that in the control group (P<0.05). After the treatment, the improvement of lung function in the observation group was better than that in the control group (P<0.05). After the treatment, the end expiratory pulmonary pressure (Ptp-ee) and driving pressure (△Ptp) levels in the observation group were significantly higher, and the duration of ICU hospitalization and the incidence of ICU-acquired weakness(ICU-AW) were significantly lower than those in the control group (P<0.05). IBC combined with HFNC can significantly improve arterial oxygen levels, lung function, and respiratory dynamics in patients with severe RF. IBC in combination with HFNC is associated with shorter stay time in the ICU, reduced of ICU-acquired weakness, and better physical recovery of patients.

Acute respiratory failure is the leading cause of intensive care unit (ICU) admission of cancer patients. Studies of the efficacy of high-flow nasal cannula (HFNC) therapy were rarely conducted in cancer populations. We here compared the clinical effects of HFNC therapy and conventional oxygen therapy (COT) in cancer patients with concurrent acute hypoxemic respiratory failure (AHRF). In this single-center retrospective study, cancer patients with concurrent acute hypoxic respiratory failure either received initial oxygen therapy via HFNC (HFNC group, 68 patients) or received initial oxygen therapy via a nasal cannula, simple mask, or mask with reservoir bag (COT group, 133 patients). Groups were propensity score matched. Differences in respiratory rate (RR), heart rate (HR), and PaO2/FiO2 ratio before and after treatment in the two groups were compared using a mixed-effects model. The 28-day mortality risk was explored using a Cox proportional hazards model. The 24-h and 48-h PaO2/FIO2 ratios were significantly higher in the HFNC than in the COT group (210.5mmHg vs. 178.5mmHg; P < 0.01; 217.1mm Hg vs. 181.6mm Hg; P < 0.01, respectively). Differences in RR and HR between the groups at each time point were nonsignificant. The 28-day mortality rate was 17.4% vs. 38.1% for the HFNC and COT groups, respectively (P < 0.01). Hazard ratio was significantly higher for COT group (HR 2.6, 95% confidence interval 1.3, 5.3). Compared with COT, HFNC use for initial oxygen therapy can improve PaO2/FIO2 ratio and survival rate in cancer patients with AHRF.

ObjectiveTo compare high-flow nasal cannula (HFNC) oxygen therapy and non-invasive ventilation (NIV) for patients after liberation from invasive mechanical ventilation, to assess whether HFNC is better than NIV at improving blood gases [PaO2, PaCO2, and oxygenation index (OI)], reducing re-intubation rates, pulmonary infections, mortality, and shortening the length of stay in intensive care unit (ICU), and to evaluate if HFNC is a feasible alternative to NIV for respiratory support.MethodsThis meta-analysis included randomized controlled trials (RCTs) and non-RCTs (NRCTs) from PubMed, Web of Science, CNKI, and Wanfang for further assessment. Evaluation indexes included PaO2, PaCO2, OI, re-intubation rate, pulmonary infection rate, length of stay in ICU, and mortality rate.ResultsHFNC showed higher PaO2 [MD = 2.95, 95%CI (2.23, 3.67), p < 0.00001], lower PaCO2 [MD = −3.04, 95%CI (−3.56, −2.52), p < 0.00001], higher OI [MD = 10.98, 95%CI (6.52, 15.45), p < 0.00001], lower re-intubation rate [OR = 0.45, 95%CI (0.33, 0.63), p < 0.00001], and shorter length of stay in ICU [MD = −6.15, 95%CI (−6.86, −5.44), p < 0.00001] compared to NIV. Additionally, no significant differences in pulmonary infection rate [OR = 0.57, 95%CI (0.29, 1.11), p = 0.10] or mortality [OR = 1.29, 95%CI (0.96, 1.72), p = 0.09] were observed between HFNC and NIV.ConclusionHFNC can improve PaO2 and OI, reduce PaCO2, re-intubation rate, and length of stay in ICU, with no difference in pulmonary infection or mortality compared to NIV, supporting it as a viable clinical alternative for post-extubation respiratory support.

Aim To determine whether the purchase of High Flow Nasal Oxygen (HFNO) for general paediatric wards was associated with reduced length of stay or intubation rates in children admitted with bronchiolitis. Method We conducted a survey of all English NHS hospitals, excluding those with paediatric intensive care facilities. The Freedom of Information Team in each hospital was contacted to ascertain if and when HFNO was purchased for their general paediatric ward. We used Hospital Episode Statistics, (an administrative hospital admission database), to compare length of stay and intubation rates, within hospital before and after HFNO was purchased, and between hospitals that did and did not purchase HFNO. We used Kolmogorov-Smirnov tests to compare length of stay and chi squared tests to compare the proportion of children intubated. Results Responses were received for 126 of the 144 hospitals contacted; 99 of which had purchased HFNO (78.6%) for their general paediatric ward. HFNO purchasing has been increasing since 1999. 84% of those who purchased HFNO bought it during 2012 – 2016, with peak number of purchases in 2013 (26%). 0.6%–0.8% of children admitted with bronchiolitis were intubated irrespective of whether HFNO was purchased or not. No significant difference was found between each group. Median length of stay was 1 day. Purchase of HFNO was associated with a small reduction in length of stay when comparing the Pre and Post–purchase groups (p = 0.035), but there was no significant difference when comparing the Not purchased and Post–purchase groups (p = 0.871). Conclusion The purchase of HFNO for use on general paediatric wards is increasing, however it does not appear to be associated with reduction in intubation rates in this study. A small statistical reduction in length of stay was found, though the clinical relevance of this is unclear. Recommendations Substantial knowledge gaps and controversies still exist in the management of bronchiolitis. In view of the increasing use of HFNO in routine care, a multi-centred randomised control study would offer the best evidence for its effectiveness in reducing the hospital burden of bronchiolitis.