![]() There was a significant difference in favor of high-flow oxygen in 90-day mortality. In patients with nonhypercapnic acute hypoxemic respiratory failure, treatment with high-flow oxygen, standard oxygen, or noninvasive ventilation did not result in significantly different intubation rates. The hazard ratio for death at 90 days was 2.01 (95% confidence interval, 1.01 to 3.99) with standard oxygen versus high-flow oxygen (P=0.046) and 2.50 (95% CI, 1.31 to 4.78) with noninvasive ventilation versus high-flow oxygen (P=0.006). 22☑0 in the standard-oxygen group and 19☑2 in the noninvasive-ventilation group P=0.02 for all comparisons). The number of ventilator-free days at day 28 was significantly higher in the high-flow-oxygen group (24☘ days, vs. The intubation rate (primary outcome) was 38% (40 of 106 patients) in the high-flow-oxygen group, 47% (44 of 94) in the standard group, and 50% (55 of 110) in the noninvasive-ventilation group (P=0.18 for all comparisons). ![]() The primary outcome was the proportion of patients intubated at day 28 secondary outcomes included all-cause mortality in the intensive care unit and at 90 days and the number of ventilator-free days at day 28.Ī total of 310 patients were included in the analyses. We performed a multicenter, open-label trial in which we randomly assigned patients without hypercapnia who had acute hypoxemic respiratory failure and a ratio of the partial pressure of arterial oxygen to the fraction of inspired oxygen of 300 mm Hg or less to high-flow oxygen therapy, standard oxygen therapy delivered through a face mask, or noninvasive positive-pressure ventilation. Therapy with high-flow oxygen through a nasal cannula may offer an alternative in patients with hypoxemia. Whether noninvasive ventilation should be administered in patients with acute hypoxemic respiratory failure is debated. Effect of non-invasive oxygenation strategies in immunocompromised patients with severe acute respiratory failure: a post-hoc analysis of a randomised trial. Odds ratios for intubation were higher in patients treated with noninvasive ventilation than in those treated with high flow nasal cannula therapy ( Frat JP, Ragot S, Girault C, et al. Effects of High-Flow Nasal Cannula on the Work of Breathing in Patients Recovering From Acute Respiratory Failure. This effect is associated with an improvement in respiratory mechanics ( Delorme M, Bouchard PA, Simon M, Simard S, Lellouche F. HFNC set at 60 l/min reduced the respiratory effort in patients recovering from acute respiratory failure. High-flow oxygen through nasal cannula in acute hypoxemic respiratory failure. There was a significant difference in favor of HFNC in 90-day mortality ( Frat JP, Thille AW, Mercat A, et al. The mouth status, flow, and compliance were the 3 major influencing factors of PEEP effect, whereas performance of the 2 mechanical ventilators was slightly superior to that of the AIRVO 2 device at higher flows.ĪIRVO 2 system HFNC device PEEP effect ventilator.Ĭopyright © 2017 by Daedalus Enterprises.Treatment with HFNC resulted in lower intubation rates in the most severe patients. Despite the difference in working curves, both the mechanical ventilators performed slightly better than the AIRVO 2 device at higher flows (40 and 50 L/min). The PEEP increased along with lung compliance (coefficient was 2.58 × 10 -3). Pairwise comparisons were conducted by using Tukey's multiple comparisons test within an overlap of flow from 0 to 50 L/min.Ī quadratic curved relationship between PEEP and flow was observed (coefficients were 8.97 × 10 -3 for flow and 4.79 × 10 -4 for a quadratic element of flow, respectively) but evanished when the mouth was open. The sum of squares reduction test was used to compare working curves of PEEP effect among 3 devices. The influencing factors were determined by multiple linear regression. The pressures were measured at 4 sites (nasopharynx, supraglottis, carina, and lung) under compliances of 50 and 100 mL/cm H 2O and tidal volume of 300, 500, and 700 mL with the mouth closed or open. The flows ranged from 0 to their maximum flow with an interval of 10 L/min. A device consisting of a test lung (5600i) and an airway model (AMT(IE)) was used to simulate spontaneous breathing. Three available HFNC devices were evaluated: the AIRVO 2 device and 2 mechanical ventilators (SV300 and Monnal T75). We investigated the factors that might affect the PEEP and compared PEEP performance among 3 HFNC devices. However, the exact determinants of this PEEP effect are unclear. High-flow nasal cannula (HFNC) is supposed to provide additional PEEP compared with conventional oxygen therapy.
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