High Flow Nasal Cannula Oxygen Therapy - Part 2

This is an automatically translated article.

The article was written by Dr., Doctor Truong Ngoc Hai, Department of Emergency Resuscitation, Vinmec Central Park International General Hospital

Matters of note

Like other medical interventions, nasal cannula high-flow oxygen therapy also has many limitations and drawbacks. One of the major disadvantages is that it is more expensive to care for than low-flow nasogastric tubes, is more complicated, and requires training to administer therapy, care, reduced mobility, risk of leakage, airway and loss of positive airway pressure effect, the possibility of delaying intubation, and the potential for inappropriately delaying end-of-life decisions (Spoletini et al. 2015). Furthermore, potential risk factors for delayed deployment of noninvasive ventilation in the application of high-flow oxygen therapy via nasal cannula. Includes patients with altered consciousness, facial trauma, hypersecretion with risk of aspiration pneumonia, and hemodynamic instability. [1] [8]

Clinically applied

High-flow oxygen therapy through a nasal cannula is used in the following cases:
Acute hypoxic respiratory failure Post-operative respiratory failure Acute heart failure / Acute pulmonary edema Hypercapnia respiratory failure, COPD Hyperoxidation before and after extubation Sleep apnea Use in emergency department For patients who require no intubation.

Acute hypoxic respiratory failure (AHRF) occurs due to intrapulmonary shunts as a result of atelectasis or alveolar edema. These cases are often poorly responsive to conventional supplemental oxygen therapy. Occurs when there is an increase in alveolar-capillary hydrostatic pressure, increased alveolar capillary permeability, and overflow of blood in the alveoli due to hemorrhage and/or fluid from inflammation (pneumonia). As discussed, nasogastric high-flow oxygen therapy induces PEEP. The FLORALI trial [9] found that although intranasal high-flow oxygen therapy did not reduce intubation rates in non-immunocompromised patients with respiratory failure without hypercapnia, but patients treated with nasogastric high-flow oxygen therapy had reduced ICU mortality and 90 days of treatment. The study results also showed an increase in ventilator-free days, comfort level, decrease in dyspnea and decrease in respiratory rate. No significant adverse effects associated with nasogastric high-flow oxygen therapy were noted. This study had an insufficient number of patients to answer the primary outcome of intubation rates; Two subsequent randomized controlled trials (Stephen et al. and Maggiore et al.) showed that nasal cannula high-flow oxygen therapy was as effective as noninvasive ventilation (NIV). in avoiding intubation and reducing mortality.

Physiologically, the ability to independently control FIO2 and oxygen flow during noninvasive ventilation (NIV) and nasal cannula high-flow oxygen therapy offers a clear advantage over conventional oxygen therapy In patients with acute respiratory failure, there is a predisposition to hypercapnia. Nasal high-flow oxygen therapy certainly offers a more comfortable alternative in patients who have difficulty tolerating the NIV modality. Finally, it is important to note the limitations of NIV to the patient and the manpower requirements in nursing care and noninvasive ventilation monitoring (NIV) compared with Nasal Catheter High Flow Oxygen Therapy.
Increasing blood oxygenation for the patient before intubation is very necessary. Nasal high-flow oxygen therapy can be performed in an awake patient, through increased oxygen flow, high FiO2 increases blood PO2. This allows more time for intubation before hypoxia occurs. Historically, a non-rebreathing mask (NRM) has been used to help increase blood oxygenation in patients like these. However, Miguel-Mantanes et al. (2015) found that nasal cannula high-flow oxygen therapy significantly improved oxygenation during intubation compared with nonrebreathing mask breathing (NRM). In a retrospective analysis, noninvasive ventilation such as BiPAP yielded similar outcomes to HFNC in relation to prognostic outcomes, but significantly reduced patient compliance (Besnier, Emmanuel et al. 2016 ). This suggests that nasogastric high-flow oxygen therapy is superior to both NRM and NIV in the pre-intubation period.

Oxygen is also important after extubation. Arman et al. (2017) found that although there was no significant difference in post-extubation oxygen saturation between low-flow nasal cannula oxygen therapy and high-flow nasal cannula oxygen therapy in ICU patients, but there were differences in heart rate and respiratory rate, suggesting that in order for the low-flow nasal oxygen patient to reach oxygen saturation, the patient needs to donate heart rate and respiratory rate. Postoperative extubation also requires oxygen therapy. Youfeng et al. (2018) completed a meta-analysis concluding that nasogastric high-flow oxygen therapy can reduce the need for respiratory support compared with nasogastric low-flow oxygen therapy in heart surgery patient. Hernandez et al published 2 articles in the journal JAMA on the application of nasogastric high-flow oxygen therapy in high-risk patients after extubation compared with low-risk and receiving found that high-flow nasogastric oxygen therapy was superior to standard care in low-risk patients after extubation and not worse than non-invasive mechanical ventilation in high-risk patients after intubation. endotracheal extubation. [10] [11] Furthermore, in high-risk patients, the combination of noninvasive mechanical ventilation with high-flow nasal cannula oxygen therapy is superior to all other modalities [12]
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