High flow nasal cannula and low level continuous positive airway pressure have different physiological effects during de novo acute hypoxemic respiratory failure
Abstract Background Large tidal volumes during de novo acute hypoxemic respiratory failure (AHRF) may promote patient self-inflicted lung injury. Tidal volume assessment under high flow nasal cannula (HFNC) is not routinely feasible at the bedside. Our objective was to determine whether tidal volume...
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SpringerOpen
2024-11-01
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| Series: | Annals of Intensive Care |
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| Online Access: | https://doi.org/10.1186/s13613-024-01408-w |
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| author | Samuel Tuffet Mohamed Ahmed Boujelben Anne-Fleur Haudebourg Tommaso Maraffi François Perier Pascale Labedade Elsa Moncomble Ségolène Gendreau Matthieu Lacheny Emmanuel Vivier Armand Mekontso-Dessap Guillaume Carteaux |
| author_facet | Samuel Tuffet Mohamed Ahmed Boujelben Anne-Fleur Haudebourg Tommaso Maraffi François Perier Pascale Labedade Elsa Moncomble Ségolène Gendreau Matthieu Lacheny Emmanuel Vivier Armand Mekontso-Dessap Guillaume Carteaux |
| author_sort | Samuel Tuffet |
| collection | DOAJ |
| description | Abstract Background Large tidal volumes during de novo acute hypoxemic respiratory failure (AHRF) may promote patient self-inflicted lung injury. Tidal volume assessment under high flow nasal cannula (HFNC) is not routinely feasible at the bedside. Our objective was to determine whether tidal volume during low-level continuous positive airway pressure (CPAP) could predict tidal volume during HFNC and to compare the physiological effects of HFNC and low-level CPAP. Methods Prospective, single-center study including 29 de novo AHRF patients treated with HFNC (50 to 60 L.min− 1). Patients were monitored using electrical impedance tomography during HFNC then CPAP at 4 cmH2O. Tidal volume during HFNC was calculated based on tidal impedance variation. The ability of tidal volume under low-level CPAP to predict tidal volume under HFNC was explored using Bland-Altman analysis. CPAP and HFNC were compared in terms of tidal volume, minute ventilation, respiratory comfort, dyspnea, oxygenation, ventilation distribution, end-expiratory lung volume, thoraco-abdominal asynchrony and recruitment. Results Under HFNC, patients had a tidal volume of 6.6 (5.9–8.7) mL.kg− 1 PBW. 20 (69%) patients exhibited a tidal volume between 4 and 8 mL.kg− 1 PBW, while in 5 (17%) patients it exceeded 9 mL.kg− 1 PBW. Tidal volume under CPAP was higher (9.4 (8.3–11) mL.kg− 1 PBW, p < 0.001). Tidal volumes under CPAP and under HFNC were modestly correlated (Spearman r = 0.50, p = 0.005). Bland-Altman analysis showed a bias of 2.4 mL.kg− 1, with limits of agreement ranging from − 1.1 mL.kg− 1to 5.9 mL.kg− 1. Nevertheless, a larger (> 11.5 mL.kg− 1 PBW ) tidal volume under low-level CPAP predicted a larger (> 9 mL.kg− 1 PBW ) tidal volume under HFNC with 80% sensitivity and 96% specificity. Low-level CPAP was associated with increased minute ventilation, end-expiratory lung volume, and oxygenation as compared to HFNC. It decreased signs of respiratory distress in the most severe patients but was associated with lower comfort compared to HFNC. Conclusion Among ICU patients with de novo AHRF, tidal volume under HFNC was mostly protective. Tidal volume during CPAP at 4 cmH2O did not predict tidal volume during HFNC. Such low-level CPAP was associated with increased tidal volume, minute ventilation, end-expiratory volume, and oxygenation. Trial registration ClinicalTrials.gov ID NCT03919331. Registration date: 2019-03-26. |
| format | Article |
| id | doaj-art-3c83766e204a4930aa503d6777113111 |
| institution | Kabale University |
| issn | 2110-5820 |
| language | English |
| publishDate | 2024-11-01 |
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| series | Annals of Intensive Care |
| spelling | doaj-art-3c83766e204a4930aa503d67771131112024-11-24T12:42:52ZengSpringerOpenAnnals of Intensive Care2110-58202024-11-011411910.1186/s13613-024-01408-wHigh flow nasal cannula and low level continuous positive airway pressure have different physiological effects during de novo acute hypoxemic respiratory failureSamuel Tuffet0Mohamed Ahmed Boujelben1Anne-Fleur Haudebourg2Tommaso Maraffi3François Perier4Pascale Labedade5Elsa Moncomble6Ségolène Gendreau7Matthieu Lacheny8Emmanuel Vivier9Armand Mekontso-Dessap10Guillaume Carteaux11Hôpital Saint Joseph Saint Luc, Médecine Intensive RéanimationGroupe de Recherche Clinique CARMAS, Faculté de Santé, Université Paris Est-CréteilGroupe de Recherche Clinique CARMAS, Faculté de Santé, Université Paris Est-CréteilGroupe de Recherche Clinique CARMAS, Faculté de Santé, Université Paris Est-CréteilService de réanimation, Centre Hospitalier de La RochelleGroupe de Recherche Clinique CARMAS, Faculté de Santé, Université Paris Est-CréteilGroupe de Recherche Clinique CARMAS, Faculté de Santé, Université Paris Est-CréteilGroupe de Recherche Clinique CARMAS, Faculté de Santé, Université Paris Est-CréteilCHU Henri Mondor-Albert Chenevier, Service de Médecine Intensive Réanimation, Assistance Publique- Hôpitaux de ParisHôpital Saint Joseph Saint Luc, Médecine Intensive RéanimationGroupe de Recherche Clinique CARMAS, Faculté de Santé, Université Paris Est-CréteilGroupe de Recherche Clinique CARMAS, Faculté de Santé, Université Paris Est-CréteilAbstract Background Large tidal volumes during de novo acute hypoxemic respiratory failure (AHRF) may promote patient self-inflicted lung injury. Tidal volume assessment under high flow nasal cannula (HFNC) is not routinely feasible at the bedside. Our objective was to determine whether tidal volume during low-level continuous positive airway pressure (CPAP) could predict tidal volume during HFNC and to compare the physiological effects of HFNC and low-level CPAP. Methods Prospective, single-center study including 29 de novo AHRF patients treated with HFNC (50 to 60 L.min− 1). Patients were monitored using electrical impedance tomography during HFNC then CPAP at 4 cmH2O. Tidal volume during HFNC was calculated based on tidal impedance variation. The ability of tidal volume under low-level CPAP to predict tidal volume under HFNC was explored using Bland-Altman analysis. CPAP and HFNC were compared in terms of tidal volume, minute ventilation, respiratory comfort, dyspnea, oxygenation, ventilation distribution, end-expiratory lung volume, thoraco-abdominal asynchrony and recruitment. Results Under HFNC, patients had a tidal volume of 6.6 (5.9–8.7) mL.kg− 1 PBW. 20 (69%) patients exhibited a tidal volume between 4 and 8 mL.kg− 1 PBW, while in 5 (17%) patients it exceeded 9 mL.kg− 1 PBW. Tidal volume under CPAP was higher (9.4 (8.3–11) mL.kg− 1 PBW, p < 0.001). Tidal volumes under CPAP and under HFNC were modestly correlated (Spearman r = 0.50, p = 0.005). Bland-Altman analysis showed a bias of 2.4 mL.kg− 1, with limits of agreement ranging from − 1.1 mL.kg− 1to 5.9 mL.kg− 1. Nevertheless, a larger (> 11.5 mL.kg− 1 PBW ) tidal volume under low-level CPAP predicted a larger (> 9 mL.kg− 1 PBW ) tidal volume under HFNC with 80% sensitivity and 96% specificity. Low-level CPAP was associated with increased minute ventilation, end-expiratory lung volume, and oxygenation as compared to HFNC. It decreased signs of respiratory distress in the most severe patients but was associated with lower comfort compared to HFNC. Conclusion Among ICU patients with de novo AHRF, tidal volume under HFNC was mostly protective. Tidal volume during CPAP at 4 cmH2O did not predict tidal volume during HFNC. Such low-level CPAP was associated with increased tidal volume, minute ventilation, end-expiratory volume, and oxygenation. Trial registration ClinicalTrials.gov ID NCT03919331. Registration date: 2019-03-26.https://doi.org/10.1186/s13613-024-01408-wAcute hypoxemic respiratory failureHigh flow nasal cannulaContinuous positive airway pressureNoninvasive ventilationRespiratory support |
| spellingShingle | Samuel Tuffet Mohamed Ahmed Boujelben Anne-Fleur Haudebourg Tommaso Maraffi François Perier Pascale Labedade Elsa Moncomble Ségolène Gendreau Matthieu Lacheny Emmanuel Vivier Armand Mekontso-Dessap Guillaume Carteaux High flow nasal cannula and low level continuous positive airway pressure have different physiological effects during de novo acute hypoxemic respiratory failure Annals of Intensive Care Acute hypoxemic respiratory failure High flow nasal cannula Continuous positive airway pressure Noninvasive ventilation Respiratory support |
| title | High flow nasal cannula and low level continuous positive airway pressure have different physiological effects during de novo acute hypoxemic respiratory failure |
| title_full | High flow nasal cannula and low level continuous positive airway pressure have different physiological effects during de novo acute hypoxemic respiratory failure |
| title_fullStr | High flow nasal cannula and low level continuous positive airway pressure have different physiological effects during de novo acute hypoxemic respiratory failure |
| title_full_unstemmed | High flow nasal cannula and low level continuous positive airway pressure have different physiological effects during de novo acute hypoxemic respiratory failure |
| title_short | High flow nasal cannula and low level continuous positive airway pressure have different physiological effects during de novo acute hypoxemic respiratory failure |
| title_sort | high flow nasal cannula and low level continuous positive airway pressure have different physiological effects during de novo acute hypoxemic respiratory failure |
| topic | Acute hypoxemic respiratory failure High flow nasal cannula Continuous positive airway pressure Noninvasive ventilation Respiratory support |
| url | https://doi.org/10.1186/s13613-024-01408-w |
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