Physiologic Effects of High-Flow Nasal Cannula Oxygen in Critical Care Subjects

• Published in: Respiratory care Vol. 60; no. 10; pp. 1369 - 1376
• Main Authors: Vargas, Frederic, Saint-Leger, Mélanie, Boyer, Alexandre, Bui, Nam H, Hilbert, Gilles
• Format: Journal Article
• Language: English
• Published: United States Daedalus Enterprises, Inc 01.10.2015; Daedalus Enterprises Inc
• Subjects: Aged; Analysis; Care and treatment; Catheters; Continuous positive airway pressure; Continuous Positive Airway Pressure - methods; Critical Care - methods; Critical Illness - therapy; Dyspnea; Editor's Choice; Female; Health aspects; Humans; Hypoxia - therapy; Male; Middle Aged; Noninvasive Ventilation - methods; Oxygen Consumption - physiology; Oxygen Inhalation Therapy - instrumentation; Oxygen Inhalation Therapy - methods; Oxygen therapy; Prevention; Prospective Studies; Pulmonary Gas Exchange - physiology; Respiratory insufficiency; Respiratory Insufficiency - therapy; France; inspiratory effort; acute hypoxemic respiratory failure; continuous positive airway pressure; high-flow nasal cannula; oxygen therapy
• ISSN: 0020-1324; 1943-3654
• DOI: 10.4187/respcare.03814

High-flow nasal cannula (HFNC) can deliver heated and humidified gas (up to 100% oxygen) at a maximum flow of 60 L/min via nasal prongs or cannula. The aim of this study was to assess the short-term physiologic effects of HFNC. Inspiratory muscle effort, gas exchange, dyspnea score, and comfort were evaluated. Twelve subjects admitted to the ICU for acute hypoxemic respiratory failure were prospectively included. Four study sessions were performed. The first session consisted of oxygen therapy given through a high-FIO2, non-rebreathing face mask. Recordings were then obtained during periods of HFNC and CPAP at 5 cm H2O in random order, and final measurements were performed during oxygen therapy delivered via a face mask. Each of these 4 periods lasted ∼20 min. Esophageal pressure signals, breathing pattern, gas exchange, comfort, and dyspnea were measured. Compared with the first session, HFNC reduced inspiratory effort (pressure-time product of 156.0 [119.2-194.4] cm H2O × s/min vs 204.2 [149.6-324.7] cm H2O × s/min, P < .01) and breathing frequency (P < .01). No significant differences were observed between HFNC and CPAP for inspiratory effort and breathing frequency. Compared with the first session, PaO2/FIO2 increased significantly with HFNC (167 [157-184] mm Hg vs 156 [110-171] mm Hg, P < .01). CPAP produced significantly greater PaO2/FIO2 improvement than did HFNC. Dyspnea improved with HFNC and CPAP, but this improvement was not significant. Subject comfort was not different across the 4 sessions. Compared with conventional oxygen therapy, HFNC improved inspiratory effort and oxygenation. In subjects with acute hypoxemic respiratory failure, HFNC is an alternative to conventional oxygen therapy. (ClinicalTrials.gov registration NCT01056952.).