Protective effects of humidified and heated high flow oxygen therapy for critically ill patients after extubation_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

CHEN Yuanjie , SUN Li , PENG Ling , DING Ning , FEI Miaomiao , YAN Susu , WAN Xiaojian ,  ZHU Keming

Critical Care Medicine Department of Anesthesiology Institution of Changhai Hospital, the Second Military Medicine University, Shanghai 200433, P. R. China;

Corresponding author：

ZHU Keming, Email: kmzhu@aliyun.com

Keywords：

Humidified and heated high flow oxygen; Critically ill patient; Respiratory function protection

DOI：

10.7507/1671-6205.201705004

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objectives To explore the efficacy of humidified and heated high flow oxygen therapy for the critically ill patients in intensive care unit (ICU) after extubation. Methods From January 2014 to December 2016, 487 patients were enrolled. Patients were allocated to two treatment groups randomly, which were humidified and heated high flow oxygen therapy group (236 patients, HFM group, aged 55.3±21.1 years old) and routine oxygen therapy group (251 patients, TO group, aged 58.4±19.3 years old). Blood oxygen saturation, arterial partial pressure of oxygen (PaO₂), arterial partial pressure of carbon dioxide (PaCO₂), fraction of inspired oxygen (FiO₂), respiratory frequency, incidence rate of reintubation, ventilator-free days, ICU length of stay, and hospital stay were assessed and compared between the HFM group and the TO group. Results The hospital stay was similar in two groups. There were more ventilator-free days in the HFM group (P<0.05), fewer patients required reintubation (4.2%vs. 10.4%, P<0.05) and less ICU length of stay [(10.5±6.1) dvs. (14.3±8.5) d, P<0.05]. PaO₂/FiO₂ of the HFM group were better than the TO group after extubation at 2 h, 4 h, 8 h, 24 h, and 48 h (P<0.05). There were no statistically significant differences in respiratory frequency and PaCO₂. Conclusions Humidified and heated high flow oxygen therapy can supply a better oxygenation for patients after extubation in ICU. It could be a common therapy in ICU for the critically patients after extubation.

Citation： CHEN Yuanjie, SUN Li, PENG Ling, DING Ning, FEI Miaomiao, YAN Susu, WAN Xiaojian, ZHU Keming. Protective effects of humidified and heated high flow oxygen therapy for critically ill patients after extubation. Chinese Journal of Respiratory and Critical Care Medicine, 2018, 17(3): 259-262. doi: 10.7507/1671-6205.201705004 Copy

1.	Maile R, Jones S, Pan YH, et al. Association between early airway damage-associated molecular patterns and subsequent bacterial infection in patients with inhalational and burn injury. Am J Physiol Lung Cell Mol Physiol, 2015, 308(9): L855-L860.
2.	梁娟, 胡雪慧, 孙新, 等. ICU 患者人工气道内痰痂堵管的发生率及影响因素分析. 医学临床研究, 2016, 33(11): 2095-2098.
3.	Wagstaff TA, Soni N. Performance of six types of oxygen delivery devices at varying respiratory rates. Anaesthesia, 2007, 62(5): 492-503.
4.	Frizzola M, Miller TI, Rodriguez ME, et al. High-flow nasal cannula: impact on oxygenation and ventilation in an acute lung injury model. Pediatr Pulmonol, 2011, 46(1): 67-74.
5.	Hasani A, Chapman TH, McCool D, et al. Domiciliary humidification improves lung mucociliary clearance in patients with bronchiectasis. Chron Respir Dis, 2008, 5(2): 81-86.
6.	Boles JM, Bion J, Connors A, et al. Weaning from mechanical ventilation. Eur Respir J, 2007, 29(5): 1033.
7.	Sreenan C, Lemke RP, Hudson-Mason A, et al. High-flow nasal cannulae in the management of apnea of prematurity: a comparison with conventional nasal continuous positive airway pressure. Pediatrics, 2001, 107(5): 1081-1083.
8.	Kubicka ZJ, Limauro J, Darnall RA. Heated, humidified high-flow nasal cannula therapy: yet another way to deliver continuous positive airway pressure?. Pediatrics, 2008, 121(1): 82-88.
9.	Saslow JG, Aghai ZH, Nakhla TA, et al. Work of breathing using high-flow nasal cannula in preterm infants. J Perinatol, 2006, 26(8): 476-480.
10.	Lee JH, Rehder KJ, Williford L, et al. Use of high flow nasal cannula in critically ill infants, children, and adults: a critical review of the literature. Intensive Care Med, 2013, 39(2): 247-257.
11.	Nishimura M. High-flow nasal cannula oxygen therapy in adults: physiological benefits, indication, clinical benefits, and adverse effects. Respiratory Care, 2016, 61(4): 529-541.
12.	Thille AW, Cortéspuch I, Esteban A. Weaning from the ventilator and extubation in ICU. Curr Opin Crit Care, 2013, 19(1): 57.
13.	Thille AW, Harrois A, Schortgen F, et al. Outcomes of extubation failure in medical intensive care unit patients. Crit Care Med, 2011, 39(12): 2612.
14.	Epstein SK, Ciubotaru RL, Wong JB. Effect of failed extubation on the outcome of mechanical ventilation. Chest, 1997, 112(1): 186-192.
15.	Corley A, Caruana LR, Barnett AG, et al. Oxygen delivery through high-flow nasal cannulae increase end-expiratory lung volume and reduce respiratory rate in post-cardiac surgical patients. Br J Anaesth, 2011, 107(6): 998.
16.	Chanques G, Constantin JM, Sauter M, et al. Discomfort associated with under humidified high-flow oxygen therapy in critically ill patients. Intensive Care Med, 2009, 35(6): 996-1003.
17.	Sztrymf B, Messika J, Mayot T, et al. Impact of high-flow nasal cannula oxygen therapy on intensive care unit patients with acute respiratory failure: A prospective observational study. J Crit Care, 2012, 27(3): 324, e9-13.
18.	Sheu C C, Gong M R, Chen F, et al. Clinical characteristics and outcomes of sepsis-related vs non-sepsis-related ARDS. Chest, 2010, 138(3): 559.
19.	Ware L B, Conner E R, Matthay M A. von Willebrand factor antigen is an independent marker of poor outcome in patients with early acute lung injury. Critical Care Medicine, 2001, 29(12): 2325.

1. Maile R, Jones S, Pan YH, et al. Association between early airway damage-associated molecular patterns and subsequent bacterial infection in patients with inhalational and burn injury. Am J Physiol Lung Cell Mol Physiol, 2015, 308(9): L855-L860.
2. 梁娟, 胡雪慧, 孙新, 等. ICU 患者人工气道内痰痂堵管的发生率及影响因素分析. 医学临床研究, 2016, 33(11): 2095-2098.
3. Wagstaff TA, Soni N. Performance of six types of oxygen delivery devices at varying respiratory rates. Anaesthesia, 2007, 62(5): 492-503.
4. Frizzola M, Miller TI, Rodriguez ME, et al. High-flow nasal cannula: impact on oxygenation and ventilation in an acute lung injury model. Pediatr Pulmonol, 2011, 46(1): 67-74.
5. Hasani A, Chapman TH, McCool D, et al. Domiciliary humidification improves lung mucociliary clearance in patients with bronchiectasis. Chron Respir Dis, 2008, 5(2): 81-86.
6. Boles JM, Bion J, Connors A, et al. Weaning from mechanical ventilation. Eur Respir J, 2007, 29(5): 1033.
7. Sreenan C, Lemke RP, Hudson-Mason A, et al. High-flow nasal cannulae in the management of apnea of prematurity: a comparison with conventional nasal continuous positive airway pressure. Pediatrics, 2001, 107(5): 1081-1083.
8. Kubicka ZJ, Limauro J, Darnall RA. Heated, humidified high-flow nasal cannula therapy: yet another way to deliver continuous positive airway pressure?. Pediatrics, 2008, 121(1): 82-88.
9. Saslow JG, Aghai ZH, Nakhla TA, et al. Work of breathing using high-flow nasal cannula in preterm infants. J Perinatol, 2006, 26(8): 476-480.
10. Lee JH, Rehder KJ, Williford L, et al. Use of high flow nasal cannula in critically ill infants, children, and adults: a critical review of the literature. Intensive Care Med, 2013, 39(2): 247-257.
11. Nishimura M. High-flow nasal cannula oxygen therapy in adults: physiological benefits, indication, clinical benefits, and adverse effects. Respiratory Care, 2016, 61(4): 529-541.
12. Thille AW, Cortéspuch I, Esteban A. Weaning from the ventilator and extubation in ICU. Curr Opin Crit Care, 2013, 19(1): 57.
13. Thille AW, Harrois A, Schortgen F, et al. Outcomes of extubation failure in medical intensive care unit patients. Crit Care Med, 2011, 39(12): 2612.
14. Epstein SK, Ciubotaru RL, Wong JB. Effect of failed extubation on the outcome of mechanical ventilation. Chest, 1997, 112(1): 186-192.
15. Corley A, Caruana LR, Barnett AG, et al. Oxygen delivery through high-flow nasal cannulae increase end-expiratory lung volume and reduce respiratory rate in post-cardiac surgical patients. Br J Anaesth, 2011, 107(6): 998.
16. Chanques G, Constantin JM, Sauter M, et al. Discomfort associated with under humidified high-flow oxygen therapy in critically ill patients. Intensive Care Med, 2009, 35(6): 996-1003.
17. Sztrymf B, Messika J, Mayot T, et al. Impact of high-flow nasal cannula oxygen therapy on intensive care unit patients with acute respiratory failure: A prospective observational study. J Crit Care, 2012, 27(3): 324, e9-13.
18. Sheu C C, Gong M R, Chen F, et al. Clinical characteristics and outcomes of sepsis-related vs non-sepsis-related ARDS. Chest, 2010, 138(3): 559.
19. Ware L B, Conner E R, Matthay M A. von Willebrand factor antigen is an independent marker of poor outcome in patients with early acute lung injury. Critical Care Medicine, 2001, 29(12): 2325.

Chinese Journal of Respiratory and Critical Care Medicine

Protective effects of humidified and heated high flow oxygen therapy for critically ill patients after extubation

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