Physiological effects of high-flow nasal cannula oxygen therapy after extubation: a randomized crossover study.
| Autor: | Basoalto R; Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, 6º Piso, P.O. Box 114D, 8330077, Santiago, Chile.; Programa de Medicina Física y Rehabilitación, Red Salud UC-CHRISTUS, Santiago, Chile.; CardioREspirAtory Research Laboratory (CREAR), Departamento de Ciencias de la Salud, Pontificia Universidad Católica de Chile, Santiago, Chile., Damiani LF; CardioREspirAtory Research Laboratory (CREAR), Departamento de Ciencias de la Salud, Pontificia Universidad Católica de Chile, Santiago, Chile.; Departamento de Ciencias de la Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile., Jalil Y; Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, 6º Piso, P.O. Box 114D, 8330077, Santiago, Chile.; CardioREspirAtory Research Laboratory (CREAR), Departamento de Ciencias de la Salud, Pontificia Universidad Católica de Chile, Santiago, Chile.; Departamento de Ciencias de la Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile., Bachmann MC; Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, 6º Piso, P.O. Box 114D, 8330077, Santiago, Chile.; CardioREspirAtory Research Laboratory (CREAR), Departamento de Ciencias de la Salud, Pontificia Universidad Católica de Chile, Santiago, Chile.; Carrera de Kinesiología, Facultad de Medicina, Universidad de los Andes, Santiago, Chile., Oviedo V; Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, 6º Piso, P.O. Box 114D, 8330077, Santiago, Chile., Alegría L; Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, 6º Piso, P.O. Box 114D, 8330077, Santiago, Chile.; Departamento de Salud del Adulto y Senescente, Escuela de. Enfermería, Pontificia Universidad Católica de Chile, Santiago, Chile., Valenzuela ED; Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, 6º Piso, P.O. Box 114D, 8330077, Santiago, Chile., Rovegno M; Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, 6º Piso, P.O. Box 114D, 8330077, Santiago, Chile., Ruiz-Rudolph P; Programa de Epidemiología, Instituto de Salud Poblacional, Facultad de Medicina, Universidad de Chile, Santiago, Chile., Cornejo R; Unidad de Pacientes Críticos, Departamento de Medicina, Hospital Clínico Universidad de Chile, Santiago, Chile.; Center of Acute Respiratory Critical Illness (ARCI), Santiago, Chile., Retamal J; Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, 6º Piso, P.O. Box 114D, 8330077, Santiago, Chile.; Center of Acute Respiratory Critical Illness (ARCI), Santiago, Chile., Bugedo G; Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, 6º Piso, P.O. Box 114D, 8330077, Santiago, Chile., Thille AW; Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Poitiers, Poitiers, France.; INSERM Centre d'Investigation Clinique 1402 IS-ALIVE, Université de Poitiers, Poitiers, France., Bruhn A; Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, 6º Piso, P.O. Box 114D, 8330077, Santiago, Chile. alejandrobruhn@gmail.com.; Center of Acute Respiratory Critical Illness (ARCI), Santiago, Chile. alejandrobruhn@gmail.com. |
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| Jazyk: | angličtina |
| Zdroj: | Annals of intensive care [Ann Intensive Care] 2023 Oct 18; Vol. 13 (1), pp. 104. Date of Electronic Publication: 2023 Oct 18. |
| DOI: | 10.1186/s13613-023-01203-z |
| Abstrakt: | Background: Prophylactic high-flow nasal cannula (HFNC) oxygen therapy can decrease the risk of extubation failure. It is frequently used in the postextubation phase alone or in combination with noninvasive ventilation. However, its physiological effects in this setting have not been thoroughly investigated. The aim of this study was to determine comprehensively the effects of HFNC applied after extubation on respiratory effort, diaphragm activity, gas exchange, ventilation distribution, and cardiovascular biomarkers. Methods: This was a prospective randomized crossover physiological study in critically ill patients comparing 1 h of HFNC versus 1 h of standard oxygen after extubation. The main inclusion criteria were mechanical ventilation for at least 48 h due to acute respiratory failure, and extubation after a successful spontaneous breathing trial (SBT). We measured respiratory effort through esophageal/transdiaphragmatic pressures, and diaphragm electrical activity (ΔEAdi). Lung volumes and ventilation distribution were estimated by electrical impedance tomography. Arterial and central venous blood gases were analyzed, as well as cardiac stress biomarkers. Results: We enrolled 22 patients (age 59 ± 17 years; 9 women) who had been intubated for 8 ± 6 days before extubation. Respiratory effort was significantly lower with HFNC than with standard oxygen therapy, as evidenced by esophageal pressure swings (5.3 [4.2-7.1] vs. 7.2 [5.6-10.3] cmH Conclusions: Prophylactic application of HFNC after extubation provides substantial respiratory support and unloads respiratory muscles. Trial registration January 15, 2021. NCT04711759. (© 2023. La Société de Réanimation de Langue Francaise = The French Society of Intensive Care (SRLF).) |
| Databáze: | MEDLINE |
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