Publication: High-flow nasal oxygen versus noninvasive ventilation in adult patients with cystic fibrosis: a randomized crossover physiological study
Issued Date
2018-12-01
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21105820
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2-s2.0-85052883325
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Mahidol University
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SCOPUS
Bibliographic Citation
Annals of Intensive Care. Vol.8, No.1 (2018)
Suggested Citation
Michael C. Sklar, Martin Dres, Nuttapol Rittayamai, Brent West, Domenico Luca Grieco, Irene Telias, Detajin Junhasavasdikul, Michela Rauseo, Tai Pham, Fabiana Madotto, Carolyn Campbell, Elizabeth Tullis, Laurent Brochard High-flow nasal oxygen versus noninvasive ventilation in adult patients with cystic fibrosis: a randomized crossover physiological study. Annals of Intensive Care. Vol.8, No.1 (2018). doi:10.1186/s13613-018-0432-4 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/46172
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Title
High-flow nasal oxygen versus noninvasive ventilation in adult patients with cystic fibrosis: a randomized crossover physiological study
Other Contributor(s)
Li Ka Shing Knowledge Institute
Fondazione Policlinico Universitario Agostino Gemelli IRCCS Università Cattolica del Sacro Cuore
Università degli Studi di Foggia
Saint Michael's Hospital University of Toronto
University of Toronto
Faculty of Medicine, Ramathibodi Hospital, Mahidol University
University of Milano - Bicocca
Faculty of Medicine, Siriraj Hospital, Mahidol University
Sorbonne Université
Fondazione Policlinico Universitario Agostino Gemelli IRCCS Università Cattolica del Sacro Cuore
Università degli Studi di Foggia
Saint Michael's Hospital University of Toronto
University of Toronto
Faculty of Medicine, Ramathibodi Hospital, Mahidol University
University of Milano - Bicocca
Faculty of Medicine, Siriraj Hospital, Mahidol University
Sorbonne Université
Abstract
© 2018, The Author(s). Background: Noninvasive ventilation (NIV) is the first-line treatment of adult patients with exacerbations of cystic fibrosis (CF). High-flow nasal oxygen therapy (HFNT) might benefit patients with hypoxemia and can reduce physiological dead space. We hypothesized that HFNT and NIV would similarly reduce work of breathing and improving breathing pattern in CF patients. Our objective was to compare the effects of HFNT versus NIV in terms of work of breathing, assessed noninvasively by the thickening fraction of the diaphragm (TFdi, measured with ultrasound), breathing pattern, transcutaneous CO 2 (PtcCO 2 ), hemodynamics, dyspnea and comfort. Methods: Adult CF patients who had been stabilized after requiring ventilatory support for a few days were enrolled and ventilated with HFNT and NIV for 30 min in crossover random order. Results: Fifteen patients were enrolled. Compared to baseline, HFNT, but not NIV, reduced respiratory rate (by 3 breaths/min, p = 0.01) and minute ventilation (by 2 L/min, p = 0.01). Patients also took slightly larger tidal volumes with HFNT compared to NIV (p = 0.02). TFdi per breath was similar under the two techniques and did not change from baseline. MAP increased from baseline with NIV and compared to HFNT (p ≤ 0.01). Comfort was poorer with the application of both HFNT and NIV than baseline. No differences were found for heart rate, SpO 2 , PtcCO 2 or dyspnea. Conclusions: In adult CF patients stabilized after indication for ventilatory support, HFNT and NIV have similar effects on diaphragmatic work per breath, but high-flow therapy confers additional physiological benefits by decreasing respiratory rate and minute ventilation. Clinical trial registration: Ethics Committee of St. Michael’s Hospital (REB #14-338) and clinicaltrial.gov (NCT02262871).
