Global and Regional Ventilation during High Flow Nasal Cannula in Patients with Hypoxia

Dong Hyun Lee, Eun Young Kim, Ga Jin Seo, Hee Jung Suh, Jin Won Huh, Sang-Bum Hong, Younsuck Koh, Chae-Man Lim, Dong Hyun Lee, Eun Young Kim, Ga Jin Seo, Hee Jung Suh, Jin Won Huh, Sang-Bum Hong, Younsuck Koh, Chae-Man Lim

Abstract

Background: High flow nasal cannula (HFNC) is known to increase global ventilation volume in healthy subjects. We sought to investigate the effect of HFNC on global and regional ventilation patterns in patients with hypoxia.

Methods: Patients were randomized to receive one of two oxygen therapies in sequence: nasal cannula (NC) followed by HFNC or HFNC followed by NC. Global and regional ventilation was assessed using electric impedance tomography.

Results: Twenty-four patients participated. Global tidal variation (TV) in the lung was higher during HFNC (NC, 2,241 ± 1,381 arbitrary units (AU); HFNC, 2,543 ± 1,534 AU; P < 0.001). Regional TVs for four iso-gravitational quadrants of the lung were also all higher during HFNC than NC. The coefficient of variation for the four quadrants of the lung was 0.90 ± 0.61 during NC and 0.77 ± 0.48 during HFNC (P = 0.035). Within the four gravitational layers of the lung, regional TVs were higher in the two middle layers during HFNC when compared to NC. Regional TV values in the most ventral and dorsal layers of the lung were not higher during HFNC compared with NC. The coefficient of variation for the four gravitational layers of the lung were 1.00 ± 0.57 during NC and 0.97 ± 0.42 during HFNC (P = 0.574).

Conclusions: In patients with hypoxia, ventilation of iso-gravitational regions of the lung during HFNC was higher and more homogenized compared with NC. However, ventilation of gravitational layers increased only in the middle layers. (Clinical trials registration number: NCT02943863).

Keywords: electric impedance; oxygen inhalation therapy; pulmonary ventilation.

Conflict of interest statement

Dräger Korea (Seoul, Korea) provided electric impedance tomography monitor (PulmoVista 500) with data analysis software. The funder had no role in the design, collection, analysis or interpretation of this study. No other potential conflict of interest relevant to this article was reported.

Copyright © 2018 The Korean Society of Critical Care Medicine.

Figures

Figure 1.
Figure 1.
Overall study design. Enrolled patients received both types of oxygen therapy, nasal cannula (NC) and high flow nasal cannula (HFNC). The sequence of oxygen therapy, NC followed by HFNC or HFNC followed by NC, was randomized with each type of oxygen therapy lasting for 20 minutes. Efficacy and subjective discomfort associated with each treatment were assessed at the end of each therapy type. ABGA: arterial blood gas analysis; EIT: electric impedance tomography.
Figure 2.
Figure 2.
Region of interest (ROI) set showing cross-sectional images and a typical electric impedance tomography image example. (A) ROI was set as quadrants or layers and tidal variations for each ROI were provided. Comparisons of right versus left and top versus bottom were also performed. (B) Dynamic image showing change in impedance for each breath is shown at top left. Tidal variations in the global section area and each ROI are shown on the right side with quantitative graphs. The presenting case shows reduced ventilation in the left dependent portion (ROI 4). The tidal variation was significantly higher during oxygen therapy with high flow nasal cannula (HFNC), especially in ROI 1. NC: nasal cannula; MTV: mean tidal variation.
Figure 3.
Figure 3.
Tidal variation comparison between nasal cannula (NC) and high flow nasal cannula (HFNC). Regions of interest were set as (A) quadrants and (B) layers.

References

    1. Slutsky AS, Ranieri VM. Ventilator-induced lung injury. N Engl J Med. 2014;370:980.
    1. Manley BJ, Dold SK, Davis PG, Roehr CC. High-flow nasal cannulae for respiratory support of preterm infants: a review of the evidence. Neonatology. 2012;102:300–8.
    1. Frat JP, Thille AW, Mercat A, Girault C, Ragot S, Perbet S, et al. High-flow oxygen through nasal cannula in acute hypoxemic respiratory failure. N Engl J Med. 2015;372:2185–96.
    1. Spoletini G, Alotaibi M, Blasi F, Hill NS. Heated humidified high-flow nasal oxygen in adults: mechanisms of action and clinical implications. Chest. 2015;148:253–61.
    1. Mündel T, Feng S, Tatkov S, Schneider H. Mechanisms of nasal high flow on ventilation during wakefulness and sleep. J Appl Physiol (1985) 2013;114:1058–65.
    1. Riera J, Pérez P, Cortés J, Roca O, Masclans JR, Rello J. Effect of high-flow nasal cannula and body position on end-expiratory lung volume: a cohort study using electrical impedance tomography. Respir Care. 2013;58:589–96.
    1. Maggiore SM, Idone FA, Vaschetto R, Festa R, Cataldo A, Antonicelli F, et al. Nasal high-flow versus Venturi mask oxygen therapy after extubation: effects on oxygenation, comfort, and clinical outcome. Am J Respir Crit Care Med. 2014;190:282–8.
    1. Sztrymf B, Messika J, Mayot T, Lenglet H, Dreyfuss D, Ricard JD. 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;27:324. e9-13.
    1. Yoo JW, Synn A, Huh JW, Hong SB, Koh Y, Lim CM. Clinical efficacy of high-flow nasal cannula compared to noninvasive ventilation in patients with post-extubation respiratory failure. Korean J Intern Med. 2016;31:82–8.
    1. Corley A, Caruana LR, Barnett AG, Tronstad O, Fraser JF. 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;107:998–1004.
    1. Calvano TP, Sill JM, Kemp KR, Chung KK. Use of a high-flow oxygen delivery system in a critically ill patient with dementia. Respir Care. 2008;53:1739–43.
    1. Parke RL, McGuinness SP, Eccleston ML. A preliminary randomized controlled trial to assess effectiveness of nasal high-flow oxygen in intensive care patients. Respir Care. 2011;56:265–70.
    1. Itagaki T, Okuda N, Tsunano Y, Kohata H, Nakataki E, Onodera M, et al. Effect of high-flow nasal cannula on thoraco-abdominal synchrony in adult critically ill patients. Respir Care. 2014;59:70–4.
    1. Tiruvoipati R, Lewis D, Haji K, Botha J. High-flow nasal oxygen vs high-flow face mask: a randomized crossover trial in extubated patients. J Crit Care. 2010;25:463–8.
    1. Rittayamai N, Tscheikuna J, Rujiwit P. High-flow nasal cannula versus conventional oxygen therapy after endotracheal extubation: a randomized crossover physiologic study. Respir Care. 2014;59:485–90.

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