High-flow nasal therapy vs standard oxygen during breaks off noninvasive ventilation for acute respiratory failure: A pilot randomized controlled trial

Giulia Spoletini; Chiara Mega; Lara Pisani; Mona Alotaibi; Alia Khoja; Lori Lyn Price; Francesco Blasi; Stefano Nava; Nicholas S Hill

doi:10.1016/j.jcrc.2018.10.004

High-flow nasal therapy vs standard oxygen during breaks off noninvasive ventilation for acute respiratory failure: A pilot randomized controlled trial

J Crit Care. 2018 Dec:48:418-425. doi: 10.1016/j.jcrc.2018.10.004. Epub 2018 Oct 5.

Authors

Giulia Spoletini¹, Chiara Mega¹, Lara Pisani¹, Mona Alotaibi¹, Alia Khoja¹, Lori Lyn Price², Francesco Blasi³, Stefano Nava⁴, Nicholas S Hill⁵

Affiliations

¹ Pulmonary, Critical Care and Sleep Medicine Division, Tufts Medical Center, Boston, MA, USA.
² Tufts Clinical and Translational Science Institute, Tufts University, Boston, MA, USA; The Institute for Clinical Research and Health Policy Study, Tufts Medical Center, Boston, MA, USA.
³ Department of Pathophysiology and Transplantation, Università degli Studi di Milano, IRCCS Fondazione Ospedale Maggiore Policlinico Ca' Granda, Milan, Italy.
⁴ Department of Clinical, Integrated and Experimental Medicine (DIMES), Respiratory and Critical Care Unit, Ospedale Sant'Orsola Malpighi, Alma Mater University, Bologna, Italy.
⁵ Pulmonary, Critical Care and Sleep Medicine Division, Tufts Medical Center, Boston, MA, USA. Electronic address: nhill@tuftsmedicalcenter.org.

PMID: 30321833
DOI: 10.1016/j.jcrc.2018.10.004

Abstract

Purpose: To assess the role of high-flow nasal therapy (HFNT) compared to standard oxygen (SO) as complementary therapy to non-invasive ventilation (NIV).

Methods: Multicenter trial including patients (n = 54) anticipated to receive NIV for ≥24 h due to acute or acute-on-chronic respiratory failure. Subjects were randomized (1:1) to SO or HFNT during breaks off NIV. Primary outcome was total time on and off NIV. Secondary outcomes were comfort and dyspnea, respiratory rate (RR), oxygen saturation (S_pO₂), tolerance and side effects.

Results: Total time per patient on NIV (1315 vs 1441 min) and breaks (1362 vs 1196 min), and mean duration of each break (520 vs 370 min) were similar in the HFNT and SO arms (p > .05). Comfort score was higher on HFNT than on SO (8.3 ± 2.7 vs 6.9 ± 2.3, p = .001). Dyspnea, RR and S_pO₂ were similar in the two arms, but the increase in RR and dyspnea seen with SO during breaks did not occur with HFNT.

Conclusion: Compared to SO, HFNT did not reduce time on NIV. However, it was more comfortable and the increase in RR and dyspnea seen with SO did not occur with HFNT. Therefore, HFNT could be a suitable alternative to SO during breaks off NIV.

Publication types

Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Aged, 80 and over
Dyspnea / etiology
Female
Humans
Male
Middle Aged
Noninvasive Ventilation / methods*
Oxygen / administration & dosage*
Oxygen / analysis
Oxygen Inhalation Therapy / methods*
Pilot Projects
Respiratory Distress Syndrome / physiopathology
Respiratory Distress Syndrome / therapy*
Respiratory Insufficiency / physiopathology
Respiratory Insufficiency / therapy*
Respiratory Rate / physiology

Substances

Oxygen