High-flow nasal cannula oxygen therapy decreases postextubation neuroventilatory drive and work of breathing in patients with chronic obstructive pulmonary disease
Abstract Background The physiological effects of high-flow nasal cannula O2 therapy (HFNC) have been evaluated mainly in patients with hypoxemic respiratory failure. In this study, we compared the effects of HFNC and conventional low-flow O2 therapy on the neuroventilatory drive and work of breathin...
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| Format: | Article |
| Language: | English |
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BMC
2018-08-01
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| Series: | Critical Care |
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| Online Access: | http://link.springer.com/article/10.1186/s13054-018-2107-9 |
| _version_ | 1818025241271599104 |
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| author | Rosa Di mussi Savino Spadaro Tania Stripoli Carlo Alberto Volta Paolo Trerotoli Paola Pierucci Francesco Staffieri Francesco Bruno Luigi Camporota Salvatore Grasso |
| author_facet | Rosa Di mussi Savino Spadaro Tania Stripoli Carlo Alberto Volta Paolo Trerotoli Paola Pierucci Francesco Staffieri Francesco Bruno Luigi Camporota Salvatore Grasso |
| author_sort | Rosa Di mussi |
| collection | DOAJ |
| description | Abstract Background The physiological effects of high-flow nasal cannula O2 therapy (HFNC) have been evaluated mainly in patients with hypoxemic respiratory failure. In this study, we compared the effects of HFNC and conventional low-flow O2 therapy on the neuroventilatory drive and work of breathing postextubation in patients with a background of chronic obstructive pulmonary disease (COPD) who had received mechanical ventilation for hypercapnic respiratory failure. Methods This was a single center, unblinded, cross-over study on 14 postextubation COPD patients who were recovering from an episode of acute hypercapnic respiratory failure of various etiologies. After extubation, each patient received two 1-h periods of HFNC (HFNC1 and HFNC2) alternated with 1 h of conventional low-flow O2 therapy via a face mask. The inspiratory fraction of oxygen was titrated to achieve an arterial O2 saturation target of 88–92%. Gas exchange, breathing pattern, neuroventilatory drive (electrical diaphragmatic activity (EAdi)) and work of breathing (inspiratory trans-diaphragmatic pressure-time product per minute (PTPDI/min)) were recorded. Results EAdi peak increased from a mean (±SD) of 15.4 ± 6.4 to 23.6 ± 10.5 μV switching from HFNC1 to conventional O2, and then returned to 15.2 ± 6.4 μV during HFNC2 (conventional O2: p < 0.05 versus HFNC1 and HFNC2). Similarly, the PTPDI/min increased from 135 ± 60 to 211 ± 70 cmH2O/s/min, and then decreased again during HFNC2 to 132 ± 56 (conventional O2: p < 0.05 versus HFNC1 and HFNC2). Conclusions In patients with COPD, the application of HFNC postextubation significantly decreased the neuroventilatory drive and work of breathing compared with conventional O2 therapy. |
| first_indexed | 2024-12-10T04:12:59Z |
| format | Article |
| id | doaj.art-1a9907bab7314efe9739babe0f13ecd4 |
| institution | Directory Open Access Journal |
| issn | 1364-8535 |
| language | English |
| last_indexed | 2024-12-10T04:12:59Z |
| publishDate | 2018-08-01 |
| publisher | BMC |
| record_format | Article |
| series | Critical Care |
| spelling | doaj.art-1a9907bab7314efe9739babe0f13ecd42022-12-22T02:02:40ZengBMCCritical Care1364-85352018-08-0122111110.1186/s13054-018-2107-9High-flow nasal cannula oxygen therapy decreases postextubation neuroventilatory drive and work of breathing in patients with chronic obstructive pulmonary diseaseRosa Di mussi0Savino Spadaro1Tania Stripoli2Carlo Alberto Volta3Paolo Trerotoli4Paola Pierucci5Francesco Staffieri6Francesco Bruno7Luigi Camporota8Salvatore Grasso9Dipartimento dell’Emergenza e Trapianti d’Organo (DETO), Sezione di Anestesiologia e Rianimazione, Ospedale Policlinico, Università degli Studi di Bari “Aldo Moro”Dipartimento di Morfologia, Chirurgia e Medicina Sperimentale, Sezione di Anestesiologia e Terapia Intensiva Universitaria, Università degli studi di FerraraDipartimento dell’Emergenza e Trapianti d’Organo (DETO), Sezione di Anestesiologia e Rianimazione, Ospedale Policlinico, Università degli Studi di Bari “Aldo Moro”Dipartimento di Morfologia, Chirurgia e Medicina Sperimentale, Sezione di Anestesiologia e Terapia Intensiva Universitaria, Università degli studi di FerraraDipartimento di Scienze Biomediche ed Oncologia Umana, Cattedra di Statistica Medica, Università degli Studi Aldo MoroDipartimento di Medicina Respiratoria e del Sonno, Università degli Studi di Bari “Aldo Moro”Dipartimento dell’Emergenza e Trapianti d’Organo (DETO), Sezione di Chirurgia Veterinaria, Università degli Studi di Bari “Aldo Moro”Dipartimento dell’Emergenza e Trapianti d’Organo (DETO), Sezione di Anestesiologia e Rianimazione, Ospedale Policlinico, Università degli Studi di Bari “Aldo Moro”Department of Adult Critical Care, Guy’s and St Thomas’ NHS Foundation Trust, King’s Health Partners, and Division of Centre of Human Applied Physiological Sciences, King’s College LondonDipartimento dell’Emergenza e Trapianti d’Organo (DETO), Sezione di Anestesiologia e Rianimazione, Ospedale Policlinico, Università degli Studi di Bari “Aldo Moro”Abstract Background The physiological effects of high-flow nasal cannula O2 therapy (HFNC) have been evaluated mainly in patients with hypoxemic respiratory failure. In this study, we compared the effects of HFNC and conventional low-flow O2 therapy on the neuroventilatory drive and work of breathing postextubation in patients with a background of chronic obstructive pulmonary disease (COPD) who had received mechanical ventilation for hypercapnic respiratory failure. Methods This was a single center, unblinded, cross-over study on 14 postextubation COPD patients who were recovering from an episode of acute hypercapnic respiratory failure of various etiologies. After extubation, each patient received two 1-h periods of HFNC (HFNC1 and HFNC2) alternated with 1 h of conventional low-flow O2 therapy via a face mask. The inspiratory fraction of oxygen was titrated to achieve an arterial O2 saturation target of 88–92%. Gas exchange, breathing pattern, neuroventilatory drive (electrical diaphragmatic activity (EAdi)) and work of breathing (inspiratory trans-diaphragmatic pressure-time product per minute (PTPDI/min)) were recorded. Results EAdi peak increased from a mean (±SD) of 15.4 ± 6.4 to 23.6 ± 10.5 μV switching from HFNC1 to conventional O2, and then returned to 15.2 ± 6.4 μV during HFNC2 (conventional O2: p < 0.05 versus HFNC1 and HFNC2). Similarly, the PTPDI/min increased from 135 ± 60 to 211 ± 70 cmH2O/s/min, and then decreased again during HFNC2 to 132 ± 56 (conventional O2: p < 0.05 versus HFNC1 and HFNC2). Conclusions In patients with COPD, the application of HFNC postextubation significantly decreased the neuroventilatory drive and work of breathing compared with conventional O2 therapy.http://link.springer.com/article/10.1186/s13054-018-2107-9High-flow nasal cannula oxygen therapyChronic obstructive pulmonary diseaseWeaning from mechanical ventilationNeuroventilatory driveWork of breathing |
| spellingShingle | Rosa Di mussi Savino Spadaro Tania Stripoli Carlo Alberto Volta Paolo Trerotoli Paola Pierucci Francesco Staffieri Francesco Bruno Luigi Camporota Salvatore Grasso High-flow nasal cannula oxygen therapy decreases postextubation neuroventilatory drive and work of breathing in patients with chronic obstructive pulmonary disease Critical Care High-flow nasal cannula oxygen therapy Chronic obstructive pulmonary disease Weaning from mechanical ventilation Neuroventilatory drive Work of breathing |
| title | High-flow nasal cannula oxygen therapy decreases postextubation neuroventilatory drive and work of breathing in patients with chronic obstructive pulmonary disease |
| title_full | High-flow nasal cannula oxygen therapy decreases postextubation neuroventilatory drive and work of breathing in patients with chronic obstructive pulmonary disease |
| title_fullStr | High-flow nasal cannula oxygen therapy decreases postextubation neuroventilatory drive and work of breathing in patients with chronic obstructive pulmonary disease |
| title_full_unstemmed | High-flow nasal cannula oxygen therapy decreases postextubation neuroventilatory drive and work of breathing in patients with chronic obstructive pulmonary disease |
| title_short | High-flow nasal cannula oxygen therapy decreases postextubation neuroventilatory drive and work of breathing in patients with chronic obstructive pulmonary disease |
| title_sort | high flow nasal cannula oxygen therapy decreases postextubation neuroventilatory drive and work of breathing in patients with chronic obstructive pulmonary disease |
| topic | High-flow nasal cannula oxygen therapy Chronic obstructive pulmonary disease Weaning from mechanical ventilation Neuroventilatory drive Work of breathing |
| url | http://link.springer.com/article/10.1186/s13054-018-2107-9 |
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