Nasal High-Flow (NHF) Improves Ventilation in Patients with Interstitial Lung Disease (ILD)—A Physiological Study
Introduction: Acute hypercapnic respiratory failure has a poor prognosis in patients with interstitial lung disease (ILD). Recent data demonstrated a positive effect of nasal high-flow (NHF) in patients with acute hypoxemic respiratory failure. Preliminary data also show benefits in several hypercap...
| Main Authors: | , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2023-09-01
|
| Series: | Journal of Clinical Medicine |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2077-0383/12/18/5853 |
| _version_ | 1797579523304194048 |
|---|---|
| author | Jens Bräunlich Marcus Köhler Hubert Wirtz |
| author_facet | Jens Bräunlich Marcus Köhler Hubert Wirtz |
| author_sort | Jens Bräunlich |
| collection | DOAJ |
| description | Introduction: Acute hypercapnic respiratory failure has a poor prognosis in patients with interstitial lung disease (ILD). Recent data demonstrated a positive effect of nasal high-flow (NHF) in patients with acute hypoxemic respiratory failure. Preliminary data also show benefits in several hypercapnic chronic lung diseases. Objectives: The aim of this study was to characterize flow-dependent changes in mean airway pressure, breathing volumes, and breathing frequency and decreases in PCO<sub>2</sub>. Methods: Mean airway pressure was measured in the nasopharyngeal space. To evaluate breathing volumes, a polysomnographic device was used (16 patients). All subjects received 20, 30, 40, and 50 L/min and—to illustrate the effects—nCPAP and nBiPAP. Capillary blood gas analyses were performed in 25 hypercapnic ILD subjects before and 5 h after the use of NHF. Additionally, comfort and dyspnea during the use of NHF were surveyed. Results: NHF resulted in a small flow-dependent increase in mean airway pressure. Tidal volume was unchanged and breathing rate decreased. The calculated minute volume decreased by 20 and 30 L/min NHF breathing. In spite of this fact, hypercapnia decreased at a flow rate of 24 L/min. Additionally, an improvement in dyspnea was observed. Conclusions: NHF leads to a reduction in paCO<sub>2</sub>. This is most likely achieved by a washout of the respiratory tract and a reduction in functional dead space. NHF enhances the effectiveness of breathing in ILD patients by the reduction in respiratory rate. In summary, NHF works as an effective ventilatory support device in hypercapnic ILD patients. |
| first_indexed | 2024-03-10T22:37:18Z |
| format | Article |
| id | doaj.art-84a3bfa4387b43669fa788955d05763a |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-10T22:37:18Z |
| publishDate | 2023-09-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-84a3bfa4387b43669fa788955d05763a2023-11-19T11:18:19ZengMDPI AGJournal of Clinical Medicine2077-03832023-09-011218585310.3390/jcm12185853Nasal High-Flow (NHF) Improves Ventilation in Patients with Interstitial Lung Disease (ILD)—A Physiological StudyJens Bräunlich0Marcus Köhler1Hubert Wirtz2Department of Respiratory Medicine, University of Leipzig, 04103 Leipzig, GermanyDepartment of Respiratory Medicine, University of Leipzig, 04103 Leipzig, GermanyDepartment of Respiratory Medicine, University of Leipzig, 04103 Leipzig, GermanyIntroduction: Acute hypercapnic respiratory failure has a poor prognosis in patients with interstitial lung disease (ILD). Recent data demonstrated a positive effect of nasal high-flow (NHF) in patients with acute hypoxemic respiratory failure. Preliminary data also show benefits in several hypercapnic chronic lung diseases. Objectives: The aim of this study was to characterize flow-dependent changes in mean airway pressure, breathing volumes, and breathing frequency and decreases in PCO<sub>2</sub>. Methods: Mean airway pressure was measured in the nasopharyngeal space. To evaluate breathing volumes, a polysomnographic device was used (16 patients). All subjects received 20, 30, 40, and 50 L/min and—to illustrate the effects—nCPAP and nBiPAP. Capillary blood gas analyses were performed in 25 hypercapnic ILD subjects before and 5 h after the use of NHF. Additionally, comfort and dyspnea during the use of NHF were surveyed. Results: NHF resulted in a small flow-dependent increase in mean airway pressure. Tidal volume was unchanged and breathing rate decreased. The calculated minute volume decreased by 20 and 30 L/min NHF breathing. In spite of this fact, hypercapnia decreased at a flow rate of 24 L/min. Additionally, an improvement in dyspnea was observed. Conclusions: NHF leads to a reduction in paCO<sub>2</sub>. This is most likely achieved by a washout of the respiratory tract and a reduction in functional dead space. NHF enhances the effectiveness of breathing in ILD patients by the reduction in respiratory rate. In summary, NHF works as an effective ventilatory support device in hypercapnic ILD patients.https://www.mdpi.com/2077-0383/12/18/5853nasal high-flowNHFhypercapnialung fibrosisILDbreathing pattern |
| spellingShingle | Jens Bräunlich Marcus Köhler Hubert Wirtz Nasal High-Flow (NHF) Improves Ventilation in Patients with Interstitial Lung Disease (ILD)—A Physiological Study Journal of Clinical Medicine nasal high-flow NHF hypercapnia lung fibrosis ILD breathing pattern |
| title | Nasal High-Flow (NHF) Improves Ventilation in Patients with Interstitial Lung Disease (ILD)—A Physiological Study |
| title_full | Nasal High-Flow (NHF) Improves Ventilation in Patients with Interstitial Lung Disease (ILD)—A Physiological Study |
| title_fullStr | Nasal High-Flow (NHF) Improves Ventilation in Patients with Interstitial Lung Disease (ILD)—A Physiological Study |
| title_full_unstemmed | Nasal High-Flow (NHF) Improves Ventilation in Patients with Interstitial Lung Disease (ILD)—A Physiological Study |
| title_short | Nasal High-Flow (NHF) Improves Ventilation in Patients with Interstitial Lung Disease (ILD)—A Physiological Study |
| title_sort | nasal high flow nhf improves ventilation in patients with interstitial lung disease ild a physiological study |
| topic | nasal high-flow NHF hypercapnia lung fibrosis ILD breathing pattern |
| url | https://www.mdpi.com/2077-0383/12/18/5853 |
| work_keys_str_mv | AT jensbraunlich nasalhighflownhfimprovesventilationinpatientswithinterstitiallungdiseaseildaphysiologicalstudy AT marcuskohler nasalhighflownhfimprovesventilationinpatientswithinterstitiallungdiseaseildaphysiologicalstudy AT hubertwirtz nasalhighflownhfimprovesventilationinpatientswithinterstitiallungdiseaseildaphysiologicalstudy |