High-flow nasal oxygen therapy in patients after esophageal interventions: аdvantages and disadvantages
- Authors: Geyze A.V.1, Koroleva I.V.2, Plotnikov G.P.1, Kovalerova N.B.1, Manevskiy A.A.2,3
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Affiliations:
- A.V. Vishnevski National Medical Research Center of Surgery
- National Medical Research Center «Treatment and Rehabilitation Center»
- Pirogov Russian National Research Medical University
- Issue: Vol 28, No 1 (2022)
- Pages: 37-45
- Section: Clinical medicine
- URL: https://medjrf.com/0869-2106/article/view/108901
- DOI: https://doi.org/10.17816/medjrf108901
- ID: 108901
Cite item
Abstract
BACKGROUND: Pulmonary complications in patients who underwent esophagectomy with one-stage esophagoplasty are a frequent cause of death in the intensive care unit (ICU). However, the use of noninvasive ventilation (NIV) in these patients is not indicated because of the failure of esophagogastric anastomosis. Compared with NIV and standard oxygen therapy, high-flow oxygen therapy (HFOT) reduces the rate of transfer to mechanical ventilation (MV) in the case of acute respiratory failure.
AIM: This study aimed to assess the clinical advantages and disadvantages of HFOT in patients with respiratory failure after esophagectomy.
MATERIALS AND METHODS: Ninety patients with esophagectomy were examined. Two groups were formed by randomization: group 1 (n=45) with standard respiratory therapy, incentive spirometry, and nasal oxygen therapy with NIV sessions and low end-expiratory pressure (up to 6 mmHg) and group 2 (n=45) with HFOT. Therapy parameters were selected according to oxygenation (PaO2/FiО2) and saturation (SaО2) index values. Parameter changes, session duration, patient’s tolerance to respiratory therapy methods (from 1 to 10 points), dynamics of chest X-ray pattern, and duration of treatment in ICU were analyzed.
RESULTS: The advantages of HFOT were the absence of discomfort during the session, possibility to decrease O2 flow required for an adequate level of oxygenation, high flow with controlled O2 fraction allowed to reach target values of oxygenation index, decreased frequency of patients transfer to MV, and time spent in ICU.
CONCLUSIONS: The use of HFOT is justified as part of the complex respiratory therapy in patients with moderate respiratory failure. In patients with severe respiratory failure, HFOT is an alternative to other high-flow techniques and NIV. The choice between these methods should be individualized and depend on the patient’s condition and ventilation requirement.
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About the authors
Anton V. Geyze
A.V. Vishnevski National Medical Research Center of Surgery
Email: antongeyze@mail.ru
ORCID iD: 0000-0002-7145-8516
MD, Cand. Sci. (Med.)
Russian Federation, MoscowIuliia V. Koroleva
National Medical Research Center «Treatment and Rehabilitation Center»
Author for correspondence.
Email: ykoroleva@med-rf.ru
ORCID iD: 0000-0002-9354-0828
Russian Federation, Moscow
Georgy P. Plotnikov
A.V. Vishnevski National Medical Research Center of Surgery
Email: georgpp@mail.ru
ORCID iD: 0000-0002-4291-3380
MD, Dr. Sci. (Med.)
Russian Federation, MoscowNatalya B. Kovalerova
A.V. Vishnevski National Medical Research Center of Surgery
Email: kovalerova.nat@gmail.com
ORCID iD: 0000-0002-6951-1816
MD, Cand. Sci. (Med.)
Russian Federation, MoscowAndrey A. Manevskiy
National Medical Research Center «Treatment and Rehabilitation Center»; Pirogov Russian National Research Medical University
Email: a_manevskiy@mail.ru
ORCID iD: 0000-0002-8776-1368
MD, Cand. Sci. (Med.), assistant
Russian Federation, Moscow; MoscowReferences
- Masclans JR, Roca O. High-flow Oxygen Therapy in Acute Respiratory Failure. Clinical Pulmonary Medicine. 2012;19(3):127–130. doi: 10.1097/CPM.0b013e3182514f29
- Dysart K, Miller TL, Wolfson MR, Shaffer TH. Research in high flow therapy: Mechanisms of action. Respir Med. 2009;103(10):1400–1405. doi: 10.1016/j.rmed.2009.04.007
- Corley A, Caruana LR, Barnett AG, et al. Oxygen delivery through high-flow nasal cannulae increase end-expiratory lung volume and reduce respiratory rate in post-cardiac surgical patients. Br JAnaesth. 2011;107(6):998-1004. doi: 10.1093/bja/aer265
- Sztrymf B, Messika J, Mayot T, et al. 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(3):324.e329–324.e313. doi: 10.1016/j.jcrc.2011.07.075
- Dewan NA, Bell CW. Effect of Low Flow and High Flow Oxygen Delivery on Exercise Tolerance and Sensation of Dyspnea. Chest. 1994;105(4):1061–1065. doi: 10.1378/chest.105.4.1061
- Chatila W, Nugent T, Vance G, et al. The Effects of High-Flow vs Low-Flow Oxygen on Exercise in Advanced Obstructive Airways Disease. Chest. 2004;126(4):1108–1115. doi: 10.1378/chest.126.4.1108
- Ricard J-D, Boyer A. Humidification during oxygen therapy and non-invasive ventilation: do we need some and how much? Intensive Care Med. 2009;35(6):963–965. doi: 10.1007/s00134-009-1457-9
- Sztrymf B, Messika J, Bertrand F, et al. Beneficial effects of humidified high flow nasal oxygen in critical care patients: a prospective pilot study. Intensive Care Med. 2011;37(11):1780–1786. doi: 10.1007/s00134-011-2354-6
- Frat J-P, Thille AW, Merkat A, et al. High-flow oxygen through Nasal Cannula in acute hipoxemic respiratory failure. N Engl J Med. 2015; 372:2185-2196. doi: 10.1056/NEJMoa1503326
- Parke R, McGuinness S, Eccleston M. Nasal high-flow therapy delivers low level positive airway pressure. Br J Anaesth. 2009;103(6):886–890. doi: 10.1093/bja/aep280
- Kassil' VL, Leskin GS, Vyzhigina MA. Respiratornaya podderzhka: Rukovodstvo po iskusstvennoi i vspomogatel'noi ventilyatsii legkikh v anesteziologii i intensivnoi terapii. Moscow: Meditsina; 1997. (In Russ).
- Davidson AC, Treacher DT, editors. Respiratory Critical Care. London: CRC Press; 2002.
- Avendano CE, Flume PA, Silvestri GA, et al. Pulmonary complications after esophagectomy. Ann Thorac Surg. 2002;73(3):922–926. doi: 10.1016/s0003-4975(01)03584-6.
- Law S, Wong KH, Kwok KF, et al. Predictive factors for postoperative pulmonary complications and mortality after esophagectomy for cancer. Ann Surg. 2004;240(5):791–800. doi: 10.1097/01.sla.0000143123.24556.1c
- Antonelli M, Conti G, Esquinas A, et al. A multiple-center survey on the use in clinical practice of noninvasive ventilation as a first-line intervention for acute respiratory distress syndrome. Crit Care Med. 2007;35(1):18–25. doi: 10.1097/01.CCM.0000251821.44259.F3
- Van de Louw A, Brocas E, Boiteau R, et al. Esophageal Perforation Associated with Noninvasive Ventilation. Chest. 2002;122(5):1857–1858. doi: 10.1378/chest.122.5.1857
- Dysart K, Miller TL, Wolfson MR, Shaffer TH. Research in high flow therapy: Mechanisms of action. Respir Med. 2009;103(10):1400–1405. doi: 10.1016/j.rmed.2009.04.007
- Parke R, McGuinness S, Eccleston M. Nasal high-flow therapy delivers low level positive airway pressure. Br J Anaesth. 2009;103(6):886–890. doi: 10.1093/bja/aep280
- Roca O, Riera J, Torres F, Masclans JR. High-flow oxygen therapy in acute respiratory failure. Respir Care. 2010;55(4):408-413
- 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(3):463–468. doi: 10.1016/j.jcrc.2009.06.050
- Chertoff J. High-Flow Oxygen, Positive End-Expiratory Pressure, and the Berlin Definition of Acute Respiratory Distress Syndrome: Are They Mutually Exclusive? Am J Respir Crit Care Med. 2017;196(3):396–397. doi: 10.1164/rccm.201701-0005LE
- Porhomayon J, El-Solh AA, Pourafkari L, et al. Applications of Nasal High-Flow Oxygen Therapy in Critically ill Adult Patients. Lung. 2016;194(5):705–714. doi: 10.1007/s00408-016-9885-0
- Kang BJ, Koh Y, Lim C-M, et al. Failure of high-flow nasal cannula therapy may delay intubation and increase mortality. Intensive Care Med. 2015;41(4):623–632. doi: 10.1007/s00134-015-3693-5
- Brochard L, Slutsky A, Pesenti A. Mechanical Ventilation to Minimize Progression of Lung Injury in Acute Respiratory Failure. Am J Respir Crit Care Med. 2017;195(4):438–442. doi: 10.1164/rccm.201605-1081CP
- Piastra M, Morena TC, Antonelli M, Conti G. Uncommon barotrauma while on high-flow nasal cannula. Intensive Care Med. 2018;44(12):2288–2289. doi: 10.1007/s00134-018-5279-5
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