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Background:
The role of high-flow nasal cannula oxygen therapy (HFNC) in respiratory management of acute exacerbation of interstitial pneumonia (AE-IP) is unknown.
Methods:
We retrospectively reviewed patients with AE-IP who were admitted to our hospital from June 2009 - May 2015 and compared mortality, complications, sedatives and analgesia use...
Contexts in source publication
Context 1
... patients were treated with high-dose corticosteroids (methylprednisolone, 250-1,000 mg/d) for 3 days followed by a tapered dosage, occasionally combined with intravenous cyclophosphamide. They also received empiric broad-spectrum antibiotic therapy until negative bacterial cultures were confirmed ( Table 2). ...Context 2
... patients were treated with high-dose corticosteroids (methylprednisolone, 250-1,000 mg/d) for 3 days followed by a tapered dosage, occasionally combined with intravenous cyclophosphamide. They also received empiric broad-spectrum antibiotic therapy until negative bacterial cultures were confirmed ( Table 2). ...Citations
... p = 0.001), and better oral intake (23.3% vs. 52.8%, p = 0.003) when compared to mechanical ventilation (MV) [35]. In addition, the use of MV with positive end-expiratory pressure (PEEP) values > 10 cm H 2 O was associated with a higher mortality in ILD patients with acute exacerbations [38]. ...
Background: High-flow nasal cannula (HFNC) therapy has emerged as a promising treatment modality for interstitial lung disease (ILD)-related respiratory failure. This systematic review aims to evaluate the efficacy and safety of HFNC therapy in patients with ILDs. Methods: A comprehensive literature search was conducted using major electronic databases to identify relevant studies investigating the use of HFNC therapy in ILD patients with respiratory failure. Outcome measures of interest included improvements in oxygenation, dyspnea relief, respiratory rate control, hospital length of stay, and mortality. Results: Twelve studies were analyzed with an overall population of 715 patients included. Idiopathic Pulmonary Fibrosis (IPF) was the most prevalent type of ILD. Evaluated clinical settings were acute (7 studies), chronic (2 studies), and end-stage (3 studies) ILDs. The HFNC as a support for acute respiratory failure seems not inferior to non-invasive ventilation while offering better comfort and patient’s perception. Poor data are available about use in chronic/long-term or rehabilitative settings. In end of life/palliative care, an HFNC might improve quality of life. Despite the promising results, further research is warranted to establish optimal HFNC protocols, identify patient subgroups most likely to benefit, and explore long-term outcomes. Conclusions: Overall, the HFNC appears to be a valuable therapeutic option for managing respiratory failure in ILD patients, offering potential improvements in oxygenation and symptom relief.
... That is why it is presumed that HFNC support would be a good complement to nasal Continuous Positive Airway Pressure or CPAP. In a lung-damaged animal model, partial carbon dioxide pressure (PaCO2) reduced as HFOT flow increased, and PaCO2 fell more effectively with the increased gas release [14]. The effectiveness, safety, and dependability of HFNC treatment have been demonstrated in several observational studies in babies with bronchiolitis. ...
High-flow oxygen therapy provides adequate oxygen to those patients who suffer from pulmonary disorders due to the COVID-19 virus. The purpose of this research is to develop an oxygen therapy device that produces high-flow oxygen and provides a humidified supply of oxygen to patients suffering from Chronic Obstructive Pulmonary Disease (COPD) and Acute Respiratory Distress Syndrome (ARDS) caused by COVID-19. The development of a High-Flow Oxygen Therapy (HFOT) device using cannulation is a much-needed solution to fill the gap in the availability of ventilators in resource-limited settings like Pakistan. The HFOT has a system that offers high-flow oxygen with the help of a blender that is capable of producing a balanced mix of air and oxygen while keeping the fraction of inspired oxygen (FiO2) at the desired level. A Proportional, Integral, and Derivative (PID) valve is used to control the flow of the mixed gas as per the requirement. The mixed air is then passed through a humidifier that warms, humidifies, and purifies respiratory gas. The flow rate of the device is designed to produce up to 60 Liters Per Minute (LPM) with ± 0.5 variations with proper humidity. The designed prototype is tested for the gas flow rate, oxygen concentration, and desired pressure using professional calibrators and artificial lungs. The test results show significant achievements in delivering humid gases with high flow rates.
... HFNC has been shown to have salutatory effects in IPF patients without an AE, specifically decreased minute ventilation and respiratory rate, and capillary carbon dioxide was seen. The minor increase in positive endexpiratory pressure seen with it is also considered beneficial [48,49]. Finally, there is the added advantage of the patient being able to eat and communicate with HFNC vs IMV. ...
Interstitial lung disease (ILD) is typically managed on an outpatient basis. Critical care physicians manage patients with ILD in the setting of an acute exacerbation (ILD flare) causing severe hypoxia. The principles of management of acute exacerbation of ILD are different from those used to manage patients with acute respiratory distress syndrome from sepsis, etc. Selected patients may be candidates for aggressive measures like extracorporeal membrane oxygenation and lung transplantation, while almost all patients will benefit from early palliative care. This review focused on the types of ILD, diagnosis, and management pathways for this challenging condition.
... This initial support for HFNOT in the management of interstitial lung disease was supported by a retrospective study of 96 patients with exacerbation of interstitial pneumonia (97). Patients were grouped into pre-HFNOT and post-HFNOT cohorts based on the introduction of HFNOT at the hospital. ...
... The incorporation of HFNOT into the management of interstitial lung disease patients in this study resulted in lower in-hospital mortality, reduced requirement for sedation and analgesia and a lower incidence of discontinuation of oral intake. There was no difference in the incidence of complications (97). ...
Oxygen therapy is the first-line treatment for hypoxemic acute respiratory failure. In veterinary medicine this has traditionally been provided via mask, low-flow nasal oxygen cannulas, oxygen cages and invasive positive pressure ventilation. Traditional non-invasive modalities are limited by the maximum flow rate and fraction of inspired oxygen (FiO2) that can be delivered, variability in oxygen delivery and patient compliance. The invasive techniques are able to provide higher FiO2 in a more predictable manner but are limited by sedation/anesthesia requirements, potential complications and cost. High-flow nasal oxygen therapy (HFNOT) represents an alternative to conventional oxygen therapy. This modality delivers heated and humidified medical gas at adjustable flow rates, up to 60 L/min, and FiO2, up to 100%, via nasal cannulas. It has been proposed that HFNOT improves pulmonary mechanics and reduces respiratory fatigue via reduction of anatomical dead space, provision of low-level positive end-expiratory pressure (PEEP), provision of constant FiO2 at rates corresponding to patient requirements and through improved patient tolerance. Investigations into the use of HFNOT in veterinary patients have increased in frequency since its clinical use was first reported in dogs with acute respiratory failure in 2016. Current indications in dogs include acute respiratory failure associated with pulmonary parenchymal disease, upper airway obstruction and carbon monoxide intoxication. The use of HFNOT has also been advocated in certain conditions in cats and foals. HFNOT is also being used with increasing frequency in the treatment of a widening range of conditions in humans. Although there remains conflict regarding its use and efficacy in some patient groups, overall these reports indicate that HFNOT decreases breathing frequency and work of breathing and reduces the need for escalation of respiratory support. In addition, they provide insight into potential future veterinary applications. Complications of HFNOT have been rarely reported in humans and animals. These are usually self-limiting and typically result in lower morbidity and mortality than those associated with invasive ventilation techniques.
... High-flow therapy (HFNC) is easier to apply than NPPV and is relatively well tolerated by patients. Similar to NPPV, it has been introduced as first-line respiratory management for acute respiratory failure of CTD-ILD [236]. Ventilator management under endotracheal intubation and extracorporeal membrane oxygenation (ECMO) are highly invasive. ...
The prognosis of patients with connective tissue disease (CTD) has improved significantly in recent years, but interstitial lung disease (ILD) associated with connective tissue disease (CTD-ILD) remains a refractory condition, which is a leading cause of mortality. Because it is an important prognostic factor, many observational and interventional studies have been conducted to date. However, CTD is a heterogeneous group of conditions, which makes the clinical course, treatment responses, and prognosis of CTD-ILD extremely diverse. To summarize the current understanding and unsolved questions, the Japanese Respiratory Society and the Japan College of Rheumatology collaborated to publish the world's first guide focusing on CTD-ILD, based on the evidence and expert consensus of pulmonologists and rheumatologists, along with radiologists, pathologists, and dermatologists. The task force members proposed a total of 27 items, including 7 for general topics, 9 for disease-specific topics, 3 for complications, 4 for pharmacologic treatments, and 4 for non-pharmacologic therapies, with teams of 2–4 authors and reviewers for each item to prepare a consensus statement based on a systematic literature review. Subsequently, public opinions were collected from members of both societies, and a critical review was conducted by external reviewers. Finally, the task force finalized the guide upon discussion and consensus generation. This guide is expected to contribute to the standardization of CTD-ILD medical care and is also useful as a tool for promoting future research by clarifying unresolved issues.
... HFNC has demonstrated utility in patients with acute exacerbations in several studies, with the majority demonstrating improved comfort and reduced hospital length of stay and mortality [51][52][53][54][55][56]. One small, observational, retrospective study suggests reduced mortality with HFNC (23% vs. NIPPV 63%) despite no difference between HFNC and NIPPV in need for intubation [52]. ...
... Koyauchi et al. evaluated HFNC in 66 patients with acute exacerbations of ILD, finding improved oxygenation, with a pulse oximetry saturation to fraction of inspired oxygen (SpO 2 /FiO 2 ) ratio > 170.9 at 24 h a significant predictor of successful HFNC therapy [53]. A retrospective study found reduced mortality with HFNC in ILD (27.9% vs. no HFNC 49.1%), reduced need for sedation and analgesia (78.6% vs. no HFNC 31.6%), and improved oral intake (52.8% vs. no HFNC 23.3%) in patients with ILD [54]. A final retrospective study found HFNC improved comfort and was better tolerated by patients with end stage ILD with a Do Not Intubate (DNI) order [57]. ...
Introduction
High flow nasal cannula (HFNC) is a noninvasive ventilation (NIV) system that has demonstrated promise in the emergency department (ED) setting.
Objective
This narrative review evaluates the utility of HFNC in adult patients with acute hypoxemic respiratory failure in the ED setting.
Discussion
HFNC provides warm (37 °C), humidified (100% relative humidity) oxygen at high flows with a reliable fraction of inspired oxygen (FiO2). HFNC can improve oxygenation, reduce airway resistance, provide humidified flow that can flush anatomical dead space, and provide a low amount of positive end expiratory pressure. Recent literature has demonstrated efficacy in acute hypoxemic respiratory failure, including pneumonia, acute respiratory distress syndrome (ARDS), coronavirus disease 2019 (COVID-19), interstitial lung disease, immunocompromised states, the peri-intubation state, and palliative care, with reduced need for intubation, length of stay, and mortality in some of these conditions. Individual patient factors play an important role in infection control risks with respect to the use of HFNC in patients with COVID-19. Appropriate personal protective equipment, adherence to hand hygiene, surgical mask placement over the HFNC device, and environmental controls promoting adequate room ventilation are the foundation for protecting healthcare personnel. Frequent reassessment of the patient placed on HFNC is necessary; those with severe end organ dysfunction, thoracoabdominal asynchrony, significantly increased respiratory rate, poor oxygenation despite HFNC, and tachycardia are at increased risk of HFNC failure and need for further intervention.
Conclusions
HFNC demonstrates promise in several conditions requiring respiratory support. Further randomized trials are needed in the ED setting.
... In a retrospective study of patients with AE-IPF, Ito and colleagues demonstrated a decreased mortality rate and need for mechanical ventilation or NIPPV in the epoch after implementation of high flow nasal, suggesting significant benefit of HFNC in AE-IPF [27]. ...
The triggers as well as etiologies for Acute exacerbation of idiopathic pulmonary fibrosis (AE-IPF) are not known. AE-IPF is defined as an “acute, clinically significant respiratory deterioration characterized by evidence of new widespread alveolar abnormality typically less than 1 month’s duration. The underlying pathologic insult is classically described as diffuse alveolar damage. Ideally, infection is excluded by BAL as in the case presentation, but the severity of hypoxemia and the desire to avoid endotracheal intubation may preclude the performance of this procedure. Supportive care is the mainstay of therapy as there are no proven therapies, although corticosteroids, cytotoxic agents and anti-coagulation have all been suggested as possible treatments. The mortality is high, particularly once invasive ventilation has been instituted.
... Ito and colleagues 30 examined patients with AE-ILD and reported that HFNC reduced the use of sedoanalgesia and the number of patients who discontinued oral intake. Vianello and colleagues 31 suggested that HFNC should be applied to patients who do not respond to conventional oxygen therapy. ...
Background
High-flow nasal cannula (HFNC) oxygen therapy provides effective respiratory management in patients with hypoxemic respiratory failure. However, the efficacy and tolerability of HFNC for patients with acute exacerbation of interstitial lung disease (AE-ILD) have not been established. This study was performed to assess the efficacy and tolerability of HFNC for patients with AE-ILD and identify the early predictors of the outcome of HFNC treatment.
Methods
We retrospectively reviewed the records of patients with AE-ILD who underwent HFNC. Overall survival, the success rate of HFNC treatment, adverse events, temporary interruption of treatment, discontinuation of treatment at the patient’s request, and predictors of the outcome of HFNC treatment were evaluated.
Results
A total of 66 patients were analyzed. Of these, 26 patients (39.4%) showed improved oxygenation and were successfully withdrawn from HFNC. The 30-day survival rate was 48.5%. No discontinuations at the patient’s request were observed, and no serious adverse events occurred. The pulse oximetric saturation to fraction of inspired oxygen (SpO 2 /FIO 2 ) ratio 24 h after initiating HFNC showed high prediction accuracy (area under the receiver operating characteristic curve, 0.802) for successful HFNC treatment. In the multivariate logistic regression analysis, an SpO 2 /FIO 2 ratio of at least 170.9 at 24 h after initiation was significantly associated with successful HFNC treatment (odds ratio, 51.3; 95% confidence interval, 6.13–430; p < 0.001).
Conclusions
HFNC was well tolerated in patients with AE-ILD, suggesting that HFNC is a reasonable respiratory management for these patients. The SpO 2 /FIO 2 ratio 24 h after initiating HFNC was a good predictor of successful HFNC treatment. The reviews of this paper are available via the supplemental material section.
OBJECTIVE: To provide humidified, heated and precis oxygen with high efficiency of Functional residual to acute respiratory distress syndrome patients caused by COVID-19.
METHODOLOGY: It was an observational research that took place at the LUMHS Hospital. In this study, 200 patients with severe respiratory distress, either caused by Covid-19 or other respiratory disorders, were enrolled. LUMHS hospital ICU ward was used as a data source. This study showed that subjects in late 30s, both male and female. Patients with acute or chronic respiratory failure were included, but those with other pulmonary disorders were excluded.
RESULTS: A total of 200 patients were selected for this study. Out of them 122 (61%) were males and 78 (39%) were females with the Standard deviation of 2.33. Regarding to age. 24%. Were below 30s. 20% patients were in 30s.and 57% belonged to above 30s. While the efficiency of HFNC was 65%. in 65% cases it was proved to be lifesaving and in 39% cases patients were sent for intubation. Oxygen delivery method using cannula was 65% in delivering SPO2 equal to or greater than 10lpm while face mask method was only 35% successful that determines for higher concentration cannulation is more efficient method than face mask.
CONCLUSION: HFNC is a recent innovation that reduces the need for intubation and oxygen loss while also providing high-flow oxygen with optimum humidification and temperature to patients with respiratory failure
Sarcoidosis is a systemic inflammatory disease defined by the presence of aberrant granulomas affecting various organs. Due to its multisystem involvement, care of patients with established sarcoidosis becomes challenging, especially in the intensive care setting. While the lungs are typically involved, extrapulmonary manifestations also occur either concurrently or exclusively within a significant proportion of patients, complicating diagnostic and management decisions. The scope of this review is to focus on what considerations are necessary in the evaluation and management of patients with known sarcoidosis and their associated complications within a cardiopulmonary and critical care perspective.
