Physiological Comparison of High-Flow Nasal Cannula and Helmet Noninvasive Ventilation in Acute Hypoxemic Respiratory Failure

Nov 6, 2019American journal of respiratory and critical care medicine

Body responses to high-flow nasal oxygen versus helmet breathing support in sudden low-oxygen lung failure

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Abstract

Helmet noninvasive ventilation (NIV) improved oxygenation with a median Pa/Fi of 255 mm Hg compared to 138 mm Hg for high-flow nasal cannula (HFNC) in patients with hypoxemia.

Helmet NIV reduced inspiratory effort to 7 cm HO compared to 15 cm HO with HFNC.
The respiratory rate was lower with helmet NIV at 24 breaths/min versus 29 breaths/min with HFNC.
Dyspnea levels, measured on a visual analog scale, were lower with helmet NIV (3) compared to HFNC (8).
Transpulmonary pressure swings did not significantly differ between helmet NIV and HFNC, but some patients showed increased swings with helmet NIV.
Higher transpulmonary pressure swings during NIV were associated with an increased need for intubation.

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High-flow nasal cannula (HFNC) and helmet noninvasive ventilation (NIV) are used for the management of acute hypoxemic respiratory failure.Physiological comparison of HFNC and helmet NIV in patients with hypoxemia.Fifteen patients with hypoxemia with Pa/Fi < 200 mm Hg received helmet NIV (positive end-expiratory pressure ≥ 10 cm HO, pressure support = 10-15 cm HO) and HFNC (50 L/min) in randomized crossover order. Arterial blood gases, dyspnea, and comfort were recorded. Inspiratory effort was estimated by esophageal pressure (Pes) swings. Pes-simplified pressure-time product and transpulmonary pressure swings were measured.As compared with HFNC, helmet NIV increased Pa/Fi(median [interquartile range]: 255 mm Hg [140-299] vs. 138 [101-172]; = 0.001) and lowered inspiratory effort (7 cm HO [4-11] vs. 15 [8-19]; = 0.001) in all patients. Inspiratory effort reduction by NIV was linearly related to inspiratory effort during HFNC ( = 0.84; < 0.001). Helmet NIV reduced respiratory rate (24 breaths/min [23-31] vs. 29 [26-32]; = 0.027), Pes-simplified pressure-time product (93 cm HO ⋅ s ⋅ min[43-138] vs. 200 [168-335]; = 0.001), and dyspnea (visual analog scale 3 [2-5] vs. 8 [6-9]; = 0.002), without affecting Pa( = 0.80) and comfort ( = 0.50). In the overall cohort, transpulmonary pressure swings were not different between treatments (NIV = 18 cm HO [14-21] vs. HFNC = 15 [8-19]; = 0.11), but patients exhibiting lower inspiratory effort on HFNC experienced increases in transpulmonary pressure swings with helmet NIV. Higher transpulmonary pressure swings during NIV were associated with subsequent need for intubation.As compared with HFNC in hypoxemic respiratory failure, helmet NIV improves oxygenation, reduces dyspnea, inspiratory effort, and simplified pressure-time product, with similar transpulmonary pressure swings, Pa, and comfort. Rationale: Objectives: Methods: Measurements and Main Results: Conclusions: O2O2 2 2O2O2 2 2CO2 2CO2P P r P P P P P P P -1

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Physiological Comparison of High-Flow Nasal Cannula and Helmet Noninvasive Ventilation in Acute Hypoxemic Respiratory Failure

Abstract

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