| Title |
Optimum support by high-flow nasal cannula in acute hypoxemic respiratory failure: effects of increasing flow rates
|
|---|---|
| Published in |
Intensive Care Medicine, July 2017
|
| DOI | 10.1007/s00134-017-4890-1 |
| Pubmed ID | |
| Authors |
Tommaso Mauri, Laura Alban, Cecilia Turrini, Barbara Cambiaghi, Eleonora Carlesso, Paolo Taccone, Nicola Bottino, Alfredo Lissoni, Savino Spadaro, Carlo Alberto Volta, Luciano Gattinoni, Antonio Pesenti, Giacomo Grasselli |
| Abstract |
Limited data exist on the correlation between higher flow rates of high-flow nasal cannula (HFNC) and its physiologic effects in patients with acute hypoxemic respiratory failure (AHRF). We assessed the effects of HFNC delivered at increasing flow rate on inspiratory effort, work of breathing, minute ventilation, lung volumes, dynamic compliance and oxygenation in AHRF patients. A prospective randomized cross-over study was performed in non-intubated patients with patients AHRF and a PaO2/FiO2 (arterial partial pressure of oxygen/fraction of inspired oxygen) ratio of ≤300 mmHg. A standard non-occlusive facial mask and HFNC at different flow rates (30, 45 and 60 l/min) were randomly applied, while maintaining constant FiO2 (20 min/step). At the end of each phase, we measured arterial blood gases, inspiratory effort, based on swings in esophageal pressure (ΔPes) and on the esophageal pressure-time product (PTPPes), and lung volume, by electrical impedance tomography. Seventeen patients with AHRF were enrolled in the study. At increasing flow rate, HFNC reduced ΔPes (p < 0.001) and PTPPes (p < 0.001), while end-expiratory lung volume (ΔEELV), tidal volume to ΔPes ratio (V T/ΔPes, which corresponds to dynamic lung compliance) and oxygenation improved (p < 0.01 for all factors). Higher HFNC flow rate also progressively reduced minute ventilation (p < 0.05) without any change in arterial CO2 tension (p = 0.909). The decrease in ΔPes, PTPPes and minute ventilation at increasing flow rates was better described by exponential fitting, while ΔEELV, V T/ΔPes and oxygenation improved linearly. In this cohort of patients with AHRF, an increasing HFNC flow rate progressively decreased inspiratory effort and improved lung aeration, dynamic compliance and oxygenation. Most of the effect on inspiratory workload and CO2 clearance was already obtained at the lowest flow rate. |
X Demographics
The data shown below were collected from the profiles of 59 X users who shared this research output. Click here to find out more about how the information was compiled.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| Spain | 10 | 17% |
| United States | 9 | 15% |
| United Kingdom | 3 | 5% |
| Canada | 3 | 5% |
| Mexico | 3 | 5% |
| Uruguay | 2 | 3% |
| Japan | 2 | 3% |
| Saudi Arabia | 1 | 2% |
| Argentina | 1 | 2% |
| Other | 6 | 10% |
| Unknown | 19 | 32% |
Demographic breakdown
| Type | Count | As % |
|---|---|---|
| Members of the public | 38 | 64% |
| Practitioners (doctors, other healthcare professionals) | 16 | 27% |
| Scientists | 4 | 7% |
| Science communicators (journalists, bloggers, editors) | 1 | 2% |
Mendeley readers
The data shown below were compiled from readership statistics for 244 Mendeley readers of this research output. Click here to see the associated Mendeley record.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| Unknown | 244 | 100% |
Demographic breakdown
| Readers by professional status | Count | As % |
|---|---|---|
| Researcher | 32 | 13% |
| Student > Bachelor | 23 | 9% |
| Student > Postgraduate | 20 | 8% |
| Other | 18 | 7% |
| Student > Doctoral Student | 15 | 6% |
| Other | 53 | 22% |
| Unknown | 83 | 34% |
| Readers by discipline | Count | As % |
|---|---|---|
| Medicine and Dentistry | 117 | 48% |
| Nursing and Health Professions | 19 | 8% |
| Agricultural and Biological Sciences | 3 | 1% |
| Pharmacology, Toxicology and Pharmaceutical Science | 3 | 1% |
| Engineering | 3 | 1% |
| Other | 10 | 4% |
| Unknown | 89 | 36% |
Attention Score in Context
This research output has an Altmetric Attention Score of 36. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 26 May 2020.
All research outputs
#1,134,346
of 25,918,104 outputs
Outputs from Intensive Care Medicine
#1,040
of 5,524 outputs
Outputs of similar age
#22,552
of 330,142 outputs
Outputs of similar age from Intensive Care Medicine
#9
of 55 outputs
Altmetric has tracked 25,918,104 research outputs across all sources so far. Compared to these this one has done particularly well and is in the 95th percentile: it's in the top 5% of all research outputs ever tracked by Altmetric.
So far Altmetric has tracked 5,524 research outputs from this source. They typically receive a lot more attention than average, with a mean Attention Score of 29.5. This one has done well, scoring higher than 81% of its peers.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 330,142 tracked outputs that were published within six weeks on either side of this one in any source. This one has done particularly well, scoring higher than 93% of its contemporaries.
We're also able to compare this research output to 55 others from the same source and published within six weeks on either side of this one. This one has done well, scoring higher than 83% of its contemporaries.