Physiological effects of high-flow nasal cannula oxygen therapy after extubation: a randomized crossover study

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dc.catalogadorjca
dc.contributor.authorBasoalto Escobar, Roque Ignacio
dc.contributor.authorDamiani Rebolledo, L. Felipe
dc.contributor.authorJalil, Yorschua
dc.contributor.authorBachmann, María Consuelo
dc.contributor.authorOviedo, Vanessa
dc.contributor.authorAlegría Vargas, Leyla
dc.contributor.authorValenzuela, Emilio Daniel
dc.contributor.authorRovegno Echavarria, Maxiliano
dc.contributor.authorRuiz-Rudolph, Pablo
dc.contributor.authorCornejo, Rodrigo
dc.contributor.authorRetamal Montes, Jaime
dc.contributor.authorBugedo Tarraza, Guillermo
dc.contributor.authorThille, Arnaud W.
dc.contributor.authorBruhn, Alejandro
dc.date.accessioned2023-10-25T18:48:23Z
dc.date.available2023-10-25T18:48:23Z
dc.date.issued2023
dc.date.updated2023-10-22T00:03:51Z
dc.description.abstractAbstract: Background: Prophylactic high-flow nasal cannula (HFNC) oxygen therapy can decrease the risk of extubation failure. It is frequently used in the postextubation phase alone or in combination with noninvasive ventilation. However, its physiological effects in this setting have not been thoroughly investigated. The aim of this study was to determine comprehensively the effects of HFNC applied after extubation on respiratory effort, diaphragm activity, gas exchange, ventilation distribution, and cardiovascular biomarkers. Methods: This was a prospective randomized crossover physiological study in critically ill patients comparing 1 h of HFNC versus 1 h of standard oxygen after extubation. The main inclusion criteria were mechanical ventilation for at least 48 h due to acute respiratory failure, and extubation after a successful spontaneous breathing trial (SBT). We measured respiratory effort through esophageal/transdiaphragmatic pressures, and diaphragm electrical activity (ΔEAdi). Lung volumes and ventilation distribution were estimated by electrical impedance tomography. Arterial and central venous blood gases were analyzed, as well as cardiac stress biomarkers. Results: We enrolled 22 patients (age 59 ± 17 years; 9 women) who had been intubated for 8 ± 6 days before extubation. Respiratory effort was significantly lower with HFNC than with standard oxygen therapy, as evidenced by esophageal pressure swings (5.3 [4.2–7.1] vs. 7.2 [5.6–10.3] cmH2O; p < 0.001), pressure–time product (85 [67–140] vs. 156 [114–238] cmH2O*s/min; p < 0.001) and ΔEAdi (10 [7–13] vs. 14 [9–16] µV; p = 0.022). In addition, HFNC induced increases in end-expiratory lung volume and PaO2/FiO2 ratio, decreases in respiratory rate and ventilatory ratio, while no changes were observed in systemic hemodynamics, Troponin T, or in amino-terminal pro-B-type natriuretic peptide. Conclusions: Prophylactic application of HFNC after extubation provides substantial respiratory support and unloads respiratory muscles.
dc.fechaingreso.objetodigital2023-10-22
dc.fuente.origenBiomed Central
dc.identifier.citationAnnals of Intensive Care. 2023 Oct 18;13(1):104
dc.identifier.urihttps://doi.org/10.1186/s13613-023-01203-z
dc.identifier.urihttps://repositorio.uc.cl/handle/11534/75182
dc.information.autorucEscuela de Medicina;Basoalto Escobar, Roque Ignacio;S/I;1010703
dc.information.autorucEscuela de Medicina;Damiani Rebolledo, L. Felipe;S/I;237645
dc.information.autorucEscuela de Medicina;Jalil Contreras, Yorschua Frederick;S/I;1079709
dc.information.autorucEscuela de Medicina;Bachmann, María Consuelo;S/I;215825
dc.information.autorucEscuela de Medicina;Oviedo, Vanessa;S/I;1009275
dc.information.autorucEscuela de Medicina;Alegría Vargas, Leyla;0000-0002-0930-4452;121090
dc.information.autorucEscuela de Medicina;Valenzuela, Emilio Daniel;0000-0001-9758-3473;1056714
dc.information.autorucEscuela de Medicina;Rovegno Echavarria, Maxiliano;0000-0002-2882-8024;1004053
dc.information.autorucEscuela de Medicina;Retamal Montes, Jaime;0000-0002-6817-3659;175147
dc.information.autorucEscuela de Medicina;Bugedo Tarraza, Guillermo;0000-0001-7527-6202;60490
dc.information.autorucEscuela de Medicina;Bruhn, Alejandro;S/I;741
dc.issue.numero13
dc.language.isoen
dc.nota.accesoContenido completo
dc.pagina.final10
dc.pagina.inicio1
dc.revistaAnnals of Intensive Care
dc.rightsacceso abierto
dc.subjectWeaning
dc.subjectWork of breathing
dc.subjectEsophageal pressure
dc.subjectReintubation
dc.subject.ddc610
dc.subject.deweyMedicina y saludes_ES
dc.subject.ods03 Good health and well-being
dc.subject.odspa03 Salud y bienestar
dc.titlePhysiological effects of high-flow nasal cannula oxygen therapy after extubation: a randomized crossover study
dc.typeartículo
sipa.codpersvinculados1010703
sipa.codpersvinculados237645
sipa.codpersvinculados1079709
sipa.codpersvinculados215825
sipa.codpersvinculados121090
sipa.codpersvinculados1056714
sipa.codpersvinculados1004053
sipa.codpersvinculados175147
sipa.codpersvinculados60490
sipa.codpersvinculados741
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