Value and Safety of High Flow Oxygenation in the Treatment of Inpatient Asthma: A Randomized, Double-blind, Pilot Study
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Abstract
This study was aimed to compare the value and safety of high-flow nasal cannula (HFNC) and conventional oxygen therapy (COT) in patients with asthma exacerbation. In this randomized double-blind study, forthy patients with moderate-to-severe asthma exacerbations, aged 18 years or older were enrolled. Patients were randomly assigned to receive either HFNC or COT for 24 hours. Dyspnea scale, O2 saturation, spirometer indexes, respiratory and heart rate, and arterial blood gas (ABG) were compared within 2 and 24 hours of intervention. Dyspnea scale decreased significantly from 7.58±1.04 to 6.45±0.51 (p=0.000), and from 7.84±1.7 to 6.89±0.9 (p=0.049) within 2 hours in HFNC and COT groups, respectively. In the HFNC group, forced expiratory volume in one second (FEV1) was 1.48 ±0.94 L at the time of admission and increased to 1.61±0.66 L (p=0.19) and 1.82±0.92 L (p=0.003) after 2 and 24 hours of experience, respectively. In addition, in the COT group, FEV1 increased from 1.43±0.65 L to 1.46±0.53 L and 1.64±0.6 L in the respective time-points, (p=0.071, 0.079). PaO2 and O2 saturation increased significantly in both groups during the first 2 hours. Two patients in the HFNC group had the complaint of nasal irritation and the device-produced heat; while one patient in the COT group needed more respiratory care. HFNC could be a therapeutic option for asthma exacerbation among adult patients after considering the patient’s selection.
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6. Milési C, Boubal M, Jacquot A, Baleine J, Durand S, Odena MP, et al. High-flow nasal cannula: Recommendations for daily practice in pediatrics. Ann Intensive Care 2014; 4(1):1–7.
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11. Frat J-P, Thille AW, Mercat A, Girault C, Ragot S, Perbet S, et al. High-flow oxygen through nasal cannula in acute hypoxemic respiratory failure. N Engl J Med. Mass Medical Soc 2015; 372(23):2185–96.
12. Rea H, McAuley S, Jayaram L, Garrett J, Hockey H, Storey L, et al. The clinical utility of long-term humidification therapy in chronic airway disease. Respir Med2010; 104(4):525–33.
13. Chisti MJ, Salam MA, Smith JH, Ahmed T, Pietroni MAC, Shahunja KM, et al. Bubble continuous positive airway pressure for children with severe pneumonia and hypoxaemia in Bangladesh: an open, randomised controlled trial. Lancet 2015; 386(9998):1057–65.
14. Global Initiative for Asthma (GINA) guideline 2015.
15. Fan E, Brodie D, Slutsky AS. Acute respiratory distress syndrome: advances in diagnosis and treatment. JAMA 2018; 319(7):698–710.
16. Burra V, Lakshmi AS, Bhat A V, Prabhakar V, Manjunatha N. Comparison of high-flow nasal cannula versus conventional oxygen therapy following extubation after paediatric cardiac surgery. Airway 2019; 2(1):4.
17. Guillot C, Reun C Le, Behal H, JL-A. First-line treatment using high-flow nasal cannula for children with severe bronchiolitis: Applicability and risk factors for failure. Archives de Pediatrie 2018; 25(3):213-8.
18. Miller AG,Gentle MA,Tyler LM,Napolitano N.High-Flow Nasal Cannula in Pediatric Patients: A Survey of Clinical Practice 2018; 63(7):894-9.
19. Martínez F, Sánchez M, B del C-A de P. Treatment with high-flow oxygen therapy in asthma exacerbations in a paediatric hospital ward: Experience from 2012 to 2016. Anales de Practice 2019; 90(2):72-8.
20. Ballestero Y, De Pedro J, Portillo N, Martinez-Mugica O, Arana-Arri E, Benito J. Pilot Clinical Trial of High-Flow Oxygen Therapy in Children with Asthma in the Emergency Service. J Pediatr 2018; 194:204–10.e3.
21. González Martínez F, González Sánchez MI, Toledo del Castillo B, Pérez Moreno J, Medina Muñoz M, Rodríguez Jiménez C, et al. Treatment with high-flow oxygen therapy in asthma exacerbations in a paediatric hospital ward: Experience from 2012 to 2016. An Pediatr 2019; 90(2):72–8.
22. Rittayamai N, Tscheikuna J, Praphruetkit N, Kijpinyochai S. Use of High-Flow Nasal Cannula for Acute Dyspnea and Hypoxemia in the Emergency Department. Respir Care 2015; 60(10):1377–82.
23. Baudin F, Buisson A, Vanel B, Massenavette B, Pouyau R, Javouhey E. Nasal high flow in management of children with status asthmaticus: a retrospective observational study. Ann Intensive Care 2017; 7(1):1–9.
24. Hegde S, Prodhan P. Serious air leak syndrome complicating high-flow nasal cannula therapy: a report of 3 cases. Pediatrics. Am Acad Pediatrics 2013; 131(3):e939-44.
25. König K, Stock EL, Jarvis M. Noise levels of neonatal high-flow nasal cannula devices-an in-vitro study. Neonatology 2013; 103(4):264–7.
26. Pilar J, Modesto V, Lopez-fernandez YM, Lopez-macias O. High-flow nasal cannula therapy versus non-invasive ventilation in children with severe acute asthma exacerbation : An observational cohort study. Med Intensiva 2017; 41(7):418–24.
27. Schibler A, Pham TMT, Dunster KR, Foster K, Barlow A, Gibbons K, et al. Reduced intubation rates for infants after introduction of high-flow nasal prong oxygen delivery. Intensive Care Med 2011; 37(5):847–52.
2. Kepreotes E, Whitehead B, Attia J, Oldmeadow C, Collison A, Searles A, et al. High-flow warm humidified oxygen versus standard low-flow nasal cannula oxygen for moderate bronchiolitis (HFWHO RCT): an open, phase 4, randomised controlled trial. Lancet 2017; 389(10072):930–9.
3. Ebmeier S, Thayabaran D, Braithwaite I, Benamara C, Weatherall M, Beasley R. Trends in international asthma mortality: analysis of data from the WHO Mortality Database from 46 countries (1993-2012). Lancet 2017; 390(10098):935–45.
4. Restrepo RD, Tate A, Gardner DD, Wittnebel LD, Wettstein R. Current approaches to the assessment and treatment of acute severe asthma. Indian J Respir Care 2015; 4(1):2015.
5. Sekiya K, Sugino K, Hojyo T, Ishida F, Sano G, Isobe K, et al. Clinical Evaluation of Severe Asthma Attacks Requiring Tracheal Intubation and Mechanical Ventilation. Allergol Int 2009; 58(2):289–94.
6. Milési C, Boubal M, Jacquot A, Baleine J, Durand S, Odena MP, et al. High-flow nasal cannula: Recommendations for daily practice in pediatrics. Ann Intensive Care 2014; 4(1):1–7.
7. Ischaki E, Pantazopoulos I, Zakynthinos S. Nasal high flow therapy: A novel treatment rather than a more expensive oxygen device. Eur Respir Rev 2017;26(145).
8. Stefan MS, Eckert P, Tiru B, Friderici J, Lindenauer PK, Steingrub JS. High flow nasal oxygen therapy utilization: 7-year experience at a community teaching hospital. Hosp Pract 2018; 46(2):73-6.
9. Fakharian A, Askarabadi MH. Non-Invasive Positive Pressure Ventilation For Management of Patients with moderate to severe acute exacerbation of asthma 2017; 12(1):7–11.
10. Wang J, Lee KP, Chong SL, Loi M, Lee JH. High flow nasal cannula in the emergency department: indications, safety and effectiveness. Expert Rev Med Devices 2018; 1:7.
11. Frat J-P, Thille AW, Mercat A, Girault C, Ragot S, Perbet S, et al. High-flow oxygen through nasal cannula in acute hypoxemic respiratory failure. N Engl J Med. Mass Medical Soc 2015; 372(23):2185–96.
12. Rea H, McAuley S, Jayaram L, Garrett J, Hockey H, Storey L, et al. The clinical utility of long-term humidification therapy in chronic airway disease. Respir Med2010; 104(4):525–33.
13. Chisti MJ, Salam MA, Smith JH, Ahmed T, Pietroni MAC, Shahunja KM, et al. Bubble continuous positive airway pressure for children with severe pneumonia and hypoxaemia in Bangladesh: an open, randomised controlled trial. Lancet 2015; 386(9998):1057–65.
14. Global Initiative for Asthma (GINA) guideline 2015.
15. Fan E, Brodie D, Slutsky AS. Acute respiratory distress syndrome: advances in diagnosis and treatment. JAMA 2018; 319(7):698–710.
16. Burra V, Lakshmi AS, Bhat A V, Prabhakar V, Manjunatha N. Comparison of high-flow nasal cannula versus conventional oxygen therapy following extubation after paediatric cardiac surgery. Airway 2019; 2(1):4.
17. Guillot C, Reun C Le, Behal H, JL-A. First-line treatment using high-flow nasal cannula for children with severe bronchiolitis: Applicability and risk factors for failure. Archives de Pediatrie 2018; 25(3):213-8.
18. Miller AG,Gentle MA,Tyler LM,Napolitano N.High-Flow Nasal Cannula in Pediatric Patients: A Survey of Clinical Practice 2018; 63(7):894-9.
19. Martínez F, Sánchez M, B del C-A de P. Treatment with high-flow oxygen therapy in asthma exacerbations in a paediatric hospital ward: Experience from 2012 to 2016. Anales de Practice 2019; 90(2):72-8.
20. Ballestero Y, De Pedro J, Portillo N, Martinez-Mugica O, Arana-Arri E, Benito J. Pilot Clinical Trial of High-Flow Oxygen Therapy in Children with Asthma in the Emergency Service. J Pediatr 2018; 194:204–10.e3.
21. González Martínez F, González Sánchez MI, Toledo del Castillo B, Pérez Moreno J, Medina Muñoz M, Rodríguez Jiménez C, et al. Treatment with high-flow oxygen therapy in asthma exacerbations in a paediatric hospital ward: Experience from 2012 to 2016. An Pediatr 2019; 90(2):72–8.
22. Rittayamai N, Tscheikuna J, Praphruetkit N, Kijpinyochai S. Use of High-Flow Nasal Cannula for Acute Dyspnea and Hypoxemia in the Emergency Department. Respir Care 2015; 60(10):1377–82.
23. Baudin F, Buisson A, Vanel B, Massenavette B, Pouyau R, Javouhey E. Nasal high flow in management of children with status asthmaticus: a retrospective observational study. Ann Intensive Care 2017; 7(1):1–9.
24. Hegde S, Prodhan P. Serious air leak syndrome complicating high-flow nasal cannula therapy: a report of 3 cases. Pediatrics. Am Acad Pediatrics 2013; 131(3):e939-44.
25. König K, Stock EL, Jarvis M. Noise levels of neonatal high-flow nasal cannula devices-an in-vitro study. Neonatology 2013; 103(4):264–7.
26. Pilar J, Modesto V, Lopez-fernandez YM, Lopez-macias O. High-flow nasal cannula therapy versus non-invasive ventilation in children with severe acute asthma exacerbation : An observational cohort study. Med Intensiva 2017; 41(7):418–24.
27. Schibler A, Pham TMT, Dunster KR, Foster K, Barlow A, Gibbons K, et al. Reduced intubation rates for infants after introduction of high-flow nasal prong oxygen delivery. Intensive Care Med 2011; 37(5):847–52.
| Files | ||
| Issue | Vol 18, No 6 (2019) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/ijaai.v18i6.2174 | |
| PMID | 32245305 | |
| Keywords | ||
| Asthma Disease exacerbation High-flow nasal cannula (HFNC) Oxygen inhalation therapy | ||
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Raeisi S, Fakharian A, Ghorbani F, Jamaati HR, Mirenayat MS. Value and Safety of High Flow Oxygenation in the Treatment of Inpatient Asthma: A Randomized, Double-blind, Pilot Study. Iran J Allergy Asthma Immunol. 2019;18(6):615-623.
