Today we have a brief discussion on the new hottie in the respiratory care world, High-Flow Nasal Cannulae
Check Out Critical Care Horizons
Critical Care Horizons published its first articles this week, with a further article due out in the next few days.
How do these Bad Boys Work?
- Best Review by Ward et al.
- Review from an RT Journal
- LitFL CCC Entry
- Josh Farkas has a great post on sole use of high-flow NC
- Gastric rupture following nasopharyngeal catheter oxygen delivery-a report of two cases
- Some of the Devices: Optiflow, Vapotherm
and the response from the FOAM World
- The Bottom Line Review
This trial demonstrates that in poor mental status, Nasal Facemask rather than Full Facemask led to better outcomes (Crit Care. 2013; 17(6): R300)
John Greenwood, editor of the CCProject, adds this great comment:
Great summary and review as always. I've seen a worrisome trend of people citing FLORALI to justify HFNC as a reasonable strategy for pts with hypoxic RF rather than (in my opinion) what should probably be a tool used as bridge during intubation planning. Consider adding this study (http://www.ncbi.nlm.nih.gov/
pubmed/25691263) to your pack.
Just out of curiosity, are there any specific patients you are maintaining on HFNC?
If I may, here's my own little rant about the FLORALI study (STRANGE subtleties in protocol)
1. HFNC was not used as a treatment option for all-comers w/ hypoxic respiratory failure. There were significant exclusion criteria & none of the enrolled patients had chronic lung disease (including COPD) and had no other organ dysfunction. These were only pts with PURE, single organ failure (hypoxic RF) and nothing else…
2. The authors targeted 7-10 cc/kg TV with their NIPPV which may have resulted in additional lung injury as the editorial noted, but I suspect the authors may have chosen this to avoid causing any hypercapnea associated with LTVV. Unfortunately this arm was doomed from the get go I think – especially since almost 25% had unilateral lung disease on presentation.
3. Not only was there a significant amount of therapy crossover between the NIPPV and HFNC arms, but the therapies weren't even independent of each other! 2/3 arms were actually HFNC arms, one of them just had intermittent/scheduled NIPPV sessions!!
Anyways, appreciate all the hard work. Keep it up. Happy Independence Day.
Now on to the Podcast…
- COVID19 – Awake Pronation (aka the Pig Roast) A guest write-up by David Gordon, MD - April 6, 2020
- EMCrit Wee – Webinar I Gave to Pulm/Crit Care Fellows on Avoiding Intubation and Initial Ventilation of COVID19 Patients - April 4, 2020
- EMCrit 269 – Rationing of Critical Care and Ventilators in COVID19 with Reub Strayer - March 31, 2020