title: Patients with New York Heart Association class III heart failure may benefit with high flow nasal cannula supportive therapy: high flow nasal cannula in heart failure.
abstract: OBJECTIVE
  High flow nasal cannula (HFNC) may decrease preload being associated with beneficial hemodynamic and respiratory effects in adults with heart failure.
  
  
  METHODS
  This is a sequential intervention prospective study including 10 adults with New York Heart Association (NYHA) class III and left ventricle ejection fraction 45% or less. High flow gas was administered (fraction of inspired oxygen, 0.21) through nasal cannula (Optiflow(TM); Fisher & Paykel, Auckland, New Zealand). Sequential echocardiographies were performed at baseline, using HFNC with 20 lpm and 40 lpm and post-HFNC. A reduction greater than 20% in the estimated inspiratory collapse of the inferior vena cava (IVC) from baseline was considered clinically significant.
  
  
  RESULTS
  Ten patients were included, with median age of 57 (44-65) years; 6 (60%) were female, and 8 (80%) had dilated cardiomyopathy. Median IVC inspiratory significantly (P<.05) decreased from baseline (37%) to HFNC with 20 lpm (28%) and HFNC with 40 lpm (21%), representing mean attributable reductions of 20% (95% confidence interval, 6-55) and 53% (95% confidence interval, 36-67) from baseline. Changes in the IVC inspiratory collapse were reversible after HFNC withdrawal. Respiratory rate was significantly reduced from 23 breaths per minute at baseline to 17 breaths per minute at HFNC with 20 lpm and 13 breaths per minute at HFNC with 40 lpm. In contrast, no significant changes in other echocardiographic or clinical variables were documented.
  
  
  CONCLUSIONS
  These findings suggest that patients with NYHA class III heart failure may benefit with HFNC supportive therapy.
authors.affiliation: Critical Care Department and CRIPS investigators, Vall d'Hebron University Hospital, Institut de Recerca Vall d'Hebron - VHIR, Universitat Autònoma Barcelona, Barcelona, Spain; CibeRes (Ciber de Enfermedades Respiratorias), Instituto de Salud Carlos III, Madrid, Spain.
authors.forename: Oriol
authors.initials: O
authors.lastname: Roca
authors.forename: Purificación
authors.initials: P
authors.lastname: Pérez-Terán
authors.forename: Joan R
authors.initials: JR
authors.lastname: Masclans
authors.forename: Lourdes
authors.initials: L
authors.lastname: Pérez
authors.forename: Enrique
authors.initials: E
authors.lastname: Galve
authors.forename: Arturo
authors.initials: A
authors.lastname: Evangelista
authors.forename: Jordi
authors.initials: J
authors.lastname: Rello
mesh_terms: D000328:Adult; D000368:Aged; D004452:Echocardiography; D005260:Female; D006333:Heart Failure / Q000145:classification / Q000000981:diagnostic imaging / Q000628:therapy*; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D010102:Oxygen Inhalation Therapy / Q000379:methods*; D011446:Prospective Studies; D016896:Treatment Outcome
keywords: Heart failure; High flow nasal cannula