title: Comparison of three high flow oxygen therapy delivery devices: a clinical physiological cross-over study.
abstract: OBJECTIVE
  High-flow-oxygen-therapy is provided by various techniques and patient interfaces, resulting in various inspired-fraction of oxygen (FiO2) and airway-pressure levels. However, tracheal measurements have never been performed.
  
  
  METHODS
  Three oxygen-delivery-devices were evaluated: 1) standard-high-flow-oxygen-facemask with reservoir-bag, 2) Optiflow(TM)-high-flow-nasal-cannulae and 3) Boussignac(TM)-oxygen-therapy-system. Main judgment criteria were airway-pressure and FiO2 measured in the trachea. The three devices were randomly evaluated in cross-over in 10 Intensive-Care-Unit patients using three oxygen flow-rates (15, 30 and 45 L/min) and two airway-tightness conditions (open and closed mouth). Airway-pressures and FiO2 were measured by a tracheal-catheter inserted through the hole of a tracheotomy tube. Comfort was evaluated by self-reporting. Data are presented as median [25-75th].
  
  
  RESULTS
  1) Regarding oxygen-delivery devices, BoussignacTM provided the highest mean tracheal pressure (13.9 [10.4-14.5] cmH20) compared to Optiflow(TM) (2 [1-2.3] cmH2O, P<0.001). BoussignacTM provided both positive inspiratory and expiratory airway-pressures, whereas Optiflow(TM) provided only positive expiratory airway-pressure. Reservoir-bag-facemask provided airway pressure close to zero. For FiO2, highest value was obtained for both Optiflow(TM) and facemask (90%) compared to Boussignac(TM) (80%), P<0.01. 2) Regarding oxygen-flow, airway-pressure and FiO2 systematically increased with oxygen-flow with the three devices except airway-pressure for the facemask. 3) Regarding the open-mouth position, mean airway-pressure decreased with Optiflow(TM) only (2 [1.2-3.3] vs. 0.6 [0.3-1] cmH2O, P<0.001). Opening the mouth had little impact on FiO2. 4) finally, discomfort-intensities were low for both Optiflow(TM) and reservoir-bag-facemask compared to Boussignac(TM), P<0.01.
  
  
  CONCLUSIONS
  On one hand, Boussignac(TM) is the only device that generates a relevant positive-airway-pressure during both inspiration-and-expiration, independently of mouth-position. Optiflow(TM) provides a low positive-airway-pressure (<4 cmH2O), highly dependent of mouth-closing. The reservoir-bag-facemask provides no positive-airway-pressure. On the other hand, FiO2 are slightly but significantly higher for Optiflow(TM) and reservoir-bag-facemask than for Boussignac(TM). Discomfort was lesser for Optiflow(TM) and reservoir-bag-facemask.
authors.affiliation: Anesthesiology and Intensive Care Department (DAR), University of Montpellier Saint Eloi Hospital, Montpellier, France - g-chanques@chu-montpellier.fr.
authors.forename: G
authors.initials: G
authors.lastname: Chanques
authors.forename: F
authors.initials: F
authors.lastname: Riboulet
authors.forename: N
authors.initials: N
authors.lastname: Molinari
authors.forename: J
authors.initials: J
authors.lastname: Carr
authors.forename: B
authors.initials: B
authors.lastname: Jung
authors.forename: A
authors.initials: A
authors.lastname: Prades
authors.forename: F
authors.initials: F
authors.lastname: Galia
authors.forename: E
authors.initials: E
authors.lastname: Futier
authors.forename: J M
authors.initials: JM
authors.lastname: Constantin
authors.forename: S
authors.initials: S
authors.lastname: Jaber
mesh_terms: D000368:Aged; D003422:Critical Care; D018592:Cross-Over Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000008:administration & dosage; D010102:Oxygen Inhalation Therapy / Q000009:adverse effects / Q000295:instrumentation*; D014140:Tracheotomy
chemical_list: D010100:Oxygen