title: Nasal high-flow oxygen therapy in patients with hypoxic respiratory failure: effect on functional and subjective respiratory parameters compared to conventional oxygen therapy and non-invasive ventilation (NIV).
abstract: BACKGROUND
  Aim of the study was to compare the short-term effects of oxygen therapy via a high-flow nasal cannula (HFNC) on functional and subjective respiratory parameters in patients with acute hypoxic respiratory failure in comparison to non-invasive ventilation (NIV) and standard treatment via a Venturi mask.
  
  
  METHODS
  Fourteen patients with acute hypoxic respiratory failure were treated with HFNC (FiO2 0.6, gas flow 55 l/min), NIV (FiO2 0.6, PEEP 5 cm H2O Hg, tidal volume 6-8 ml/kg ideal body weight,) and Venturi mask (FiO2 0.6, oxygen flow 15 l/min,) in a randomized order for 30 min each. Data collection included objective respiratory and circulatory parameters as well as a subjective rating of dyspnea and discomfort by the patients on a 10-point scale. In a final interview, all three methods were comparatively evaluated by each patient using a scale from 1 (=very good) to 6 (=failed) and the patients were asked to choose one method for further treatment.
  
  
  RESULTS
  PaO2 was highest under NIV (129 ± 38 mmHg) compared to HFNC (101 ± 34 mmHg, p <0.01 vs. NIV) and VM (85 ± 21 mmHg, p <0.001 vs. NIV, p <0.01 vs. HFNC, ANOVA). All other functional parameters showed no relevant differences. In contrast, dyspnea was significantly better using a HFNC (2.9 ± 2.1, 10-point Borg scale) compared to NIV (5.0 ± 3.3, p <0.05), whereas dyspnea rating under HFNC and VM (3.3 ± 2.3) was not significantly different. A similar pattern was found when patients rated their overall discomfort on the 10 point scale: HFNC 2.7 ± 1.8, VM 3.1 ± 2.8 (ns vs. HFNC), NIV 5.4 ± 3.1 (p <0.05 vs. HFNC). In the final evaluation patients gave the best ratings to HFNC 2.3 ± 1.4, followed by VM 3.2 ± 1.7 (ns vs. HFNC) and NIV 4.5 ± 1.7 (p <0.01 vs. HFNC and p <0.05 vs. VM). For further treatment 10 patients chose HFNC, three VM and one NIV.
  
  
  CONCLUSIONS
  In hypoxic respiratory failure HFNC offers a good balance between oxygenation and comfort compared to NIV and Venturi mask and seems to be well tolerated by patients.
  
  
  BACKGROUND
  GERMAN CLINICAL TRIALS REGISTER: DRKS00005132.
authors.affiliation: Department of Internal Medicine, Medical Intensive Care Unit, University of Tübingen, Otfried-Müller-Str, 10, Tübingen 72076, Germany.
authors.forename: Norbert
authors.initials: N
authors.lastname: Schwabbauer
authors.affiliation: Department of Internal Medicine, Medical Intensive Care Unit, University of Tübingen, Otfried-Müller-Str, 10, Tübingen 72076, Germany.
authors.forename: Björn
authors.initials: B
authors.lastname: Berg
authors.affiliation: Department of Clinical Epidemiology and Applied Biometry, University of Tübingen, Tübingen, Germany.
authors.forename: Gunnar
authors.initials: G
authors.lastname: Blumenstock
authors.affiliation: Department of Internal Medicine, Medical Intensive Care Unit, University of Tübingen, Otfried-Müller-Str, 10, Tübingen 72076, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Haap
authors.affiliation: Department of Internal Medicine, Division of Pulmonary Medicine, University of Tübingen, Tübingen, Germany.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Hetzel
authors.affiliation: Department of Internal Medicine, Medical Intensive Care Unit, University of Tübingen, Otfried-Müller-Str, 10, Tübingen 72076, Germany.
authors.forename: Reimer
authors.initials: R
authors.lastname: Riessen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004417:Dyspnea / Q000628:therapy; D005260:Female; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D000860:Hypoxia / Q000628:therapy*; D008297:Male; D008397:Masks; D008875:Middle Aged; D063087:Noninvasive Ventilation / Q000379:methods*; D010101:Oxygen Consumption / Q000502:physiology; D010102:Oxygen Inhalation Therapy / Q000379:methods*; D012129:Respiratory Function Tests; D012131:Respiratory Insufficiency / Q000628:therapy*
keywords: High-flow nasal cannula; Non-invasive ventilation; Oxygen; Respiratory failure; Venturi mask
references.citation: Curr Opin Crit Care. 2012 Feb;18(1):54-60
references.pmid: 22143051
references.citation: Respir Care. 2010 Apr;55(4):408-13
references.pmid: 20406507
references.citation: Curr Opin Crit Care. 2007 Feb;13(1):73-8
references.pmid: 17198052
references.citation: Aust Crit Care. 2007 Nov;20(4):126-31
references.pmid: 17931878
references.citation: J Crit Care. 2012 Oct;27(5):434-9
references.pmid: 22762937
references.citation: Anaesthesia. 2007 May;62(5):492-503
references.pmid: 17448063
references.citation: Respir Care. 2013 Apr;58(4):589-96
references.pmid: 23050520
references.citation: Respir Care. 2002 Jun;47(6):717-20
references.pmid: 12078655
references.citation: Br J Anaesth. 2011 Dec;107(6):998-1004
references.pmid: 21908497
references.citation: Minerva Anestesiol. 2012 Jul;78(7):836-41
references.pmid: 22531566
references.citation: Respir Care. 2012 Oct;57(10):1571-7
references.pmid: 22417569
references.citation: Anaesthesia. 2008 Sep;63(9):938-40
references.pmid: 18540928
references.citation: Lancet Oncol. 2013 Mar;14(3):219-27
references.pmid: 23406914
references.citation: Am J Respir Crit Care Med. 2003 Dec 15;168(12):1438-44
references.pmid: 14500259
references.citation: Curr Opin Crit Care. 2013 Feb;19(1):1-8
references.pmid: 23235541
references.citation: Respir Med. 2009 Oct;103(10):1400-5
references.pmid: 19467849
references.citation: J Crit Care. 2012 Jun;27(3):324.e9-13
references.pmid: 21958974
references.citation: Respir Med. 2012 Nov;106(11):1509-16
references.pmid: 22944604
references.citation: Respir Care. 2012 Nov;57(11):1873-8
references.pmid: 22417844
references.citation: Pulm Med. 2012;2012:380686
references.pmid: 22988501
references.citation: Intensive Care Med. 2011 Nov;37(11):1780-6
references.pmid: 21946925
references.citation: Anaesthesist. 2008 Nov;57(11):1091-102
references.pmid: 18989651
references.citation: Respir Care. 2012 Oct;57(10):1696-8
references.pmid: 23013907
references.citation: Thorax. 2008 Oct;63 Suppl 6:vi1-68
references.pmid: 18838559
references.citation: Intensive Care Med. 2009 Jun;35(6):996-1003
references.pmid: 19294365