Efficacy of high-flow oxygen by nasal cannula with active humidification in a patient with acute respiratory failure of neuromuscular origin

The treatment of choice for patients with respiratory failure of neuromuscular origin, especially in patients with hypercapnic respiratory acidosis, is noninvasive ventilation (NIV). Endotracheal intubation and invasive ventilation are indicated for patients with severe respiratory compromise or fai...

Full description

Saved in:
Bibliographic Details
Published in:Respiratory care 2013-12, Vol.58 (12), p.e164-e167
Main Authors: Díaz-Lobato, Salvador, Folgado, Miguel Angel, Chapa, Angel, Mayoralas Alises, Sagrario
Format: Article
Language:English
Subjects:
Acidosis, Respiratory - blood
Acidosis, Respiratory - etiology
Acute Disease
Aged
Amyotrophic Lateral Sclerosis - complications
Amyotrophic Lateral Sclerosis - physiopathology
Blood Gas Analysis
Care and treatment
Case studies
Catheters
Female
Humans
Hypercapnia - blood
Hypercapnia - etiology
Noninvasive Ventilation - adverse effects
Noninvasive Ventilation - methods
Oxygen - administration & dosage
Oxygen - pharmacokinetics
Oxygen Inhalation Therapy - instrumentation
Oxygen Inhalation Therapy - methods
Oxygen therapy
Patient outcomes
Respiratory insufficiency
Respiratory Insufficiency - diagnosis
Respiratory Insufficiency - etiology
Respiratory Insufficiency - physiopathology
Respiratory Insufficiency - therapy
Treatment Outcome
Citations: Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:The treatment of choice for patients with respiratory failure of neuromuscular origin, especially in patients with hypercapnic respiratory acidosis, is noninvasive ventilation (NIV). Endotracheal intubation and invasive ventilation are indicated for patients with severe respiratory compromise or failure of NIV. In recent years, high-flow oxygen therapy and active humidification devices have been introduced, and emerging evidence suggests that high-flow oxygen may be effective in various clinical settings, such as acute respiratory failure, after cardiac surgery, during sedation and analgesia, in acute heart failure, in hypoxemic respiratory distress, in do-not-intubate patients, in patients with chronic cough and copious secretions, pulmonary fibrosis, or cancer, in critical areas and the emergency department. We report on a patient with amyotrophic lateral sclerosis who arrived at the emergency department with acute hypercapnic respiratory failure. She did not tolerate NIV and refused intubation, but was treated successfully with heated, humidified oxygen via high-flow nasal cannula. Arterial blood analysis after an hour on high-flow nasal cannula showed improved pH, P(aCO2), and awareness. The respiratory acidosis was corrected, and she was discharged after 5 days of hospitalization. Her response to high-flow nasal cannula was similar to that expected with NIV. We discuss the mechanisms of action of heated, humidified high-flow oxygen therapy.
ISSN:0020-1324
1943-3654
DOI:10.4187/respcare.02115