Acil Serviste Yüksek Akımlı Oksijen Tedavisi

Year 2018, Volume: 1 Issue: 2, 33 - 37, 28.12.2018

Özge Ecmel Onur , Arzu Denizbaşı , Çiğdem Özpolat

Abstract

Dispne,
acil servise gelen hastaların en yaygın şikayetlerinden biridir.
Oksijen tedavisi acil serviste önemli bir rol oynar. Geleneksel
oksijen tedavisinin bazı yan etkileri ve kısıtlılıkları
mevcuttur. HFNC (nemlendirilmiş yüksek akışlı nazal oksijen),
günümüzde hipoksemik solunum yetmezliği olan hastalarda yaygın
olarak çalışılmaktadır. HFNC, fizyolojik sıcaklıklarda (37 ◦C)
ve nem seviyelerinde (44 mg H20 / L) geniş konsantrasyonlarda (%
100'e kadar FiO2) ve akış hızlarında (60 L / dk'ya kadar) oksijen
verilmesine olanak sağlar. Burun kanülü ile rahat kullanım
olanağı sunar. HFNC, yüksek akış, nemlendirilmiş oksijen, sabit
FiO2 ve pozitif hava yolu basıncı sağladığından ve ölü alanı
azalttığından, geleneksel oksijen terapisine kıyasla bir çok
avantaja sahiptir. Çalışmalar HFNC kullanan hastalarda daha iyi
oksijenlenme göstermiştir; bununla birlikte, PaCO2'deki
değişiklikler çalışmalar arasında farklılık göstermektedir.
HFNC, pozitif son ekspiratuar basınca (PEEP) benzeyen pozitif bir
hava yolu basıncı (faringeal seviyede 2 ila 8 cmH2O arasında)
üretir. HFNC, nazofarengeal boşluğun önemli, akışa bağlı bir
“CO2 yıkama etkisi” sağlar, bu da anatomik ölü alan
havalandırmasını ve dolayısıyla CO2 yeniden solunmasını
azaltır. Acil servislerde özellikle hipoksemik solunum yetmezliği
ve ayrıca hiperkapnik solunum yetmezliği, preintübasyon
oksijenasyonu, akut kalp yetmezliğinde kullanılabilir. Ancak,
özellikle ileriye dönük randomize çalışmalar açısından
sınırlı veri bulunmaktadır. Burada HFNC ile ilgili klinik
çalışmaları ve acil servisteki kullanım alanlarını gözden
geçirmek istedik.

Keywords

Yüksek akımlı oksijen tedavisi, acil servis, hipoksemik solunum yetmezliği

High Flow Oxygen Therapy in Emergency Department

Abstract

Dyspnea is a common complaint of patients visiting the emergency department. Supplemental oxygen therapy plays an important role in the Emergency Department (ED). Drawbacks of conventional oxygen therapy are present. HFNC(humidified high-flow nasal oxygen) is nowadays widely studied in the patients with hypoxemic respiratory failure. HFNC allows for high concentrations (up to 100% FiO2) and flow rates (up to 60 L/min) of oxygen to be delivered at physiological temperatures (37 ◦C) and humidity levels (44 mg H2O/L) through a wide-bore nasal cannula. An HFNC has several benefits compared with those of conventional oxygen therapy, as it provides high flow, humidified oxygen, constant FiO2, and positive airway pressure and reduces dead space. Studies have shown better oxygenation in patients who use an HFNC; however, the changes in PaCO2 differed among studies. HFNC generates a positive airway pressure (between 2 and 8 cmH2O at the pharyngeal level) which resembles positive end-expiratory pressure (PEEP). HFNC results in a significant, flow-dependent ‘CO2 wash out effect’ of the nasopharyngeal space which decreases the anatomical dead space ventilation and therefore the CO2 rebreathing. It is used in emergency services especially in hypoxemic respiratory failure and also in hypercapnic respiratory failure, preintubation oxygenation, acute heart failure. But there are limited data especially in terms of prospective randomised trials. Here we want to review the studies in these clinical situtaions about HFNC.

Keywords

Humidified High-Flow Nasal Oxygen Therapy, Emergency Medicine, Hypoxemic Respiratory Failure

References

• Kaynaklar1. Nishimura M. High-Flow Nasal Cannula Oxygen Therapy in Adults: Physiological Benefits, Indication, Clinical Benefits, and Adverse Effects. Respir Care. 2016; 61(4):529-412. Drake MG. High-Flow Nasal Cannula Oxygen in Adults: An Evidence-based Assessment.Ann Am Thorac Soc. 2018;15(2):145-1553. Frat JP, Thille AW, Mercat A, Girault C, Ragot S, Perbet S, et al.; FLORALI Study Group; REVA Network. High-flow oxygen through nasal cannula in acute hypoxemic respiratory failure. N Engl J Med 2015;372:2185-2196.4. Ni YN, Luo J, Yu H, Liu D, Ni Z, Cheng J, et al. Can high-flow nasal cannula reduce the rate of endotracheal intubation in adult patients with acute respiratory failure compared with conventional oxygen therapy and noninvasive positive pressure ventilation? A systematic review and meta-analysis. Chest 2017; 151:764-7755. Hughes J, Doolabh A. Heated, humidified, high-flow nasal oxygen usage in the adult Emergency Department. Australas Emerg Nurs J. 2016;19(4):173-178.6. Lin SM, Liu KX, Lin ZH, Lin PH. Does high-flow nasal cannula oxygen improve outcome in acute hypoxemic respiratory failure? A systematic review and meta-analysis. Respir Med. 2017;131:58-64.7. Shebl E, Embarak S. High-flow nasal oxygen therapy versus noninvasive ventilation in chronic interstitial lung disease patients with acute respiratory failure. Egyptian Journal of Chest Disease and Tuberculosis 2018; 67 (3) : 270-2758. Azoulay E, Lemiale V, Mokart D, Nseir S, Argaud L, Pène F et al. Effect of High-Flow Nasal Oxygen vs Standard Oxygen on 28-Day Mortality in Immunocompromised Patients With Acute Respiratory Failure: The HIGH Randomized Clinical Trial. JAMA. 2018;320(20):2099-2107.9. Coudroy R, Jamet A , Petua P , Robert R, Frat JP, Thille AW. High-flow nasal cannula oxygen therapy versus noninvasive ventilation in immunocompromised patients with acute respiratory failure: An observational cohort study. Ann. Intensive Care 2016; 6:45 .10. Scala R. High-flow nasal oxygen therapy in acute respiratory failure. Geriatric Care 2018; 4:7799 11. Jeong JH , Kim DH, Kim SC ,Kang C, Lee SH , Kang TS et al. Changes innarterial blood gases after use of high-flow nasal cannula therapy in the ED. Am J Emerg Med. 2015;33(10):1344-9. 12. Nilius G, Franke KJ, Domanski U, Rühle KH, Kirkness JP, Schneider H.Effects of nasal insufflation on arterial gas exchange and breathing pattern in patients with chronic obstructive pulmonary disease and hypercapnic respiratory failure. Adv Exp Med Biol. 2013;755:27-3413. Fraser JF, Spooner AJ, Dunster KR, Anstey CM, Corley A. Nasal high flow oxygen therapy in patients with COPD reduces respiratory rate and tissue carbon dioxide while increasing tidal and end-expiratory lung volumes: a randomised crossover trial. Thorax 2016;71(8):759-6114. Rittayamai N, Tscheikuna J, Praphruetkit N, Kijpinyochai S. Use of High-Flow Nasal Cannula for Acute Dyspnea and Hypoxemia in the Emergency Department. Respir Care. 2015;60(10):1377-82. 15. Ricard JD, Dib F, Esposito-Farese M, Messika J, Girault C, REVA network. Comparison of high flow nasal cannula oxygen and conventional oxygen therapy on ventilatory support duration during acute-on-chronic respiratory failure: study protocol of a multicentre, randomised, controlled trial. The 'HIGH-FLOW ACRF' study. BMJ Open. 2018;8(9).16. Bräunlich J, Seyfarth HJ, Wirtz H. Nasal High-flow versus noninvasive ventilation in stable hypercapnic COPD: a preliminary report. Multidiscip Respir Med 2015;10:27. 17. Bräunlich J, Köhler M, Wirtz H. Nasal highflow improves ventilation in patients with COPD. Int J Chron Obstruct Pulmon Dis 2016;11:1077–85.18. Pisani L, Fasano L, Corcione N, et al. Change in pulmonary mechanics and the effect on breathing pattern of high flow oxygen therapy in stable hypercapnic COPD. Thorax 2017;72:373–5. 19. Frat JP, Coudroy R, Thille AW. Non-invasive ventilation or high-flow oxygen therapy: When to choose one over the other? Respirology. 2018 [Epub ahead of print]20. Carratalá Perales JM, Llorens P, Brouzet B, Albert Jiménez AR, Fernández-Cañadas JM, Carbajosa Dalmau J, Martínez Beloqui E, Ramos Forner S. High-Flow therapy via nasal cannula in acute heart failure. Rev Esp Cardiol. 2011;64(8):723-5.21. Makdee O, Monsomboon A, Surabenjawong U, Praphruetkit N, Chaisirin W et al. High-Flow Nasal Cannula Versus Conventional Oxygen Therapy in Emergency Department Patients With Cardiogenic Pulmonary Edema: A Randomized Controlled Trial. Ann Emerg Med. 2017;70(4):465-472.e2. 22. Chua MT, Kuan WS. The use of high-flow nasal cannula in acute decompensated heart failure: ready for prime time yet? J Emerg Crit Care Med 2017;1:22. 23. Raineri SM, Cortegiani A, Accurso G, Procaccianti C, Vitale F, Caruso S, Giarratano A, Gregoretti C.Efficacy and Safety of Using High-Flow Nasal Oxygenation in Patients Undergoing Rapid Sequence Intubation. Turk J Anaesthesiol Reanim. 2017;45(6):335-339.24. Frizzola M, Miller TL, Rodriguez ME, Zhu Y, Rojas J, Hesek A, Stump A, Shaffer TH, Dysart K. High-flow nasal cannula: impact on oxygenation and ventilation in an acute lung injury model. Pediatr Pulmonol. 2011;46(1):67-74. 25. http://www.emdocs.net/looking-for-a-better-way-to-treat-hypoxia-in-the-emergency-department-reach-for-high-flow-nasal-cannula/ erişim tarihi: 13.01.201926. Roca O, Caralt B, Messika J, Samper M , Sztrymf B, Hernández G et al. An Index Combining Respiratory Rate and Oxygenation to Predict Outcome of Nasal High FlowTherapy. Am J Respir Crit Care Med. 2018 [Epub ahead of print]