Physiologic Effects of High-Flow Nasal Cannula in Acute Hypoxemic Respiratory Failure
Open accessAbstract
Rationale: High-flow nasal cannula (HFNC) improves the clinical outcomes of nonintubated patients with acute hypoxemic respiratory failure (AHRF). Objectives: To assess the effects of HFNC on gas exchange, inspiratory effort, minute ventilation, end-expiratory lung volume, dynamic compliance, and ventilation homogeneity in patients with AHRF. Methods: This was a prospective randomized crossover study in nonintubated patients with AHRF with PaO2/setFiO2 less than or equal to 300 mm Hg admitted to the intensive care unit. We randomly applied HFNC set at 40 L/min compared with a standard nonocclusive facial mask at the same clinically set FiO2 (20 min/step). Measurements and Main Results: Toward the end of each phase, we measured arterial blood gases, inspiratory effort, and work of breathing by esophageal pressure swings (ΔPes) and pressure time product, and we estimated changes in lung volumes and ventilation homogeneity by electrical impedance tomography. We enrolled 15 patients aged 60 ± 14 years old with PaO2/setFiO2 130 ± 35 mm Hg. Seven (47%) had bilateral lung infiltrates. Compared with the facial mask, HFNC significantly improved oxygenation (P < 0.001) and lowered respiratory rate (P < 0.01), ΔPes (P < 0.01), and pressure time product (P < 0.001). During HFNC, minute ventilation was reduced (P < 0.001) at constant arterial CO2 tension and pH (P = 0.27 and P = 0.23, respectively); end-expiratory lung volume increased (P < 0.001), and tidal volume did not change (P = 0.44); the ratio of tidal volume to ΔPes (an estimate of dynamic lung compliance) increased (P < 0.05); finally, ventilation distribution was more homogeneous (P < 0.01). Conclusions: In patients with AHRF, HFNC exerts multiple physiologic effects including less inspiratory effort and improved lung volume and compliance. These benefits might underlie the clinical efficacy of HFNC.
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- Authors
- Mauri, T., Turrini, C., Eronia, N., Grasselli, G., Volta, C. A., Bellani, G., & Pesenti, A.
- Affiliations
- University of Milan (IT)
- University of Ferrara (IT)
- Azienda Ospedaliera San Gerardo (IT)
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico (IT)
- Corresponding author
- Pesenti, Antonio
- ORCID
- Venue
- American Journal of Respiratory and Critical Care Medicine
- Publisher
- Oxford University Press (OUP)
- Published
- 2017-05-01
- Volume
- 195
- Issue
- 9
- Pages
- 1207-1215
- ISSN
- 1073-449X (ISSN-L)
- 1535-4970
- OpenAlex
- W2582995183
- Cited by
- 641
- References
- 42
- Citations by year
- 2026: 75 · 2025: 76 · 2024: 68 · 2023: 74 · 2022: 81 · 2021: 79 · 2020: 66 · 2019: 57 · 2018: 38 · 2017: 26
- FWCI
- 41.96
- Type
- journal article
- Language
- en
- Open access
- green
- hdl.handle.net
- Locations
- American Journal of Respiratory and Critical Care Medicine (publishedVersion)
- PubMed (publishedVersion)
- BOA (University of Milano-Bicocca) (submittedVersion)
- Institutional Research Information System University of Ferrara (University of Ferrara) (submittedVersion, other-oa)
- Topics
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Respiratory Support and Mechanisms
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Neonatal Respiratory Health Research
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Airway Management and Intubation Techniques
- Keywords
- high-flow nasal cannula, acute hypoxemic respiratory failure, non-intubated patients, gas exchange, work of breathing, inspiratory effort, end-expiratory lung volume, dynamic compliance, electrical impedance tomography, minute ventilation, oxygenation
- MeSH terms
- Cannula, Adult, Aged, Aged, 80 and over, Hypoxia, Blood Gas Analysis, Female, Humans, Lung Volume Measurements, Male, Middle Aged, Oxygen Inhalation Therapy, Prospective Studies, Respiratory Insufficiency, Work of Breathing, Cross-Over Studies
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