High-flow nasal oxygen versus noninvasive ventilation in adult patients with cystic fibrosis: a randomized crossover physiological study

• Published in: Annals of intensive care Vol. 8; no. 1; pp. 85 - 9
• Main Authors: Sklar, Michael C., Dres, Martin, Rittayamai, Nuttapol, West, Brent, Grieco, Domenico Luca, Telias, Irene, Junhasavasdikul, Detajin, Rauseo, Michela, Pham, Tai, Madotto, Fabiana, Campbell, Carolyn, Tullis, Elizabeth, Brochard, Laurent
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 05-09-2018; Springer Nature B.V; SpringerOpen
• Subjects: Anesthesiology; Critical Care Medicine; Cystic fibrosis; Dyspnea; Emergency Medicine; Intensive; Intensive care; Life Sciences; Medicine; Medicine & Public Health; NCT; NCT02262871; Physiology; Respiratory therapy; Ventilation; Diaphragmatic Work; Improving Breathing Pattern; Nasal High-flow Oxygen Therapy (HFNT); Comfort Scores; Noninvasive Ventilation (NIV)
• ISSN: 2110-5820; 2110-5820
• DOI: 10.1186/s13613-018-0432-4

Background
Noninvasive ventilation (NIV) is the first-line treatment of adult patients with exacerbations of cystic fibrosis (CF). High-flow nasal oxygen therapy (HFNT) might benefit patients with hypoxemia and can reduce physiological dead space. We hypothesized that HFNT and NIV would similarly reduce work of breathing and improving breathing pattern in CF patients. Our objective was to compare the effects of HFNT versus NIV in terms of work of breathing, assessed noninvasively by the thickening fraction of the diaphragm (TFdi, measured with ultrasound), breathing pattern, transcutaneous CO
2
(PtcCO
2
), hemodynamics, dyspnea and comfort.
Methods
Adult CF patients who had been stabilized after requiring ventilatory support for a few days were enrolled and ventilated with HFNT and NIV for 30 min in crossover random order.
Results
Fifteen patients were enrolled. Compared to baseline, HFNT, but not NIV, reduced respiratory rate (by 3 breaths/min,
p
 = 0.01) and minute ventilation (by 2 L/min,
p
 = 0.01). Patients also took slightly larger tidal volumes with HFNT compared to NIV (
p
 = 0.02). TFdi per breath was similar under the two techniques and did not change from baseline. MAP increased from baseline with NIV and compared to HFNT (
p
 ≤ 0.01). Comfort was poorer with the application of both HFNT and NIV than baseline. No differences were found for heart rate, SpO
2
, PtcCO
2
or dyspnea.
Conclusions
In adult CF patients stabilized after indication for ventilatory support, HFNT and NIV have similar effects on diaphragmatic work per breath, but high-flow therapy confers additional physiological benefits by decreasing respiratory rate and minute ventilation.
Clinical trial registration
Ethics Committee of St. Michael’s Hospital (REB #14-338) and clinicaltrial.gov (NCT02262871).