Acute Crit Care.  2018 Feb;33(1):7-15. 10.4266/acc.2017.00507.

Global and Regional Ventilation during High Flow Nasal Cannula in Patients with Hypoxia

• Lee DH
• Kim EY
• Seo GJ
• Suh HJ
• Huh JW
• Hong SB
• Koh Y
• Lim CM

• KMID: 2436302
• DOI: http://doi.org/10.4266/acc.2017.00507

Abstract

BACKGROUND
High flow nasal cannula (HFNC) is known to increase global ventilation volume in healthy subjects. We sought to investigate the effect of HFNC on global and regional ventilation patterns in patients with hypoxia.
METHODS
Patients were randomized to receive one of two oxygen therapies in sequence: nasal cannula (NC) followed by HFNC or HFNC followed by NC. Global and regional ventilation was assessed using electric impedance tomography.
RESULTS
Twenty-four patients participated. Global tidal variation (TV) in the lung was higher during HFNC (NC, 2,241 ± 1,381 arbitrary units (AU); HFNC, 2,543 ± 1,534 AU; P < 0.001). Regional TVs for four iso-gravitational quadrants of the lung were also all higher during HFNC than NC. The coefficient of variation for the four quadrants of the lung was 0.90 ± 0.61 during NC and 0.77 ± 0.48 during HFNC (P = 0.035). Within the four gravitational layers of the lung, regional TVs were higher in the two middle layers during HFNC when compared to NC. Regional TV values in the most ventral and dorsal layers of the lung were not higher during HFNC compared with NC. The coefficient of variation for the four gravitational layers of the lung were 1.00 ± 0.57 during NC and 0.97 ± 0.42 during HFNC (P = 0.574).
CONCLUSIONS
In patients with hypoxia, ventilation of iso-gravitational regions of the lung during HFNC was higher and more homogenized compared with NC. However, ventilation of gravitational layers increased only in the middle layers. (Clinical trials registration number: NCT02943863).

Keyword

electric impedance; oxygen inhalation therapy; pulmonary ventilation

MeSH Terms

Anoxia*
Catheters*
Electric Impedance
Healthy Volunteers
Humans
Lung
Oxygen
Oxygen Inhalation Therapy
Pulmonary Ventilation
Ventilation*
Oxygen

Figure

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  Figure 1. Overall study design. Enrolled patients received both types of oxygen therapy, nasal cannula (NC) and high flow nasal cannula (HFNC). The sequence of oxygen therapy, NC followed by HFNC or HFNC followed by NC, was randomized with each type of oxygen therapy lasting for 20 minutes. Efficacy and subjective discomfort associated with each treatment were assessed at the end of each therapy type. ABGA: arterial blood gas analysis; EIT: electric impedance tomography.

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  Figure 2. Region of interest (ROI) set showing cross-sectional images and a typical electric impedance tomography image example. (A) ROI was set as quadrants or layers and tidal variations for each ROI were provided. Comparisons of right versus left and top versus bottom were also performed. (B) Dynamic image showing change in impedance for each breath is shown at top left. Tidal variations in the global section area and each ROI are shown on the right side with quantitative graphs. The presenting case shows reduced ventilation in the left dependent portion (ROI 4). The tidal variation was significantly higher during oxygen therapy with high flow nasal cannula (HFNC), especially in ROI 1. NC: nasal cannula; MTV: mean tidal variation.

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  Figure 3. Tidal variation comparison between nasal cannula (NC) and high flow nasal cannula (HFNC). Regions of interest were set as (A) quadrants and (B) layers.

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