A randomized cross-over physiological study of high flow nasal oxygen cannula versus non-invasive ventilation in adult patients with cystic fibrosis: The HIFEN Study
CCCF ePoster library. Sklar M. Oct 31, 2016; 150892; 14
Dr. Michael Sklar
Dr. Michael Sklar
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Topic: Clinical Trial

A randomized cross-over physiological study of high flow nasal oxygen cannula versus non-invasive ventilation in adult patients with cystic fibrosis: The HIFEN Study

Sklar, Michael1,2,3;  Rittayamai, Nuttapol1,2,4; Dres, Martin1,2,5 ;  Rauseo, Michela1,2; Campbell, Carolyn1; West, Brent6; Tullis, Elizabeth6; Brochard, Laurent1,2

Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada, 2Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada, 3Department of Anesthesia, University of Toronto, Toronto, Canada, 4Division of Respiratory Diseases and Tuberculosis, Department of Medicine, Faculty of Medicine Siriraj Hospital, Bangkok, Thailand, 5Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Universités, Paris, France, 6Division of Respirology, St. Michael's Hospital, Toronto, Canada

Grant acknowledgements:
GRANT ACKNOWLEDGMENT.This study was supported by Cystic Fibrosis Canada and by a grant from Siriraj Hospital in Bangkok. LB’s laboratory received a grant and equipment from Fisher Paykel for the study. LB holds the Keenan Chair in Critical Care and Acute Respiratory Failure.


Non-invasive ventilation (NIV) is the first option for the treatment of cystic fibrosis (CF) patients with acute exacerbation. High flow nasal oxygen cannula (HFNC) is a heated humidified, high flow oxygen delivery system that has demonstrated benefits in terms of survival in patients with acute hypoxemic respiratory failure and in preventing postextubation failure. This device may also have benefits in patients with hypercapneic respiratory failure including CF patients. We hypothesize that HFNC would not be inferior to NIV in terms of reducing work of breathing and improving breathing pattern in CF patients requiring ventilator support.

To compare HFNC vs. NIV induced changes in inspiratory work of breathing assessed by the thickening fraction of the diaphragm (TFdi), and breathing pattern, hemodynamics, dyspnea and comfort.

CF patients with acute exacerbation requiring ventilator support were ventilated with HFNC and NIV for 30 minutes in random order. TFdi was measured using ultrasound at baseline and at 25 minutes with each device. Pulse oximetry (SpO2), transcutaneous CO2 (PtcCO2) were continuously recorded and respiratory rate, tidal volume (VT) and minute ventilation (MV) measured by bio-impedance techniques; hemodynamics, dyspnea and comfort assessed by visual analog scales were also recorded. Results were compared using a Mann Whitney, 2 tailed test, and are expressed as mean (SD) with each intervention compared to baseline conditions.

12 patients were enrolled (mean age 31.3 years, mean FEV1/FVC 49.9%, mean FEV1 28.4% predicted). TFdi was similar with the two techniques, but HFNC, compared to NIV, resulted in a significant decrease in respiratory rate (-20.2% (18.0) vs -0.2% (18.7), p=0.002), higher tidal volume (8.8% (17.6) vs -11.1% (19.7), p=0.036) and a lower mean arterial pressure (0.3% (5.6) vs 5.8% (4.9), p=0.044). No significant differences were found in heart rate, SpO2, PtcCO2, MV, comfort and dyspnea (Table 1).

HFNC was not inferior to NIV with respect to diaphragmatic work in CF patients who had an indication for ventilator support. These preliminary data suggest that HFNC may confer physiological benefits by decreasing respiratory rate, and constitute an interesting alternative to NIV.



1.Madden BP, Kariyawasam H, Siddiqi AJ, Machin A, Pryor JA, Hodson ME. Noninvasive ventilation in cystic fibrosis patients with acute or chronic respiratory failure. Eur Respir J 2002;19(2):310–3.
2.Vivier E, Mekontso Dessap A, Dimassi S, Vargas F, Lyazidi A, Thille AW, et al. Diaphragm ultrasonography to estimate the work of breathing during non-invasive ventilation. Intensive Care Med 2012;38(5):796–803.


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