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 4, 2017; 198112; 88
Dr. Michael Sklar
Dr. Michael Sklar
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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, Michael C1,2;  Dres, Martin1,2,3; Rittayamai, Nuttapol1,2,4; West, Brent5; Pham, Tai1,2; Grieco, Domenico-Luca1,2; Telias, Irene1,2; Junhasavasd, Detajin1,2; Rauseo, Michela1,2; Campbell, Carolyn1; Tullis, Elizabeth5; Brochard, Laurent1,2



1Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada, 2Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada, 3Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Universités, Paris, France, 4Division of Respiratory Diseases and Tuberculosis, Department of Medicine, Faculty of Medicine Siriraj Hospital, Bangkok, Thailand, 5Division of Respirology, St. Michael's Hospital, Toronto, Canada

 


INTRODUCTION.
Non-invasive ventilation (NIV) is the first option for the treatment of patients with exacerbations of cystic fibrosis (CF). 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 technique 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.

OBJECTIVES.
To compare HFNC vs. NIV induced changes in inspiratory work of breathing assessed non-invasively by the thickening fraction of the diaphragm (TFdi), and breathing pattern, CO2 level, hemodynamics, dyspnea and comfort.

METHODS.
CF patients with exacerbation requiring ventilator support were stabilized and 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, Sentec, Switzerland) were continuously recorded; respiratory rate, tidal volume (VT) and minute ventilation (MV) were measured by bio-impedance (ExSpiron, Respiratory Motion, MA, USA); hemodynamics, dyspnea (high scores associated with more shortness of breath) and comfort (high scores associated with better comfort) were assessed by visual analog scales were also recorded. Results were compared using a Wilcoxon rank sum, paired 2 tailed test, and are expressed as median (IQR) with HFNC compared to NIV.

RESULTS.
15 patients were enrolled (mean age 31.3 years, mean FEV1/FVC 49.0%, mean FEV1 28.0% predicted). TFdi was similar with the two techniques.  Compared to baseline, HFNC significantly reduced the respiratory rate by 19% vs 2.8% for NIV (p<0.01). Similarly, NIV resulted in a significantly increased mean arterial pressure by 6% vs 0.6% for HFNC (p<0.01). Although both devices reduced VT from baseline, HFNC compared to NIV resulted in a significantly higher VT by 10.8% (p=0.03). No differences were found for heart rate, MV, SpO2, PtcCO2, dyspnea or comfort (Table 1).

CONCLUSIONS.
HFNC was not inferior to NIV with respect to diaphragmatic work in stabilized 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 or complement to NIV.



 

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