Physiological Comparison of High-Flow Nasal Cannula and Helmet Noninvasive Ventilation in Acute Hypoxemic Respiratory Failure

Domenico Luca Grieco; Luca S Menga; Valeria Raggi; Filippo Bongiovanni; Gian Marco Anzellotti; Eloisa S Tanzarella; Maria Grazia Bocci; Giovanna Mercurio; Antonio M Dell'Anna; Davide Eleuteri; Giuseppe Bello; Riccardo Maviglia; Giorgio Conti; Salvatore Maurizio Maggiore; Massimo Antonelli

doi:10.1164/rccm.201904-0841OC

Physiological Comparison of High-Flow Nasal Cannula and Helmet Noninvasive Ventilation in Acute Hypoxemic Respiratory Failure

Am J Respir Crit Care Med. 2020 Feb 1;201(3):303-312. doi: 10.1164/rccm.201904-0841OC.

Authors

Domenico Luca Grieco^{1

2}, Luca S Menga^{1

2}, Valeria Raggi^{1

2}, Filippo Bongiovanni^{1

2}, Gian Marco Anzellotti^{1

2}, Eloisa S Tanzarella^{1

2}, Maria Grazia Bocci^{1

2}, Giovanna Mercurio^{1

2}, Antonio M Dell'Anna^{1

2}, Davide Eleuteri^{1

2}, Giuseppe Bello^{1

2}, Riccardo Maviglia^{1

2}, Giorgio Conti^{1

2}, Salvatore Maurizio Maggiore³, Massimo Antonelli^{1

2}

Affiliations

¹ Dipartimento di Scienze dell'Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
² Department of Anesthesiology and Intensive Care Medicine, Catholic University of the Sacred Heart, Rome, Italy; and.
³ Department of Medical, Oral and Biotechnological Sciences, School of Medicine and Health Sciences, Section of Anesthesia, Analgesia, Perioperative and Intensive Care, SS. Annunziata Hospital, Gabriele d'Annunzio University of Chieti-Pescara, Chieti, Italy.

PMID: 31687831
DOI: 10.1164/rccm.201904-0841OC

Abstract

Rationale: High-flow nasal cannula (HFNC) and helmet noninvasive ventilation (NIV) are used for the management of acute hypoxemic respiratory failure.Objectives: Physiological comparison of HFNC and helmet NIV in patients with hypoxemia.Methods: Fifteen patients with hypoxemia with Pa_O₂/Fi_O₂ < 200 mm Hg received helmet NIV (positive end-expiratory pressure ≥ 10 cm H₂O, pressure support = 10-15 cm H₂O) and HFNC (50 L/min) in randomized crossover order. Arterial blood gases, dyspnea, and comfort were recorded. Inspiratory effort was estimated by esophageal pressure (Pes) swings. Pes-simplified pressure-time product and transpulmonary pressure swings were measured.Measurements and Main Results: As compared with HFNC, helmet NIV increased Pa_O₂/Fi_O₂ (median [interquartile range]: 255 mm Hg [140-299] vs. 138 [101-172]; P = 0.001) and lowered inspiratory effort (7 cm H₂O [4-11] vs. 15 [8-19]; P = 0.001) in all patients. Inspiratory effort reduction by NIV was linearly related to inspiratory effort during HFNC (r = 0.84; P < 0.001). Helmet NIV reduced respiratory rate (24 breaths/min [23-31] vs. 29 [26-32]; P = 0.027), Pes-simplified pressure-time product (93 cm H₂O ⋅ s ⋅ min^-1 [43-138] vs. 200 [168-335]; P = 0.001), and dyspnea (visual analog scale 3 [2-5] vs. 8 [6-9]; P = 0.002), without affecting Pa_CO₂ (P = 0.80) and comfort (P = 0.50). In the overall cohort, transpulmonary pressure swings were not different between treatments (NIV = 18 cm H₂O [14-21] vs. HFNC = 15 [8-19]; P = 0.11), but patients exhibiting lower inspiratory effort on HFNC experienced increases in transpulmonary pressure swings with helmet NIV. Higher transpulmonary pressure swings during NIV were associated with subsequent need for intubation.Conclusions: As compared with HFNC in hypoxemic respiratory failure, helmet NIV improves oxygenation, reduces dyspnea, inspiratory effort, and simplified pressure-time product, with similar transpulmonary pressure swings, Pa_CO₂, and comfort.

Keywords: acute respiratory failure; high-flow nasal oxygen; noninvasive ventilation.

Publication types

Comparative Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Acute Disease
Aged
Cannula
Cross-Over Studies
Female
Humans
Hypoxia / complications
Hypoxia / physiopathology*
Hypoxia / therapy*
Male
Middle Aged
Noninvasive Ventilation / instrumentation*
Respiratory Insufficiency / complications
Respiratory Insufficiency / physiopathology*
Respiratory Insufficiency / therapy*