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SPCI - Sociedade Portuguesa de Cuidados Intensivos

Revista Brasileira de Terapia Intensiva

AMIB - Associação de Medicina Intensiva Brasileira

OFFICIAL JOURNAL OF THE ASSOCIAÇÃO BRASILEIRA DE MEDICINA INTENSIVA AND THE SOCIEDADE PORTUGUESA DE CUIDADOS INTENSIVOS

ISSN: 0103-507X
Online ISSN: 1982-4335

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Esquinas AM, Karim HMR. Para: Eficácia e segurança da oxigenoterapia com cânula nasal de alto fluxo na insuficiência respiratória hipercápnica moderada aguda. Rev Bras Ter Intensiva. 2020;32(1):163-164

 

 

2020 2020;32(1):163-164
LETTER TO THE EDITOR

10.5935/0103-507X.20200026

To: Efficacy and safety of high-flow nasal cannula oxygen therapy in moderate acute hypercapnic respiratory failure

Para: Eficácia e segurança da oxigenoterapia com cânula nasal de alto fluxo na insuficiência respiratória hipercápnica moderada aguda

Antonio M Esquinas1, Habib Md Reazaul Karim2

1 Intensive Care Unit, Hospital Morales Meseguer - Murcia, Spain.
2 Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences - Raipur, India.

Conflicts of interest: None.

Submitted on June 10, 2019
Accepted on August 05, 2019

Corresponding author: Habib Md Reazaul Karim, Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Great Eastern Road Tatibandh, Raipur, Chhattisgarh 492099, Índia. E-mail: [email protected]

 

To the Editor,

We read with great interest the article “Efficacy and safety of high-flow nasal cannula oxygen therapy in moderate acute hypercapnic respiratory failure” by Yuste et al., where the use of high-flow nasal cannula (HFNC) is evaluated in patients with moderate hypercapnic respiratory failure (HRF).(1) We complement the authors for their exciting work; however, we consider that the conclusions of this study and its results can be commented on from a clinical perspective that in our opinion should be taken into account.

The protocol implemented for HFNC applications needs attention. Although the authors indicate that they used an established protocol, it is essential to know the method of HFNC use in context, specifically, a) if the authors maintained their application during the nighttime(2,3) and b) if the use of the HFNC step with other devices was regulated by some criteria, such as the flow or previous pressures.(4) We think that these considerations can raise the importance of their results and their clinical extrapolation.

Furthermore, although the authors use hypercapnia as a criterion, the patients in their study may have a different etiology of hypercapnia (hypoventilation, increased airway resistance or cardiac insufficiency). This perspective on the use of HFNC can condition the results and the clinical extrapolation of them.(5,6)

Lastly, we do not reject the authors’ claim about the efficacy and safety of HFNCs in such patients, but we feel that other aspects of interest, such as time to control of hypercapnia, clinical improvement and successful management of patients with noninvasive mechanical ventilation after HFNC failure, also need to be described and considered. The authors have defined the indication for the use of the HFNC, but selecting one method over another was kept at the physicians’ discretion, which poses an inherent bias. Therefore, even though they had acceptable nonresponders to HFNC therapy, future studies will be required for better acceptance of their results and conclusions.

REFERENCES

Yuste ME, Moreno O, Narbona S, Acosta F, Peñas L, Colmenero M. Efficacy and safety of high-flow nasal cannula oxygen therapy in moderate acute hypercapnic respiratory failure. Rev Bras Ter Intensiva. 2019;31(2):156-63. Link PubMed
Biselli P, Fricke K, Grote L, Braun AT, Kirkness J, Smith P, et al. Reductions in dead space ventilation with nasal high flow depend on physiological dead space volume: metabolic hood measurements during sleep in patients with COPD and controls. Eur Respir J. 2018;51(5). pii: 1702251. Link PubMed
Biselli PJ, Kirkness JP, Grote L, Fricke K, Schwartz AR, Smith P, et al. Nasal high-flow therapy reduces work of breathing compared with oxygen during sleep in COPD and smoking controls: a prospective observational study. J Appl Physiol (1985). 2017;122(1):82-8. Link DOILink PubMed
Papazian L, Corley A, Hess D, Fraser JF, Frat JP, Guitton C, et al. Use of high-flow nasal cannula oxygenation in ICU adults: a narrative review. Intensive Care Med. 2016;42(9):1336-49. Link DOILink PubMed
Bräunlich J, Wirtz H. Nasal high-flow in acute hypercapnic exacerbation of COPD. Int J Chron Obstruct Pulmon Dis. 2018;13:3895-7. Link DOILink PubMed
Hill NS, Spoletini G, Schumaker G, Garpestad E. Noninvasive ventilatory support for acute hypercapnic respiratory failure. Respir Care. 2019;64(6):647-57. Link DOILink PubMed

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