High-velocity nasal insufflation with oxygen assist module versus conventional high-velocity nasal insufflation after extubation: an open-label randomized crossover study.

IF 2.1 3区医学 Q3 RESPIRATORY SYSTEM

Journal of thoracic disease Pub Date : 2025-01-24 Epub Date: 2025-01-20 DOI:10.21037/jtd-24-1345

Suharit Visuthisakchai, Patharapan Lersritwimanmaen, Nuttapol Rittayamai

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引用次数: 0

Abstract

Background: The current technology of high-velocity nasal insufflation (HVNI) can be equipped with an oxygen assist module (OAM) that continuously monitors and automatically adjusts the inspired oxygen fraction (FiO₂) to maintain oxygen saturation by pulse oximetry (SpO₂) within the target range. This study aimed to evaluate the use of HVNI with OAM compared to conventional HVNI in patients after endotracheal extubation.

Methods: This randomized crossover study enrolled 16 mechanically ventilated subjects who were ready to wean. The subjects were randomized to protocol A (HVNI with OAM for 60 min, followed by conventional HVNI for another 60 min) or protocol B (conventional HVNI for 60 min, followed by HVNI with OAM for another 60 min) after extubation. In HVNI with OAM, the target SpO₂ was set at 94% with a range of 92-98%, temperature of 37 °C and flow rate of 40 L/min. In the conventional HVNI group, the attending physician adjusted the FiO₂ to maintain an SpO₂ of at least 94%. The primary outcome was the time in the SpO₂ range between the two groups. The secondary outcomes included FiO₂, transcutaneous carbon dioxide pressure (PtcCO₂), respiratory rate oxygenation (ROX) index, and hemodynamic variables.

Results: HVNI with OAM significantly maintained SpO₂ within the target range compared to conventional HVNI [99.4% (97.4-99.8%) vs. 5.3% (1.5-68.1%); P=0.001]. The use of FiO₂ was significantly lower and the ROX index was significantly higher at the end of the study in the HVNI with OAM group than in the conventional HVNI group [0.22 (0.21-0.25) vs. 0.40 (0.40-0.40); P=0.001 and 22.26 (15.94-26.46) vs. 13.01 (10.72-14.66); P=0.001, respectively]. No differences in breathing frequency, PtcCO₂ or hemodynamic variables were observed between the two groups.

Conclusions: HVNI with OAM can maintain SpO₂ within the target range while using a lower FiO₂ and providing a higher ROX index than conventional HVNI in patients after extubation.

Trial registration: This study was registered in the Thai Clinical Trial Registry (TCTR20220801007) before the inclusion of the first patient.

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拔管后使用氧辅助模块进行高速鼻腔插管与传统高速鼻腔插管：一项开放标签随机交叉研究。

背景：目前的高速鼻灌气（HVNI）技术可以配备氧气辅助模块（OAM），连续监测并自动调节吸入氧分数（FiO2），通过脉搏血氧仪（SpO2）将氧饱和度维持在目标范围内。本研究旨在评估在气管内拔管后使用HVNI与OAM相比常规HVNI的效果。方法：这项随机交叉研究招募了16名准备断奶的机械通气受试者。拔管后，受试者被随机分为方案A （HVNI + OAM 60分钟，然后再进行常规HVNI 60分钟）或方案B（常规HVNI 60分钟，然后再进行HVNI + OAM 60分钟）。在OAM的HVNI中，目标SpO2设定为94%，范围为92-98%，温度为37℃，流速为40 L/min。在传统的HVNI组中，主治医生调整FiO2以保持SpO2至少为94%。主要观察指标是两组患者在SpO2范围内的时间。次要结局包括FiO2、经皮二氧化碳压（PtcCO2）、呼吸速率氧合（ROX）指数和血流动力学变量。结果：与常规HVNI相比，OAM HVNI可将SpO2维持在目标范围内[99.4%（97.4-99.8%）比5.3% (1.5-68.1%)；P = 0.001)。研究结束时，与常规HVNI组相比，OAM HVNI组FiO2使用量显著降低，ROX指数显著升高[0.22（0.21-0.25）比0.40 (0.40-0.40)；P=0.001和22.26（15.94-26.46）比13.01 (10.72-14.66)；分别为P = 0.001)。两组患者呼吸频率、PtcCO2及血流动力学指标均无差异。结论：与常规HVNI相比，OAM HVNI拔管后患者在使用较低的FiO2和较高的ROX指数的情况下，可以将SpO2维持在目标范围内。试验注册：本研究在纳入第一位患者之前已在泰国临床试验注册中心（TCTR20220801007）注册。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of thoracic disease RESPIRATORY SYSTEM-

CiteScore

4.60

自引率

4.00%

发文量

254

期刊介绍： The Journal of Thoracic Disease (JTD, J Thorac Dis, pISSN: 2072-1439; eISSN: 2077-6624) was founded in Dec 2009, and indexed in PubMed in Dec 2011 and Science Citation Index SCI in Feb 2013. It is published quarterly (Dec 2009- Dec 2011), bimonthly (Jan 2012 - Dec 2013), monthly (Jan. 2014-) and openly distributed worldwide. JTD received its impact factor of 2.365 for the year 2016. JTD publishes manuscripts that describe new findings and provide current, practical information on the diagnosis and treatment of conditions related to thoracic disease. All the submission and reviewing are conducted electronically so that rapid review is assured.