{"title":"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。","authors":"Suharit Visuthisakchai, Patharapan Lersritwimanmaen, Nuttapol Rittayamai","doi":"10.21037/jtd-24-1345","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>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 (FiO<sub>2</sub>) to maintain oxygen saturation by pulse oximetry (SpO<sub>2</sub>) within the target range. This study aimed to evaluate the use of HVNI with OAM compared to conventional HVNI in patients after endotracheal extubation.</p><p><strong>Methods: </strong>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 SpO<sub>2</sub> 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 FiO<sub>2</sub> to maintain an SpO<sub>2</sub> of at least 94%. The primary outcome was the time in the SpO<sub>2</sub> range between the two groups. The secondary outcomes included FiO<sub>2</sub>, transcutaneous carbon dioxide pressure (PtcCO<sub>2</sub>), respiratory rate oxygenation (ROX) index, and hemodynamic variables.</p><p><strong>Results: </strong>HVNI with OAM significantly maintained SpO<sub>2</sub> within the target range compared to conventional HVNI [99.4% (97.4-99.8%) <i>vs.</i> 5.3% (1.5-68.1%); P=0.001]. The use of FiO<sub>2</sub> 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) <i>vs.</i> 0.40 (0.40-0.40); P=0.001 and 22.26 (15.94-26.46) <i>vs.</i> 13.01 (10.72-14.66); P=0.001, respectively]. No differences in breathing frequency, PtcCO<sub>2</sub> or hemodynamic variables were observed between the two groups.</p><p><strong>Conclusions: </strong>HVNI with OAM can maintain SpO<sub>2</sub> within the target range while using a lower FiO<sub>2</sub> and providing a higher ROX index than conventional HVNI in patients after extubation.</p><p><strong>Trial registration: </strong>This study was registered in the Thai Clinical Trial Registry (TCTR20220801007) before the inclusion of the first patient.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"17 1","pages":"333-343"},"PeriodicalIF":2.1000,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11833560/pdf/","citationCount":"0","resultStr":"{\"title\":\"High-velocity nasal insufflation with oxygen assist module versus conventional high-velocity nasal insufflation after extubation: an open-label randomized crossover study.\",\"authors\":\"Suharit Visuthisakchai, Patharapan Lersritwimanmaen, Nuttapol Rittayamai\",\"doi\":\"10.21037/jtd-24-1345\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>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 (FiO<sub>2</sub>) to maintain oxygen saturation by pulse oximetry (SpO<sub>2</sub>) within the target range. This study aimed to evaluate the use of HVNI with OAM compared to conventional HVNI in patients after endotracheal extubation.</p><p><strong>Methods: </strong>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 SpO<sub>2</sub> 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 FiO<sub>2</sub> to maintain an SpO<sub>2</sub> of at least 94%. The primary outcome was the time in the SpO<sub>2</sub> range between the two groups. The secondary outcomes included FiO<sub>2</sub>, transcutaneous carbon dioxide pressure (PtcCO<sub>2</sub>), respiratory rate oxygenation (ROX) index, and hemodynamic variables.</p><p><strong>Results: </strong>HVNI with OAM significantly maintained SpO<sub>2</sub> within the target range compared to conventional HVNI [99.4% (97.4-99.8%) <i>vs.</i> 5.3% (1.5-68.1%); P=0.001]. The use of FiO<sub>2</sub> 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) <i>vs.</i> 0.40 (0.40-0.40); P=0.001 and 22.26 (15.94-26.46) <i>vs.</i> 13.01 (10.72-14.66); P=0.001, respectively]. No differences in breathing frequency, PtcCO<sub>2</sub> or hemodynamic variables were observed between the two groups.</p><p><strong>Conclusions: </strong>HVNI with OAM can maintain SpO<sub>2</sub> within the target range while using a lower FiO<sub>2</sub> and providing a higher ROX index than conventional HVNI in patients after extubation.</p><p><strong>Trial registration: </strong>This study was registered in the Thai Clinical Trial Registry (TCTR20220801007) before the inclusion of the first patient.</p>\",\"PeriodicalId\":17542,\"journal\":{\"name\":\"Journal of thoracic disease\",\"volume\":\"17 1\",\"pages\":\"333-343\"},\"PeriodicalIF\":2.1000,\"publicationDate\":\"2025-01-24\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11833560/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of thoracic disease\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.21037/jtd-24-1345\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/1/20 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q3\",\"JCRName\":\"RESPIRATORY SYSTEM\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of thoracic disease","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.21037/jtd-24-1345","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/1/20 0:00:00","PubModel":"Epub","JCR":"Q3","JCRName":"RESPIRATORY SYSTEM","Score":null,"Total":0}
High-velocity nasal insufflation with oxygen assist module versus conventional high-velocity nasal insufflation after extubation: an open-label randomized crossover study.
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.
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.
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