Gustavo Ferrer

High flow nasal cannula versus conventional oxygen therapy and non-invasive ventilation in adults with acute hypoxemic respiratory failure: A systematic review

INTRODUCTION Humidified oxygen via a high flow nasal cannula (HFNC) is a form of supplemental oxygen therapy that has significant theoretical advantages over conventional oxygen therapy (COT). However, the clinical role of HFNC in acute hypoxemic respiratory failure (AHRF) has not been well established. This review compares the efficacy of HFNC with COT and non-invasive ventilation (NIV) in patients with AHRF. METHODS Studies reviewed were selected based on relevance from a systematic literature search conducted in Medline and EMBASE to include all published original research through May 2016. Twelve studies matched the inclusion criteria. RESULTS In the majority of the studies, HFNC was associated with superior comfort and patient tolerance as compared to NIV or COT. HFNC was associated with reduced work of breathing in comparison with COT in some, but not all, studies in the review. COT and NIV were associated with a higher 90-day mortality rate compared to HFNC in only one multicenter randomized trial versus no mortality difference reported by others. Three out of four studies demonstrated a decreased need for escalation of oxygen therapy with HFNC. Six out of eight studies demonstrated improved oxygenation with HFNC as compared to COT. Two of three studies revealed worse oxygenation with HFNC as compared to NIV. CONCLUSION This review suggests that HFNC may be superior to COT in AHRF patients in terms of oxygenation, patient comfort, and work of breathing. It may be reasonable to consider HFNC as an intermediate level of oxygen therapy between COT and NIV.

Feasibility and Safety of Flexible Bronchoscopy Performed Via Tracheal Tubes in Patients With Tracheostomies: A Retrospective, Single-Center Experience

Background: Flexible bronchoscopy (FB) is commonly performed to assess, diagnose, and treat patients with respiratory disease, and is typically performed via transnasal or transoral approaches. FB can be performed via tracheal tubes in patients with tracheostomies; however, the safety and technical feasibility has not been established. The present study evaluates the safety and feasibility of performing FB via tracheal tubes. Materials and Methods: A total of 45 patients underwent 56 procedures involving FB via tracheal tubes at a single institution from November 2013 to November 2014 and were included in this retrospective case series. Results: Patients had a median age of 68 years (interquartile range, 56 to 82.5), and 51% were female. Most patients had 2 comorbidities (interquartile range, 1 to 3), with the most common being hypertension, diabetes mellitus, and chronic kidney disease. Upper airway obstruction was the primary indication for bronchoscopy in 40% of patients. Fifty-three percent of patients had a Shiley tube #6, [internal cannula diameter (ICD) of 6.5 mm]; tracheal tubes in the remaining patients ranged from Shiley #4 (ICD, 5.5 mm) to Shiley #8 (ICD, 8.5 mm). One patient did not complete the procedure due to severe hypertension (intraprocedural systolic blood pressure >180 mm Hg). During FB, no patients experienced cardiorespiratory arrest, arrhythmia, bleeding, or desaturation that required resuscitation. Eleven patients had a mucus plug leading to atelectasis during bronchoscopy, and 8 of these had a postprocedural chest x-ray finding of lung reexpansion. Conclusion: FB via tracheal tubes is a technically feasible and safe procedure that does not compromise patient oxygenation.

Families Perception, Knowledge, and Psychological Stress of Transitions of Care From the ICU: Improving Transition of Care

PURPOSE: Transition of care from the intensive care unit is fundamental for patient recovery and overall outcomes. This complex process requires strong coordination between healthcare providers and patients’ families. Inadequate communication can hinder patient’s safety during transition of care. Our objective is to assess the quality of continuity of care by analyzing family perceptions, education, and their psychological stress during the process.

1035: USE OF HIGH-FLOW NASAL CANNULA IN HYPOXEMIC RESPIRATORY FAILURE

Crit Care Med 2016 • Volume 44 • Number 12 (Suppl.) and remained unchanged (p=0.4295). MoH rates among IMV with & without PTX/H were 40.3% & 28.0%, respectively (p=0.0977). Conclusions: In this first population-based study of adults with CF-ICU, IMV was consistently required in 1 in 5 ICU admissions, with IMV events involving diagnoses of PTX/H only in a small minority. CF-ICU with IMV was associated with high, though unchanged use of hospital resources. Short-term survival was unchanged during study period despite progressive rise in risk of death, possibly reflecting in part improved care over time. A diagnosis of PTX/H tended to be associated with better short-term survival. The present findings support consideration of IMV among adults with CF, though additional studies are warranted in other healthcare settings to corroborate these results and identify sources of the observed trends.