Skip to main content
  • Airways in health and disease
  • Open access
  • Published:

Evaluation of nasal optiflow device in the management of chronic obstructive pulmonary disease patients with acute excerbations

Abstract

Background

A new form of therapy that provides humidified high-flow oxygen through a nasal cannula has been introduced recently as an alternative in the treatment of spontaneously ventilating patients with high oxygen requirements.

Objective

The aim of the study was to evaluate the efficacy of a nasal optiflow device in the management of chronic obstructive pulmonary disease (COPD) patients with acute exacerbations in comparison with a conventional venturi mask.

Patients and methods

Forty-five COPD patients with respiratory failure type II admitted to the RICU at Abbasia Chest Hospital were recruited and divided into two groups: group 1 included 20 randomly selected COPD patients with acute exacerbations connected to a venturi mask; group 2 included 25 randomly selected COPD patients with acute exacerbations connected to nasal high flow (NHF) oxygen with an optiflow system. All patients were subjected to full history taking, thorough clinical examination, and routine laboratory investigations with chest X ray (CXR) and repeated analyses of arterial blood gases (ABGs).

Results

No statistically significant difference was observed between the two groups with respect to baseline ABG variables (on admission). In both methods (NHF and venturi mask) there was statistically significant improvement in ABG variables in the form of raised pH, PO2, and O2 saturation and reduced PCO2 when compared with baseline ABG values. Although there was no significant difference in weaning results between the two groups, there was significant decline in PCO2 in the NHF group. There was no significant difference in the outcome and end result between the two groups; successful weaning was achieved in 70% of patients in the venturi group and in 64% of the NHF group, whereas failure was reported in 30% of patients in the venturi group and in 36% in the NHF group.

Conclusion

The nasal optiflow device is highly expensive compared with the venturi mask, although both are approximately equally successful in the treatment of COPD patients with respiratory failure type II.

References

  1. Kaynar AM, Sharma S, Michael R, et al. Respiratory failure: Medscape. Australian Critical Care 2010; 23:53–70.

    Article  Google Scholar 

  2. Ritchie JE, Williams AB, Gerard C. Evaluation of a high-flow nasal oxygen delivery system using oxygraphy, capnography and measurement of upper airway pressures. New Zealand Region Annual Scientific Meeting. Christchurch, New Zealand: Australia and New Zealand Intensive Care Society; 3–5 July 2006.

    Google Scholar 

  3. Sim MA, Dean P, Kinsella J, Black R, Carter R, Hughes M. Performance of oxygen delivery devices when the breathing pattern of respiratory failure is simulated. Anaesthesia 2008; 63:938–940.

    Article  CAS  Google Scholar 

  4. Dysart K, Miller TL, Wolfson MR, Shaffer TH. Research in high flow therapy: mechanisms of action. Respir Med 2009; 103:1400–1405.

    Article  Google Scholar 

  5. Hasani A, Chapman TH, McCool D, Smith RE, Dilworth JP, Agnew JE. Domiciliary humidification improves lung mucociliary clearance in patients with bronchiectasis. Chron Respir Dis 2008; 5:81–86.

    Article  CAS  Google Scholar 

  6. GOLD. Global strategy for the diagnosis and prevention of chronic obstructive pulmonary disease updated 2014: GOLD; 2014. www.goldcopd.org.

  7. Giuliano KK, Higgins TL. New-generation pulse oximetry in the care of critically ill patients. Am J Crit Care 2005; 14:26–37.

    Article  Google Scholar 

  8. Ricard JD. High flow nasal oxygen in acute respiratory failure. Minerva Anestesiol 2012; 78: 836–841.

    PubMed  Google Scholar 

  9. Miller MC, Knapp RG. Clinical epidemiology and biostatistics. 3rd ed. Maryland: Williams & Wilkins; 1992.

    Google Scholar 

  10. Charles A, Thomas M, Nicholas M, Kathryn H, Sharon C, Hobart S. RRT Chest; 140: (4_Meeting Abstracts): 536A, 2011.

  11. Lenglet H, Sztrymf B, Leroy C, Brun P, Dreyfuss D, Ricard JD. Humidified high flow nasal oxygen during respiratory failure in the emergency department: feasibility and efficacy. Respir Care 2012; 57: 1873–1878.

    Article  Google Scholar 

  12. Sztrymf B, Messika J, Mayot T, Lenglet H, Dreyfuss D, Ricard JD. Impact of high-flow nasal cannula oxygen therapy on intensive care unit patients with acute respiratory failure: a prospective observational study. J Crit Care 2012; 27: 324.e9–324.e13.

    Article  Google Scholar 

  13. Roca O, Riera J, Torres F, Mascalans JR. High flow oxygen therapy in acute respiratory failure. Respir Care 2010; 55:408–413.

    PubMed  Google Scholar 

  14. Bräunlich J, Beyer D, Mai D, Hammeschmidt S, Seyfarth HJ, Wirtz H. Department of Respiratory Medicine, University of Leipzig, Leipzig. Germany Respiration 2013; 85:319–25.

    Article  Google Scholar 

  15. Makowski A, Misztal B, Plowright C, Safranow K. Effectiveness of vapotherm therapy for patients with respiratory failure at surgical high dependency unit. Intensive Care Med 2007; 33:s85.

    Google Scholar 

  16. Sztrymf B, Messika J, Bertrand F, Hurel D, Leon R, Dreyfuss D, Ricard JD. Beneficial effects of humidified high flow nasal oxygen in critical care patients: a prospective pilot study. Intensive Care Med 2011; 37:1780–1786.

    Article  CAS  Google Scholar 

  17. Peters SG, Holets SR, Gay PC. Nasal high flow oxygen therapy in do-not-intubate patients with hypoxemic respiratory distress. Respir Care 2012; 49:99–109.

    Google Scholar 

  18. Parke RL, McGuinness SP, Dixon R, Jull A. Protocol for a randomised controlled trial of nasal high flow oxygen therapy compared to standard care in patients following cardiac surgery: the HOT-AS study. Int J Nurs Stud 2012; 49: 338–344.

    Article  Google Scholar 

  19. Sarkisian-Donovan J, Hill JJ, Neary MJ, Murphy DMF. 2004. High flow gas therapy via nasal cannula for respiratory insufficiency. In Proceedings of the American Association for Respiratory Care open forum abstracts 25 Novamber Philadelphia.

  20. Taft A, Battles R, Bamford OFC, Nguyen A, Hill J. Prospective evaluation of the vapotherm (R) 2000i delivering high flow oxygen therapy (HFT) via nasal cannula in adult respiratory insufficiency. Respiratory Care 2005; 50:1780–86.

    Google Scholar 

  21. Roca O, Masclans JR, Labroda C, Sacanell J, Serra J. High flow nasal cannula improves oxygen administration in hypoxemic respiratory failure. Intensive Care Med 2007; 33:408–13.

    Google Scholar 

  22. Idone FA, Festa R, Antonicelli F, Di Muzio F, Cataldo A, Antonelli M, et al. 2010. Nasal high-flow oxygen therapy vs standard oxygen therapy via venturi mask after extubation: preliminary results of a randomized controlled trial. Paper presented at the 23rd Annual ESICM Congress, Barcelona, Spain. Intensive Care Medicine 36 (Abstract 0107), S110. 26 August.

  23. Antonicelli F, Cataldo A, Festa R, Idone F, Moccaldo A, Antonelli M, Maggiore SM. A. Gemell University Hospital, Rome, Italy. Crit Care 2011; 15:P165.

    Article  Google Scholar 

  24. Riessen T, Schwabbauer N, Berg B, Blumenstock G, Haap M, Hetzel J. Crit Care 2012; 16:P136.

    Article  Google Scholar 

  25. Richard WC, Richard L, Walter TM. Short Term oxygen therapy Nursing Times. Thorax 1995; 50:405–406.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Khaled M. Wagih MD.

Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Saeed, A.M., Wagih, K.M. & Hussein, N.A. Evaluation of nasal optiflow device in the management of chronic obstructive pulmonary disease patients with acute excerbations. Egypt J Bronchol 9, 34–42 (2015). https://doi.org/10.4103/1687-8426.153593

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.4103/1687-8426.153593

Keywords