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Objective: Fan therapy is widely acknowledged as an essential component in the management of dyspnoea with numerous studies supporting its efficacy in alleviating dyspnoea among patients with chronic illnesses. However, there is limited evidence regarding the effectiveness of fan therapy in reducing dyspnoea in patients with respiratory failure undergoing continuous oxygen therapy. This study aimed to assess the efficacy of fan therapy in mitigating dyspnoea in this specific patient population through a randomised controlled trial., Methods: Participants meeting the inclusion criteria were randomly assigned to either an experimental group or a control group. In the experimental group, a handheld fan (HHF) was directed at the face, while in the control group the fan was aimed at the legs. Both interventions were conducted at a distance of 15-30 cm for 10 min. Key physiological and subjective measures, including heart rate, respiratory rate, blood pressure, blood oxygen saturation, facial skin temperature and Visual Analogue Scale (VAS) scores, were recorded immediately after fan therapy., Results: The experimental group demonstrated a statistically significant reduction in VAS scores (p<0.05) compared with the control group indicating that fan therapy effectively alleviates dyspnoea in patients with respiratory failure receiving continuous oxygen therapy., Conclusion: HHFs are affordable, widely accessible and highly effective in relieving dyspnoea with minimal risk. Therefore, fan therapy should be considered as a complementary treatment for patients with respiratory failure and incorporated alongside standard therapeutic interventions for the condition., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.)

In a hospital setting, the supply and utilisation of oxygen are crucial for high-quality healthcare. This quality improvement project aimed to increase the rate of timely and safe oxygen delivery from 30% to 75% at Wallaga University Comprehensive Specialized Hospital from 1 January to 30 June 2024.Using the Plan-Do-Study-Act (PDSA) cycle, the project team identified root causes through fishbone and driver diagrams. Key interventions included staff orientation on safe handling of oxygen devices, clear job descriptions for compliance, improved handover processes between shifts, regular maintenance and inventory checks, increasing the number of oxygen cylinders, using hospital vehicles for transport and establishing a communication system with suppliers for timely requests.Results showed that the inventory of regular oxygen delivery devices improved to 76%, with equipment checks conducted 65% of the time. Emergency preparedness reached 20%, and onsite training for staff achieved 75%. Oxygen usage monitoring was nearly perfect at 99%, with delivery times reduced to 1 day for 70% of orders. A standard protocol for oxygen supply and use was established, resulting in a significant increase in timely and safe oxygen delivery from 30% to 75%.This project effectively optimised oxygen supply management, highlighting the importance of proactive management, communication and continuous monitoring in building a reliable oxygen therapy service. Improvements in inventory management and delivery efficiency were facilitated by a dedicated dashboard, standardised operating procedures and comprehensive staff training., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.)

Background: Gastrointestinal endoscopy with sedation is frequently complicated by hypoxemia. Nasal cannulas have limitations in eliminating hypoxemia. We hypothesized that the combination of nasal clips and nasal cannulas would improve the inspired oxygen concentrations and prevent hypoxemia compared with the use of nasal cannulas alone., Methods: A total of 600 adult patients were randomly assigned to receive supplemental oxygen through single-lumen nasal cannulas or through the combination of nasal clips and nasal cannulas. The primary outcome was the incidence of hypoxemia. Additionally, subclinical respiratory depression and severe hypoxemia, duration of hypoxemia, lowest SpO 2 level, measures to increase oxygen saturation level, and adverse events such as cough and hiccups were compared as secondary outcomes., Results: Three hundred patients in the nasal clip group and 296 patients in the nasal cannula group were included in the intention-to-treat analysis. Nasal clips significantly decreased the incidence of hypoxemia from 25.0-17.7%(RR = 0.707, 95% CI = 0.516 to 0.967, P = 0.029). The median and interquartile range of lowest SpO 2 in the nasal clip group (96 [92 to 98]) was significantly greater than that in the nasal cannula group (95 [89 to 97]; median difference = 1.000, 95% CI = 0.000 to 2.000, P = 0.004). No significant differences were found between the two groups in subclinical respiratory depression or severe hypoxemia, duration of hypoxemia, adverse events or measures taken to increase oxygen saturation., Conclusions: The combination of nasal clips and cannulas reduces hypoxemia during gastrointestinal endoscopy with sedation, demonstrating a significant advantage over the sole use of nasal cannulas, with tolerable adverse events., Trial Registration: Chinese Clinical Trial Registry (ChiCTR2200065407)., Competing Interests: Declarations. Ethics approval and consent to participate: This study was approved by the Medical Ethics Committee of Taizhou Enze Medical Centre (Group) Enze Hospital, Taizhou, Zhejiang, China (approval no. K20220307) on 28 March 2022. All participants provided written informed consent before participation. The trial followed the Consolidated Standards of Reporting Trials (CONSORT) reporting guidelines and was registered before patient recruitment at the Chinese Clinical Trial Registry (registration no. ChiCTR2200065407; date of registration: November 4, 2022). Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Objective: To identify predictive factors for failure in the installation of high-flow nasal cannulas in children diagnosed with acute viral bronchiolitis under 24 months of age admitted to the pediatric intensive care unit., Methods: This work was a retrospective single-center cohort study conducted from March 2018 to July 2023 involving infants under 24 months of age who were diagnosed with acute viral bronchiolitis and who received high-flow nasal cannulas upon admission to the pediatric intensive care unit. Patients were categorized into two groups, the Success Group and Failure Group, on the basis of high-flow nasal cannula therapy efficacy. The primary outcome was treatment failure, which was defined as the transition to invasive or noninvasive ventilation. The analyzed variables included age, sex, weight, high-flow nasal cannula parameters, vital signs, risk factors, comorbidities, and imaging. Acute viral bronchiolitis severity was assessed using the Wood-Downes Scale, and functional status was assessed via the Functional Status Scale, both of which were administered by trained physiotherapists., Results: In total, 162 infants with acute viral bronchiolitis used high-flow nasal cannulas, with 17.28% experiencing treatment failure. The significant differences between the Failure and Success Groups included age (p = 0.001), weight (p = 0.002), bronchiolitis severity (p = 0.004), initial high-flow nasal cannula flow (p = 0.001), and duration of use (p = 0.000). The cutoff values for initial flow (≤ 12L/min), weight (≤ 5kg), and Wood-Downes score (≥ 9 points) were determined from the ROC curves. Initial flow ≤ 12L/min was the most predictive for failure (AUC = 0.71; 95%CI: 0.61 - 0.84; p = 0.001). Multivariate analysis indicated that weight was a protective factor (RR = 0.87; 95%CI: 0.78 - 0.98), duration of use reduced the risk of failure (RR = 0.49; 95%CI: 0.38 - 0.64; p = 0.000), and Wood-Downes score was not significant (RR = 1.04; 95%CI: 0.95 - 1.14; p = 0.427). Weight explained 84.7% of the variation in initial flow., Conclusion: Risk factors for high-flow nasal cannula therapy failure in bronchiolitis patients include younger age, consequently lower weight, and a lower initial flow rate.

Objectives: High velocity therapy (HVT), a form of high-flow oxygen therapy, utilizing a small-bore nasal cannula has been widely used in acute care settings. A new dual-prong (newDP) cannula made using more comfortable material and a single-prong (SP) cannula were evaluated to compare comfort and functionality as measured by relief of dyspnea of patients with chronic obstructive pulmonary disease (COPD) receiving HVT therapy., Design: Randomized crossover evaluation., Setting: Outpatient and in patient critical care setting., Patients: Patients with hypercapnic COPD presenting with dyspnea above baseline., Interventions: HVT therapy was provided using an existing HVT dual-prong nasal cannula (traditional) to determine the most efficacious flow rate. Patients were then randomized to receive either the newDP cannula, or the SP cannula, and retitrated for optimal flow rate. During each session of therapy, Rated Perceived Dyspnea (RPD) scores, vital signs, transcutaneous carbon dioxide partial pressure (PTCco2) levels, and clinician/ patient perceptions were documented., Measurements and Main Results: Of 31 enrolled, 26 patients completed the trial. The median flow rate that relieved dyspnea for the traditional, newDP, and SP cannulas were 25 L/min (20-30 L/min), 25 L/min (19.1-30 L/min), and 15 L/min (13-17 L/min), respectively. The change in RPD from baseline for traditional, newDP, and SP were -1 (-1 to 0), -1 (-2 to -1), and -1 (-2 to -1). Change in RPD from baseline for newDP and SP compared with the traditional cannula was significantly different (p = 0.044 and p = 0.01, respectively). Changes in vital signs and PTCco2 were similar between the three cannula types compared with baseline. The SP cannula provided comparable therapeutic efficacy at significantly lower flow rates (traditional vs. SP; p < 0.0001 and newDP vs. SP; p < 0.0001)., Conclusions: The new cannula designs provided comparable relief of dyspnea. The single-prong cannula provided comparable efficacy at significantly lower flow rates (traditional vs. SP; p < 0.0001 and newDP vs. SP; p < 0.0001). The use of a single-prong cannula with HVT warrants further study., Competing Interests: Ms. Bergeski, Mr. Dungan, and Dr. Volakis were employed by Vapotherm (Exeter, NH) during the trial period. Mr. Dungan received a consultant from Vapotherm; he holds multiple patents on high-velocity nasal cannula, high-flow nasal cannula, ventilation, and diagnostic technologies. Dr. Whittle is employed by Vapotherm presently. The remaining authors have disclosed that they do not have any potential conflicts of interest.

Background: Acute respiratory failure is common occurrence in critical care, with varying causes, depending on case mix of the ICU. High flow nasal cannula (HFNC) is commonly utilized in both adult and pediatric population. However, traditionally, neurologically ill patients have been considered unsuitable for HFNC due to poor sensorium and risk of aspiration. Therefore, we conducted a study to assess the effectiveness of HFNC in Neuro ICU., Methodology: We did a prospective observational study on all adult patients requiring HFNC during their stay in Neuro ICU. Primary aim of the study was to find common indications for use of HFNC in neuro ICU. The secondary objective was to observe if HFNC could prevent re-intubation. The various other factors studied included age, gender, diagnosis (traumatic brain injury, postoperative neurosurgical condition or other neurological conditions), GCS score, HFNC settings, duration and cost of HFNC therapy., Results: During the period from January 1, 2021- 23, out of 1825 patients admitted to neuro ICU, 98 required HFNC therapy. Mean age was 43.3 years (range 18-85), 75.5% of which were males. Utilization rate of HFNC was 5.3%. HFNC was more commonly used for non-trauma patients, most often to reduce work of breathing following extubation (85%). HFNC helped prevent the need for re-intubation in 76.5% of patients with a failure rate of 23.5% across all subgroups of patients in neuro ICU. Requirements for higher flow rate and FiO 2 were significant predictors of HFNC failure. The mean cost of HFNC usage accounted for only 5.6% of the total inpatient bill., Conclusion: In neurocritical care, the causes of extubation failures and hypoxemia, differ significantly from other ICUs. In our study, HFNC was used most often to reduce work of breathing following extubation and was useful in preventing re-intubation. The use of HFNC did not significantly increase the cost of healthcare., Competing Interests: Declarations. Human ethics and consent to participate: Ethical clearance for the study was obtained from the institutional review board of Christian Medical College Vellore with a waiver of consent (IRB Min No: 14383 dated 22.12.2021) for the study titled “Exploring the effectiveness of High-Flow Nasal Cannula in the Neurointensive Care Unit: A prospective observational study” in accordance with the Institute’s ethical standards on human experimentation and with the Helsinki declaration of 1975. Consent to participate: Was waived by the Institutional review board as there was no change in existing practice of management. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Background: The Rapid-O2 oxygen insufflation device® (Rapid-O2) was designed primarily for rescue oxygenation in cannot intubate, cannot oxygenate (CICO) events; thus, hypercapnia is inevitable. Rapid-O2 was modified to enhance ventilation using the Venturi effect during expiration., Methods: To determine the most effective combination of inner catheters (20 gauge [G], 18 G, 16 G, 14 G, and 2-mm inner diameter [ID] transtracheal catheter [TTC]) and insufflation catheters (16 G, 14 G, and 2-mm ID TTC) for achieving optimum ventilation, insufflating and expiratory flows were measured at an oxygen flow rate of 15 L/min. The insufflating and expiratory pressures were measured at 6-15 L/min. The flows and pressures were measured using a gas flow analyzer. The insufflating and expiratory times were measured using a trachea-lung model to obtain minute volumes. To assess the improvement by modifying the Rapid-O2, minute volumes were measured using the Rapid-O2., Results: The most appropriate inner catheter was 18 G. The insufflating pressures ranged from 97 (2-mm ID TTC) to 377 cmH2O (16 G) at 15 L/min. During expiration, similar negative pressures of 50 cmH2O were measured in the insufflation catheters at 15 L/min. At lung compliance of 100 ml/cmH2O, the minute volumes through a 2-mm ID and 14 G insufflation catheters were 7.0 and 5.37 L/min, respectively, at 15 L/min. The minute volumes were significantly greater in modified Rapid-O2., Conclusions: Modified Rapid-O2 provided sufficient minute volumes in adults using a 14 G or 2-mm ID insufflation catheter at 15 L/min, demonstrating its potential for ventilation in CICO events.

Background: Oxygen therapy is critical and vital treatment for hypoxemia and respiratory distress, however, access to reliable oxygen systems remains limited in SSA. Despite WHO initiatives that distributed over 30,000 OC oxygen concentrators worldwide, SSA faces significant challenges related to their maintenance and use, due to harsh environmental conditions, technical skill shortages and inadequate infrastructure. This review aims to systematically identify and assess the literature on OC design adaptations, maintenance challenges, and knowledge gaps in SSA, providing actionable recommendations to inform innovative and context-sensitive solutions to improve healthcare delivery in the region., Methods: The study focused on medical oxygen concentrators in SSA countries. It was conducted by following the PRISMA statement and searching three databases, i.e., Scopus, PubMed, and Web of Science, for publications in the period 2001-2023, using the search terms: oxygen concentrator, therapy, cylinder, plant, supply, delivery, and availability, design, and maintenance. The screening process involved evaluating manuscripts based on their titles, abstracts and full texts, based on specific inclusion and exclusion criteria. The extracted information included the author's publication year, country, study aim, and key findings., Results: Overall, 1,057 papers were returned for our analysis, of which 20 met the inclusion criteria. These studies primarily examined the design, availability and cost-effectiveness of oxygen concentrators compared to cylinders, revealing a significant supply and demand gap for these devices in SSA. It also illustrated how the environmental challenges impacted the devices durability, highlighting the need for more locally adapted resilient solutions. Solar-powered systems provide a sustainable option in areas with unstable power supplies, although initial costs remain high. Robust maintenance strategies, capacity building and strict procurement protocols proved essential to ensuring equipment long-term functionality., Conclusion: This review synthesized and critically assessed the current in the body of literature, enabling highlighting valuable insights for innovators and stakeholders with an interest in enhancing the oxygen availability in SSA. It highlighted a pressing need for improved healthcare infrastructure investment, context-aware OC design and novel standards and regulatory frameworks to support frugal innovation., Competing Interests: Declarations. Ethics approval and consent to participate: Not applicable. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Background: Literature regarding the advantages of HFNC in infants for ensuring oxygen supply after non-cardiac surgery is insufficient. The purpose of our study is to compare COT vs. HFNC on postoperative outcomes in infants undergoing non-cardiac surgery. We hypothesize that prophylactic use of HFNC after non-cardiac surgery in infants would reduce the incidence of post-anesthesia hypoxemia and could also be adapted as first-line oxygen therapy after non-cardiac surgery., Methods: This is a superior, single-blind, randomized controlled study. A total of 394 infants undergoing general anesthesia will be randomly assigned to accept COT or HFNC in a 1:1 ratio. The primary outcome is the rate of desaturation post-extubation. Secondary outcomes include the rate of mild upper airway obstruction, the rate of severe respiratory depression, the rate of transfer to PICU, duration of oxygen therapy, length of PACU stay, the time to reach full enteral feeding, and postoperative adverse events, including nasal injury, agitation, vomiting, and unplanned secondary surgery related to the initial surgery., Discussion: This is the first randomized controlled trial to explore the advantages of HFNC in infants to ensure oxygen supply after non-cardiac surgery. If favorable evidence is obtained, HFNC could be adopted as first-line oxygen therapy for infants following non-cardiac surgery., Trial Registration: The trial was registered at https://www.chictr.org.cn (Registration number: ChiCTR2400081600, Date: March 6, 2024)., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2025 Zhang et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: The understanding of how pharyngeal pressure is transmitted to the trachea with high-flow nasal cannula (HFNC) implementation and the behavior of tracheal pressure in the presence of mouth leaks remains controversial. This study aimed to assess the impact of HFNC administration on tracheal pressure by comparing measurements taken with open and closed mouth with varying flows. Methods: A crossover study was conducted between March 2019 and June 2023. Subjects age > 18 years, with a tracheostomy and who were in the process of decannulation were included. Tracheal and pharyngeal pressures were measured by using specific devices, with different HFNC flows and mouth conditions. Results: Nine subjects were assessed: 77% women, with an average age of 60.5 years. Tracheal pressure was significantly higher than pharyngeal pressure only in baseline conditions ( P = .03). With regard to the rest of the scenarios, there were no significant differences between both pressures. Tracheal pressure was higher than the baseline condition both with an open mouth and a closed mouth ( P = .02). The tracheal pressure at 60 L/min with an open mouth was higher than at 40 L/min ( P = .042). The median pharyngeal pressure with a closed mouth was higher than with an open mouth, both with 40 and 60 L/min of flow ( P = .048 and P < .001, respectively). Pharyngeal pressure at 60 L/min with an open mouth was higher than both baseline condition and at 40 L/min ( P = .002 and P = .043, respectively). However, pharyngeal pressure with the closed mouth was significantly higher than with the open mouth both with 40 and 60 L/min of flow ( P = .031 and P = .02 respectively). Conclusions: The implementation of HFNC changes airway pressures with values that impact at a tracheal level as flow increases. Our data contribute to the difficult interpretation of the existing interrelation between the flow and its effects on the respiratory system.

Background/purpose: The use of high-flow nasal cannulas (HFNC) in patients admitted to the pediatric intensive care unit (PICU) has gradually increased worldwide; however, details on clinical efficacy remain limited in Taiwan. Therefore, we explored the clinical characteristics and outcomes of pediatric patients using HFNC in the PICU., Methods: Medical records were retrospectively collected from pediatric patients (aged <18 years) who received HFNC support from December 2021 to January 2023 in the PICU of a medical center. Outcome parameters included treatment failure (defined as increased respiratory support to advanced non-invasive ventilators or intubations), duration of support from HFNC, and changes in clinical parameters after initiating HFNC., Results: A total of 261 episodes of HFNC use were included, with a failure rate of 24.5% and a median support length of 4 days. Multivariable analysis showed that infant age (adjusted odds ratio [aOR]: 2.1, p = 0.02) and accompanying complex chronic disease (aOR: 4.4, p = 0.014) were risk factors for treatment failure and a diagnosis of asthma or bronchiolitis had a lower hazard of treatment failure (aOR: 0.29, p = 0.025) than other diagnoses did. Improvements in clinical parameters, including pulse rate, respiratory rate, SpO 2 , and CO 2 levels, were observed 24 h after the initiation of HFNC., Conclusion: The application of HFNC in the PICU in Taiwan is effective but should be performed with care in infants with accompanying complex chronic diseases. In addition to low treatment failure, HFNC utilizations stabilized the clinical parameters of children with asthma/bronchiolitis within one day., Competing Interests: Declaration of competing interest Jeng-Hung Wu and En-Ting Wu participated in speakers bureaus of Fisher and Paykel., (Copyright © 2024 Formosan Medical Association. Published by Elsevier B.V. All rights reserved.)

Background: Patients with tracheotomy are often monitored in the anesthesia recovery room after reoperation. During this period, oxygen therapy is necessary, and the existing tracheostomy oxygen supply device has many defects., Objective: To evaluate the efficacy of a self-made tracheostomy oxygen delivery device on oxygen therapy during postoperative anesthesia recovery., Methods: Patients were randomly divided into two groups, E and C, with 30 patients in each group, and admitted to the post-anesthesia care unit (PACU). Patients in group E received oxygen through a self-made tracheostomy oxygen delivery device, while patients in group C were supplied oxygen through a unilateral nasal cannula. Respiration (R), pulse oximetry (SpO2), and the number of patients on ventilators were recorded at the time of admission (T0) and one hour after admission (T1). Rapid dry blood gas analyses were performed on 0.6 ml samples of arterial blood collected at T0 and T1., Results: Compared to group C, patients in group E had significantly higher arterial partial pressure of oxygen (PaO2), arterial oxygen saturation (SaO2), total carbon dioxide (T-CO2), and actual bicarbonate (AB), while arterial partial pressure of carbon dioxide (PaCO2) was significantly reduced (P< 0.01 or < 0.05). Compared to T0, PaO2 decreased in both groups at T1, PaCO2 decreased in group E, while SaO2, T-CO2, and AB decreased in group C (P< 0.01 or < 0.05)., Conclusion: We found that using the self-made tracheostomy oxygen delivery device in postoperative anesthesia recovery had advantages such as a secure connection to the tracheostoma, adjustable oxygen concentration, air filtration, and the ability to switch oxygen supply between the ventilator and humidifier.

Background: In the last decades none of the medical therapies investigated have shown clear efficacy in the treatment of bronchiolitis, and literature agrees on a general de-implementation of pharmacological therapies, recognizing an effective role only to nutritional support and oxygen therapy. High-flow nasal cannulas (HFNC) has become increasingly popular in the last decade, despite its lack of clear efficacy. Recent randomized controlled trials (RCT) comparing standard oxygen therapy (SOT) and HFNC did not demonstrate significant benefit of HFNC. To acquire more clinical data on HFNC efficacy we performed a retrospective, quasi-experimental analysis of patients admitted for bronchiolitis in the epidemic seasons 2021-2022 and 2022-2023., Methods: To assess the efficacy of SOT and HFNC we used a pragmatic approach, a fuzzy regression discontinuity design, which is a quasi-experimental test. Unlike RCTs, this process is not a true randomization, but may be interpreted as quasi-randomization in an observational setting., Results: HFNC did not reduce length of oxygen therapy (LOO) nor length of hospitalization (LOS) (respectively, p: 0.383 and p: 0.454). Treatment failure was not significantly different in the treatment groups (p: 0.354)., Conclusions: It is crucial to perform additional RCTs with uniform protocols to determine the efficacy of HFNC more accurately in the treatment of bronchiolitis. HFNC does not reduce LOO, suggesting that early use of HFNC does not change the course of disease in moderate bronchiolitis. In view of the greater complexity and higher cost, HFNC should not be routinely used as first-line treatment in children with moderate respiratory distress and mild hypoxemia., (© 2024 The Author(s). Pediatric Pulmonology published by Wiley Periodicals LLC.)

Introduction: High-flow nasal oxygen (HFNO), or transnasal humidified rapid-insufflation ventilatory exchange (THRIVE), is a technique providing apneic oxygenation and a degree of ventilation during microlaryngeal surgery. Its use with laser has been questioned due to concern for airway fire. For fire to occur, a triad of ignition source, oxidizer, and fuel source must be present. By using HFNO and eliminating an endotracheal tube (fuel source), it is hypothesized that airway fire risk is minimal. We tested this theory with human cadavers using HFNO with increasing levels of FiO 2 while performing microlaryngeal laser surgery., Methods: HFNO was placed on two cadavers, and oxygen was administered at incrementally increasing fraction of inspired oxygen (FiO 2 ) concentrations (30%-100%). Laryngeal microsurgery was conducted with CO 2 and KTP lasers applied for 30 s. Oxygen readings were taken at several anatomic locations along the body assessing oxygen concentrations in correlation with increasing FiO 2 administration., Results: The use of CO 2 and KTP laser on cadaveric vocal folds produced char but no spark or airway fire at any of the tested oxygen concentrations. Apart from the mouth, there was minimal increase in oxygen levels at the surrounding anatomic sites despite elevating FiO 2 levels., Conclusion: HFNO may be safe to use during microlaryngeal laser surgery. By eliminating the endotracheal tube as a fuel source, risk of airway fire may be negligible. Our study safely applied CO 2 and KTP lasers for an uninterrupted 30 s with HFNO at 70 L/min and 100% FiO 2 producing no spark or fire., Level of Evidence: NA Laryngoscope, 135:223-226, 2025., (© 2024 The American Laryngological, Rhinological and Otological Society, Inc.)

Background: High-flow nasal cannula (HFNC) therapy has gained popularity in the pediatric intensive care unit (PICU). However, the nationwide effect of HFNC on mechanical ventilation duration has not been studied., Methods: We retrospectively analyzed pediatric patients (28 days to 17 years old) admitted to tertiary ICUs for respiratory support from 2012 to 2019 using the Korean National Health Insurance database. Pre-/post-HFNC periods were defined as the 12 months before and after the application of HFNC in any hospital, respectively, allowing a 6-month transition period. Mechanical ventilation duration and ventilator-free days during these two periods were compared using a multivariable regression model., Results: Using data from 46 hospitals, 4,705 and 4,864 respective pre-/post-HFNC period patients were evaluated. During the post-HFNC period, 14.8% of patients were treated by HFNC, and 67.1% were treated using invasive mechanical ventilation. In adjusted analysis, mechanical ventilation duration was reduced by 0.99 days (confidence interval [CI]: -1.86, -0.12). The duration was significantly reduced by 17.81 days (CI: -35.46, -0.16) among patients whose ventilation duration was longer than 28 days. In subgroup analysis, mechanical ventilation duration was reduced by 1.49 days (CI: -2.78, -0.19) in the overall surgical group and 6.71 days (CI: -11.71, - 1.71) in the neurologic subgroup. Ventilator-free days were increased only in the overall surgical group, by 0.31 days (CI: 0.01, 0.61)., Conclusions: Application of HFNC to PICU patients could reduce mechanical ventilation duration, especially in patients requiring prolonged mechanical ventilator support or in post-operative patients., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Choi et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Oxygen therapy is commonly administered to patients with acute cardiovascular conditions during hospitalisation. Both hypoxaemia and hyperoxia can cause harm, making it essential to maintain oxygen saturation (SpO 2 ) within a target range. Traditionally, oxygen administration is manually controlled by nursing staff, guided by intermittent pulse oximetry readings. This study aimed to compare standard manual oxygen administration with automated oxygen administration (AOA) using the O2matic device., Methods: In this randomised controlled trial, 60 patients admitted to a cardiac department with an acute cardiovascular condition requiring oxygen therapy were randomised to either standard care (manual oxygen administration) or AOA via the O2matic device. The primary outcome was the percentage of time spent within the desired SpO 2 range (92%-96% or 94%-98%) over 24 hours., Results: Patients had a mean age of 75.8±12.4 years, with an average SpO 2 of 93%. Those in the AOA group (n=25) spent significantly more time within the target SpO 2 range (median 87.0% vs 60.6%, p<0.001) compared with the standard care group (n=28). Time spent below the desired SpO 2 range was significantly lower in the AOA group (7.9% vs 33.6%, p<0.001). No significant differences in time spent above the desired SpO 2 range were observed between the two groups., Conclusions: AOA with the O2matic device is superior to standard manual control in maintaining SpO 2 within the target range in patients hospitalised with acute cardiovascular conditions. The automated systems significantly reduce the time spent in hypoxaemia without increasing hyperoxia., Trial Registration Number: NCT05452863., Competing Interests: Competing interests: Coauthors EFH and JDH hold shares in O2matic, and EFH is a board member; however, they did not receive any fees or support from O2matic in relation to this trial. The remaining authors did not report any conflicts of interest, (© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.)

The objective of this review is to compare high-flow nasal cannula (HFNC) oxygen (High flow oxygen) and noninvasive ventilation (NIV) for the management of acute respiratory failure secondary to suspected or confirmed acute heart failure (AHF). A comprehensive and relevant literature search of MEDLINE, Web of Science, and the Cochrane Library was conducted using Medical Subject Heading and Free text terms from January 2010 to March 2024. All randomized clinical trials and observational retrospective and prospective studies reporting adult patients with acute respiratory failure due to suspected or confirmed AHF and comparing HFNC to NIV were included. Primary outcome included treatment failure, as a composite outcome including early termination to the allocated treatment, need for in-hospital intubation or mortality, or the definition used in the study for treatment failure if adequate. Secondary outcomes included change in respiratory rate and dyspnea intensity after treatment initiation, patient comfort, invasive mechanical ventilation requirement, and day-30 mortality. Six of the 802 identified studies were selected for final analysis, including 572 patients (221 assigned to high flow and 351 to NIV). Treatment failure rate was 20% and 13% in the high flow oxygen and NIV groups, respectively [estimated odds ratio (OR): 1.7, 95% confidence interval (95% CI): 0.9-3.1] in randomized studies and 34% and 16% in the high flow oxygen and NIV groups, respectively (OR: 3.1, 95% CI: 0.7-13.5), in observational studies. Tracheal intubation requirement was 7% and 5% of patients in the HFNC and NIV groups, respectively (OR: 1.4, 95% CI: 0.5-3.5) in randomized studies, and 20% and 9% in the high flow oxygen and NIV group, respectively (OR: 2.1, 95% CI: 0.5-9.4) in observational studies. Mortality was 13% and 8% in the high flow oxygen and the NIV groups, respectively (OR: 1.8, 95% CI: 0.8-1.1) in randomized studies and 14% and 9% in the high flow oxygen and the NIV groups, respectively (OR: 1.4, 95% CI: 0.5-3.7) in observational studies. Compared with NIV, high flow oxygen was not associated with a higher risk of treatment failure during initial management of patients with acute respiratory failure related to suspected or confirmed AHF., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Background: A high-flow nasal cannula (cHFNC) delivers flow continuously (during inspiration and expiration). Using the diaphragm electrical activity (Edi), synchronizing HFNC could be an alternative (cycling high/low flow on inspiration/expiration, respectively). The objective of this study was to demonstrate the feasibility of synchronized HFNC (sHFNC) and compare it to cHFNC., Methods: Different levels of cHFNC and sHFNC (4, 6, 8, and 10 liters per minute [LPM], with 2 LPM on expiration for sHFNC) were compared in eight rabbits (mean weight 3.16 kg), before and after acute lung injury (pre-ALI and post-ALI). Edi, tracheal pressure (Ptr), esophageal pressure (Pes), flow, and arterial CO 2 were measured. In addition to the animal study, one 3.52 kg infant received sHFNC and cHFNC using a Servo-U ventilator., Results: In the animal study, there were more pronounced decreases in Edi, reduced Pes swings and reduced PaCO 2 at comparable flows during sHFNC compared to cHFNC both pre and post-ALI (p < .05). Baseline (pre-inspiratory) Ptr was 2-7 cmH 2 O greater during cHFNC (p < .05) indicating more dynamic hyperinflation. In one infant, the ventilator performed as expected, delivering Edi-synchronized high/low flow., Conclusion: Synchronizing high flow unloaded breathing, decreased Edi, and reduced PaCO 2 in an animal model and is feasible in infants., (© 2024 Wiley Periodicals LLC.)

Bronchiolitis continues to be the most common cause of hospitalization in the first year of life. We continue to search for the remedy that will improve symptoms, shorten hospitalization and prevent worsening of disease. Although initially thought to be a promising therapy, large randomized controlled trials show us that high flow nasal cannula (HFNC) use is not that remedy. These trials show no major differences in duration of hospital stay, intensive care unit (ICU) admission rates, duration of stay in the ICU, duration of oxygen therapy, intubation rates, heart rate, respiratory rate or comfort scores. Additionally, practices regarding initiation, flow rates and weaning continue to vary from institution to institution and there are currently no agreed upon indications for its use. This reveals the need for evidence based guidelines on HFNC use in bronchiolitis., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

High Flow Nasal Cannula therapy (HFNC) is a form of respiratory support for bronchiolitis. Recent evidence confirms HFNC reduces the risk of treatment escalation by nearly half (45%) compared to standard oxygen therapy (SOT), although most patients (75%) with mild-moderate respiratory distress manage well on SOT. The majority of children (60%) failing SOT respond well to HFNC making rescue use of HFNC a more cost-effective approach compared to its first-line use. HFNC is compared toCPAP in the setting of moderate to severe bronchiolitis. Patients on HFNC have a slightly elevated risk of treatment failure especially in severe bronchiolitis, but this does not translate to a significant difference in patient or healthcare centred outcomes. HFNC has improved tolerance, a lower complication rate and is more easily available in peripheral hospitals. It is therefore the preferred first line option followed by rescue CPAP. HFNC is clinically effective and safe to use in bronchiolitis of all severities., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Padmanabhan Ramnarayanreceived grant funding from the National Institute of Health Research (NIHR) for the FIRST-ABC trial and is currently leading the BACHb trial in bronchiolitis. All other authors report no conflicts of interest. ., (Crown Copyright © 2024. Published by Elsevier Ltd. All rights reserved.)

Rationale: The high-flow nasal cannula (HFNC) device is commonly used to treat pediatric severe acute asthma. However, there is little evidence regarding its effectiveness in real-world practice., Objectives: We sought to compare the physiologic effects and clinical outcomes for children treated for severe acute asthma with HFNC versus matched controls., Methods: This was a single-center retrospective matched cohort study at a quaternary care children's hospital. Children ages 2-18 hospitalized for severe acute asthma from 2015 to 2022 were included. Encounters receiving treatment with HFNC within the first 24 h of hospitalization were included as cases. Controls were primarily treated with oxygen facemask. Logistic regression 1:1 propensity score matching was done using demographics, initial vital signs, and medications. The primary outcome was an improvement in clinical asthma symptoms in the first 24 h of hospitalization measured as percent change from initial., Measurements and Main Results: Of 693 eligible cases, 443 were matched to eligible controls. Propensity scores were closely aligned between the cohorts, with the only significant difference in clinical characteristics being a higher percentage of patients of Black race in the control group (54.3% vs. 46.6%; p = 0.02). Compared to the matched controls, the HFNC cohort had smaller improvements in heart rate (-11.5% [-20.9; -0.9] vs. -14.7% [-22.6;-5.7]; p < 0.01), respiratory rate (-14.3% [-27.9;5.4] vs. -16.7% [-31.5;0.0]; p = 0.03), and pediatric asthma severity score (-14.3% [-28.6;0.0] vs. -20.0% [-33.3;0.0]; p < 0.01) after 24 h of hospitalization. The HFNC cohort also had longer pediatric intensive care unit (PICU) length of stay (LOS) (1.5 days [1.1;2.1] vs. 1.2 days [0.9;1.8]; p < 0.01) and hospital LOS (2.8 days [2.1;3.8] vs. 2.5 days [1.9;3.4]; p < 0.01). When subgrouping to younger patients (2-3 years old), or those with the highest severity scores (PASS > 9), those treated with HFNC had no difference in clinical symptom improvements but maintained a longer PICU LOS., Conclusions: Encounters using HFNC for severe acute pediatric asthma had decreased clinical improvement in 24 h of hospitalization compared to matched controls and increased LOS. Specific subgroups of younger patients and those with the highest severity scores showed no differences in clinical symptom improvement suggesting differential effects in specific patient populations., (© 2024 The Author(s). Pediatric Pulmonology published by Wiley Periodicals LLC.)

Background: High flow nasal cannula therapy (HFNC) and continuous positive airway pressure (CPAP) are two widely used modes of non-invasive respiratory support in paediatric critical care units. The FIRST-ABC randomised controlled trials (RCTs) evaluated the clinical and cost-effectiveness of HFNC compared with CPAP in two distinct critical care populations: acutely ill children ('step-up' RCT) and extubated children ('step-down' RCT). Clinical effectiveness findings (time to liberation from all forms of respiratory support) showed that HFNC was non-inferior to CPAP in the step-up RCT, but failed to meet non-inferiority criteria in the step-down RCT. This study evaluates the cost-effectiveness of HFNC versus CPAP., Methods: All-cause mortality, health-related Quality of Life (HrQoL), and costs up to six months were reported using FIRST-ABC RCTs data. HrQoL was measured with the age-appropriate Paediatric Quality of Life Generic Core Scales questionnaire and mapped onto the Child Health Utility 9D index score at six months. Quality-Adjusted Life Years (QALYs) were estimated by combining HrQoL with mortality. Costs at six months were calculated by measuring and valuing healthcare resources used in paediatric critical care units, general medical wards and wider health service. The cost-effectiveness analysis used regression methods to report the cost-effectiveness of HFNC versus CPAP at six months and summarised the uncertainties around the incremental cost-effectiveness results., Results: In both RCTs, the incremental QALYs at six months were similar between the randomised groups. The estimated incremental cost at six months was - £4565 (95% CI - £11,499 to £2368) and - £5702 (95% CI - £11,328 to - £75) for step-down and step-up RCT, respectively. The incremental net benefits of HFNC versus CPAP in step-down RCT and step-up RCT were £4388 (95% CI - £2551 to £11,327) and £5628 (95% CI - £8 to £11,264) respectively. The cost-effectiveness results were surrounded by considerable uncertainties. The results were similar across most pre-specified subgroups, and the base case results were robust to alternative assumptions., Conclusions: HFNC compared to CPAP as non-invasive respiratory support for critically-ill children in paediatric critical care units reduces mean costs and is relatively cost-effective overall and for key subgroups, although there is considerable statistical uncertainty surrounding this result., Competing Interests: Declarations. Ethical approval and consent to participate: The FIRST-ABC master protocol was approved by the East of England–Cambridge South Research Ethics Committee (19/EE/0185) and the UK Health Research Authority (IRAS 260536). The trial was registered with the International Standard Randomised Controlled Trial Number (ISRCTN) Registry (ISRCTN60048867). Written informed consent was obtained from parents/legal guardians of each trial participant. Consent for publication: Not applicable. Competing interests: The authors report funding from the National Institute for Health and Social Care Research (NIHR) Health Technology Assessment Programme to their institutions for the work presented in the manuscript. KR is Director of the NIHR Health and Social Care Delivery Research Programme., (© 2024. The Author(s).)

COVID-19, caused by SARS-CoV-2 infection, led to a pandemic of acute respiratory illness that is ongoing. High-flow nasal cannula (HFNC) is a commonly used form of respiratory support during acute respiratory distress and is used to treat patients with COVID-19 in many centers. Due to the novel nature of COVID-19 at the onset of the pandemic, evidence to support the use and best practices of HFNC for treating patients with COVID-19 was lacking. This is a review of key peer-reviewed manuscripts from 2022-2023 discussing the efficacy and best practices for using HFNC for patients with COVID-19. Efficacy of HFNC for COVID-19, the use of the respiratory oxygenation index to guide HFNC for COVID-19, and concerns of generated/fugitive aerosols when using HFNC for COVID-19 are emphasized., Competing Interests: Dr Davis is a patent holder of Optate and also a co-founder of both Airbase Breathing Company and Partner Liberia., (Copyright © 2024 by Daedalus Enterprises.)

Background: Nasal continuous positive airway pressure (NCPAP) is widely used for premature infants with respiratory distress syndrome (RDS). A high-flow nasal cannula (HFNC) provides positive end-expiratory pressure using high-flow oxygen; however, the variability in distending pressure is a primary concern. This study evaluated the feasibility and safety of a newly designed protocol for NCPAP weaning with cyclic HFNC use for premature infants., Methods: Premature infants with RDS using NCPAP support who were ready for weaning were enrolled. The weaning protocol used cyclic NCPAP with HFNC every 3 h for 3 days in the neonatal intensive care unit. The heart rate (HR), respiratory rate (RR), pulse oximetry (SpO 2 ), transcutaneous carbon dioxide (PtcCO 2 ), and cerebral tissue oxygen saturation (StO 2 ) at the end of NCPAP with HFNC support were recorded once daily for 3 days., Results: From June 2019 to April 2021, 46 premature infants (27 male, 19 female) were enrolled. The mean gestational age and birth body weight were 28.7 ± 2.6 weeks and 1181 ± 354 g, respectively. No statistically significant differences in the HR, RR, SpO 2 , and cerebral StO 2 during NCPAP weaning with HFNC were observed. However, the mean PtcCO 2 with NCPAP was statistically significantly lower than that with HFNC (46.9 ± 6.0 mmHg vs. 47.9 ± 6.4 mmHg, P = 0.02)., Conclusions: The feasibility and safety of the NCPAP weaning protocol with cyclic HFNC for premature infants are acceptable in this preliminary study. Due to the limited number of participants, further studies are required for more comprehensive analysis., Trial Registration: This prospective observational case study was approved by the Human Experiment and Ethics Committee of our hospital (approval number: KMUHIRB-SV(I)-20180059; approval date: January 11, 2019)., Competing Interests: Declarations Ethics approval and consent to participate This prospective observational case study was approved by the Human Experiment and Ethics Committee of our hospital (approval number: KMUHIRB-SV(I)-20180059; approval date: January 11, 2019). All experiments were performed in accordance with relevant guidelines and regulations. Written informed consent was obtained from the parents of the included premature infants. Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Chronic obstructive pulmonary disease (COPD) is one of the most common clinical respiratory illnesses, defined by permanent pathological deterioration that leads to respiratory failure. Regarding COPD treatment, oxygen therapy is very important. Non-invasive positive pressure ventilation (NPPV) is a technique for non-invasive mechanical ventilation that enables patients to get positive pressure support without the need of an artificial airway. Instead, it merely employs the mask by covering the mouth and nose, or simply the nose of patients. NPPV has been shown to be beneficial for COPD patients experiencing respiratory failure. High-flow nasal cannula (HFNC) oxygen therapy shows some advantages, including the reduction of anatomical dead space, the prompt correction of low oxygen levels as well as the improvement of patients' tolerance. Owing to its continuous progress, ventilation technology strongly improves COPD treatment. In this study, the authors analyze the application of NPPV and HFNC in COPD so as to provide recommendations for mechanical ventilation treatment., Competing Interests: Yuting Wang and Yan Liu are co-first authors for this study. The authors report no conflicts of interest in this work., (© 2024 Wang et al.)

Study Objective: Hypoxemia is the most frequent adverse event observed during gastrointestinal endoscopy under procedural sedation. An optimum oxygen therapy has still not been conclusively determined., Design: A systematic review and network meta-analysis of randomized clinical trials., Setting: Digestive Endoscopy Center., Patients: Adults (≥18 years old and of both sexes) during gastrointestinal endoscopy under procedural sedation., Interventions: Pubmed, MEDLINE, Web of Science, Embase, and Clinicaltrials.gov. were searched until June 30, 2023. Randomized clinical trials (RCTs) comparing any oxygen therapy with another oxygen therapy or with placebo (nasal cannula, NC) were included., Measurement: The primary outcome was the incidence of hypoxemia, defined as the pulse oxygen saturation (SpO 2 ). Random-effects network meta-analyses were performed. Data are reported as odds ratios (OR), prediction intervals (PrI) and 95% CI. Bias risk was evaluated following the guidelines outlined by the Cochrane Collaboration. The quality of evidence was evaluated through the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework., Main Results: We included 27 RCTs with a total of 7552 patients. Compared to the use of NC, non-invasive positive pressure ventilation (NIPPV) demonstrated superior efficacy in mitigating hypoxemia (NIPPV vs. NC, OR = 0.16, 95% CI: 0.08-0.31, 95% PrI: 0.06-0.41), followed by Wei nasal jet tube (WNJT) (WNJT vs. NC, OR = 0.17, 95% CI: 0.10-0.30, 95% PrI: 0.07-0.42). The efficacy for preventing hypoxemia was ranked as follows: NIPPV > WNJT > oropharynx/nasopharyngeal catheter > high-flow nasal oxygenation > nasal mask > NC., Conclusions: During gastrointestinal endoscopy under procedural sedation, all other advanced oxygen therapies were found to be more efficacious than nasal cannula. NIPPV and WNJT appear to be the most efficacious oxygen therapy for preventing hypoxemia. Additionally, clinicians should make a choice regarding the most suitable oxygen therapy based on the risk population, type of endoscopy and adverse events., Competing Interests: Declaration of competing interest The authors declare no conflicts of interest., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Respiratory support is one of the key technologies for treating pediatric respiratory diseases. High-flow nasal cannula oxygen therapy (HFNC) represents a novel method of assisted respiratory support. The commonly used indicator for assessing HFNC efficacy in clinical practice is oxygenation index (PaO 2 /FiO 2 ). However, this parameter has several limitations when evaluating the efficacy of HFNC in pediatrics. The ROX index, introduced in recent years, offers a more sensitive and specific assessment tool. This article reviews the application of the ROX index in assessing the efficacy of HFNC for pediatric respiratory failure, aiming to provide a more accurate assessment method.

Background: Chronic respiratory diseases (CRDs) affect at least 545 million people globally, leading to symptoms such as dyspnoea, fatigue and limited physical activity. Pulmonary rehabilitation (PR) programmes aim to improve the exercise capacity and quality of life of patients with CRD through exercise training. High-flow nasal cannula (HFNC) therapy shows potential as an adjunct treatment during exercise, but its effects on CRD populations are unclear. The purpose of this systematic review was to evaluate the effects of HFNC during exercise in people with CRD., Methods: A systematic review was conducted and eight databases and other resources were searched from inception (28 June 2022) to 4 April 2023. Studies that used adult patients with CRD and randomised controlled trial that compared the effect of HFNC versus standard care (conventional oxygen therapy or room air) during exercise were included. Two authors independently selected trials, extracted the data, assessed risks of bias and employed the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach to judging the certainty of evidence. We pooled trials using random-effect models and inverse variance estimation., Results: Seventeen studies (n=8406) were included in the review (570 patients). The evidence suggests that HFNC increases exercise time after multiple training sessions (weighted mean difference (WMD)=160.58 s; 95% 95% CI=67.32-253.83, 2 studies) and increase after a single session (WMD=72.10 s; 95% CI=28.95-115.24, 11 studies). HFNC may result in little improvements in secondary outcomes (quality of life, dyspnoea, comfort, complications and adherence)., Discussion: The evidence suggests that HFNC may increase functional exercise capacity and positively enhance secondary outcomes. Continued research is justified to elucidate the role of HFNC in PR during exercise training., Prospero Registration Number: CRD42022336263., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: Adequate oxygenation and airway management during deep sedation can be challenging. We investigated the effect of high-flow nasal cannula (group HF) and conventional nasal cannula (group CO) during sedation for endoscopic submucosal dissection (ESD)., Methods: Patients undergoing ESD with deep sedation were enrolled. The primary outcome was difference in lowest oxygen saturation (SpO 2 ) between the groups. Incidence of hypoxia (SpO 2  < 90%), patients with SpO 2  < 95%, hypercapnia, and airway interventions; operator satisfaction; and adverse events were recorded., Results: Thirty-two patients in each group completed the study. The mean of minimum SpO 2 values was significantly higher in group HF than in group CO (96.8% ± 4.2% vs. 93.3% ± 5.3%, p = 0.005). The incidence of hypoxia was comparable between the groups (4 [12.5%] vs. 6 [18.8%], p = 0.491); however, patients with SpO 2  < 95% were significantly less in group HF (5 [15.6%] vs. 18 [56.3%], p = 0.003). Incidence of hypercapnia was higher in group HF than in group CO (14 [46.7%] vs. 5 [16.7%], p = 0.013). Airway rescue interventions were significantly less common in group HF. Satisfaction of operators and post-procedural complications were comparable between the two groups. In multivariable analysis, group CO and higher body mass index were risk factors for airway managements (odds ratio [95% confidence interval]: 6.204 [1.784-21.575], p = 0.004; 1.337 [1.043-1.715], p = 0.022, respectively)., Conclusions: Compared to conventional nasal cannula, high-flow nasal cannula maintained higher minimum SpO 2 value during deep sedation with propofol-remifentanil for ESD., Trial Registration: Clinical Trial Registry of the Republic of Korea (KCT0006618, https://cris.nih.go.kr ; registered September 29, 2021; principal investigator: Ji Won Choi)., (© 2024. The Author(s) under exclusive licence to Japanese Society of Anesthesiologists.)

Introduction: Obstructive sleep apnea (OSA) in infants is treated with low flow oxygen via nasal cannula (NC), CPAP (continous positive airway pressure), or surgery. Literature supports the use of high flow NC (HFNC) in children in the outpatient setting, however there is limited data on the use of HFNC in infants., Objective: The purpose of this study was to compare HFNC and low-flow oxygen as treatments for OSA in infants., Methods: A prospective pilot study was performed at two institutions. Infants with primarily OSA underwent a 3-4 h sleep study with HFNC titration at 6-14 lpm for OSA, followed by clinical polysomnography (PSG) for oxygen titration (1/8-1 lpm). Infants with primarily central apnea were excluded., Results: Nine infants were enrolled, with a mean age of 1.3 ± 1.7 months. Average apnea hypopnea index (AHI), average obstructive apnea hypopnea index (OAHI) and average central apnea index during the diagnostic PSG was 17.2 ± 7/h, 13.4 ± 5.4/h and 3.7 ± 4.8/h respectively. OSA improved in 44.4% of subjects with HFNC; the mean AHI and OAHI decreased from 15.6 ± 5.65/h and 12.8 ± 4.4/h on diagnostic PSG to 5.12 ± 2.5/h and 4.25 ± 2.5/h on titration PSG. OSA improved universally with low flow oxygen; the mean AHI decreased from 17.2 ± 7/h on diagnostic PSG to 4.44 ± 3.6/h on titration PSG., Conclusion: HFNC reduced OSA in some infants, though low flow oxygen reduced OSA in all subjects. Respiratory instability (high loop gain) in infants may explain why infants responded to low flow oxygen. More studies are needed to determine if HFNC is beneficial in selected groups of infants with OSA., (© 2024 Wiley Periodicals LLC.)

Introduction: Passive oxygenation with non-rebreather face mask (NRFM) has been used during cardiac arrest as an alternative to positive pressure ventilation (PPV) with bag-valve-mask (BVM) to minimize chest compression disruptions. A dual-channel pharyngeal oxygen delivery device (PODD) was created to open obstructed upper airways and provide oxygen at the glottic opening. It was hypothesized for this study that the PODD can deliver oxygen as efficiently as BVM or NRFM and oropharyngeal airway (OPA) in a cardiopulmonary resuscitation (CPR) manikin model., Methods: Oxygen concentration was measured in test lungs within a resuscitation manikin. These lungs were modified to mimic physiologic volumes, expansion, collapse, and recoil. Automated compressions were administered. Five trials were performed for each of five arms: (1) CPR with 30:2 compression-to-ventilation ratio using BVM with 15 liters per minute (LPM) oxygen; continuous compressions with passive oxygenation using (2) NRFM and OPA with 15 LPM oxygen, (3) PODD with 10 LPM oxygen, (4) PODD with 15 LPM oxygen; and (5) control arm with compressions only., Results: Mean peak oxygen concentrations were: (1) 30:2 CPR with BVM 49.3% (SD = 2.6%); (2) NRFM 47.7% (SD = 0.2%); (3) PODD with 10 LPM oxygen 52.3% (SD = 0.4%); (4) PODD with 15 LPM oxygen 62.7% (SD = 0.3%); and (5) control 21% (SD = 0%). Oxygen concentrations rose rapidly and remained steady with passive oxygenation, unlike 30:2 CPR with BVM, which rose after each ventilation and decreased until the next ventilation cycle (sawtooth pattern, mean concentration 40% [SD = 3%])., Conclusions: Continuous compressions and passive oxygenation with the PODD resulted in higher lung oxygen concentrations than NRFM and BVM while minimizing CPR interruptions in a manikin model.

Background: Tracheostomized patients undergoing liberation from mechanical ventilation (MV) are exposed to the ambient environment through humidified air, potentially heightening aerosol particle dispersion. This study was designed to evaluate the patterns of aerosol dispersion during spontaneous breathing trials in such patients weaning from prolonged MV., Methods: Particle Number Concentrations (PNC) at varying distances from tracheostomized patients in a specialized weaning unit were quantified using low-cost particle sensors, calibrated against a Condensation Particle Counter. Different oxygen delivery methods, including T-piece and collar mask both with the humidifier or with a small volume nebulizer (SVN), and simple collar mask, were employed. The PNC at various distances and across different oxygen devices were compared using the Kruskal-Wallis test., Results: Of nine patients receiving prolonged MV, five underwent major surgery, and eight were successfully weaned from ventilation. PNCs at distances ranging from 30 cm to 300 cm showed no significant disparity (H(4) = 8.993, p = 0.061). However, significant differences in PNC were noted among oxygen delivery methods, with Bonferroni-adjusted pairwise comparisons highlighting differences between T-piece or collar mask with SVN and other devices., Conclusion: Aerosol dispersion within 300 cm of the patient was not significantly different, while the nebulization significantly enhances ambient aerosol dispersion in tracheostomized patients on prolonged MV., Competing Interests: Declaration of competing interest None, (Copyright © 2024 Formosan Medical Association. Published by Elsevier B.V. All rights reserved.)

Background: The flow reaching the vocal folds may be lower than that at the output of high-flow nasal cannula (HFNC) system. This could be due to upper-respiratory obstruction, oxygen leakage, or other factors. The objective of this study was to observe the effect of flow through a nasopharyngeal airway on intrapharyngeal pressure (IPP) in subjects undergoing fiberoptic bronchoscopy (FOB)., Methods: Patients scheduled for FOB were invited to participate. Measurements were performed at flows of 0-60 L/min; the subjects wore WN-N95 folding medical protective masks (N95) and either underwent FOB or not. IPP at each flow was recorded following 15 s of ventilation, and the cross-sectional area (CSA) of the gastric sinus was measured before and after FOB. Hypoxemia, reflux aspiration, and other pertinent events were recorded., Results: Sixty subjects undergoing FOB at the Affiliated Hospital of Jiaxing University participated in this trial from October 2022-September 2023. IPP increased significantly with an increase in flow and also increased after placing the N95 mask with the same flow ( P < .001). When results from before to after FOB were compared, the difference in CSA was statistically significant 263.6 (220.7-300.5) mm 2 vs 305.5 (275.4-329.5) mm 2 , P < .001, but the difference in the risk of reflux aspiration was not statistically significant (0% vs 6.7%, P = .13). Complication rates during treatment were 8.3% for hypoxemia, 0% for reflux aspiration, 1.7% for hypertension, 1.7% for hypotension, 6.7% for tachycardia, 5% for bradycardia, and 10% for postoperative nausea and vomiting., Conclusions: HFNC can provide effective oxygen therapy for people undergoing FOB, and increases in IPP with flow in the range of 0-60 L/min may not increase the risk of reflux aspiration., Competing Interests: The authors have disclosed no conflicts of interest., (Copyright © 2024 by Daedalus Enterprises.)

The newly developed portable oxygen concentrator with an auto-demand oxygen delivery system (auto-DODS) automatically switches between 3 sensitivities according to the negative pressure gradient of inhalation and supplies oxygen only during inhalation. The aim of this study was to verify the effectiveness and safety of auto-demand devices compared with a continuous flow oxygen concentrator, during sleep, in a randomized crossover noninferiority trial. We alternatively used an auto-DODS or a continuous-flow oxygen concentrator, all night on separate days for HOT (Home Oxygen Therapy) patients with nocturnal hypoxemic symptoms. The primary endpoints were the mean value of oxygen saturation (SpO 2 ) over the total sleep time. The secondary endpoints included the efficacy endpoints and the safety endpoints. Regarding the primary endpoint, the difference in SpO 2 between the auto-DODS and continuous flow was 0.835%. Since the upper limit of this difference did not exceed 2.8, which was set as the noninferiority margin, it was shown that the auto-DODS did not reduce SpO 2 by at least 2.8% on average compared to continuous flow. No equipment failure or exacerbation of disease was observed, confirming the safety of the auto-DODS during the night., (© 2024. The Author(s).)

Objective: To describe the high-flow nasal cannula (HFNC) indications in the Spanish pediatric critical care units (PICUs)., Design: Descriptive cross-sectional observational study., Setting: Electronic survey among members of the Spanish Society of Pediatric Intensive Care (SECIP). It was sent weekly from April 10, 2023, to May 21, 2023., Participants: All SECIP members., Interventions: None., Main Variables of Interest: The questions focused on workplace, years of experience, use or non-use of HFNC, justification and expectations regarding its application, starting point within each center, clinical criteria for indication, existence of clinical guidelines, evaluation during its use, and criteria and mode of withdrawal., Results: Two hundred and two participants, 176 were from Spain. Of these, 87/176 had over ten years of experience. One hundred sixty two use HFNC and 66/162 have HFNC clinical guidelines. Acute bronchiolitis (138/162) and respiratory assistance after extubation (106/56) are the two main indications. For 62/162 HFNC may reduce therapeutic escalation. Neuromuscular diseases (105/162) and anatomical airway diseases (135/162) are the two main contraindications. The reasons to do not use HFNC were the absence of evidence about it effectiveness (8/14) and its inadequate cost/effectiveness balance (8/14)., Conclusions: A majority of Spanish pediatric intensivists use HFNC. Its application and withdrawal appears to be primarily based on clinical experience. Besides, those who use HFNC are aware of its limitations and the lack of evidence in some cases. It is necessary to develop single-center and multicenter studies to elucidate the effectiveness of this therapy in the context of critically ill children., (Copyright © 2024 Elsevier España, S.L.U. and SEMICYUC. All rights reserved.)

Background and Objectives: High-flow nasal cannula (HFNC) is used in up to 50% of children admitted with bronchiolitis. Consensus recommendations for feeding these children have not been established, and there is variability in practice. We sought to identify factors influencing feeding decisions for general care patients admitted with bronchiolitis on HFNC from a national sample of interdisciplinary care team members., Methods: In this qualitative study, we conducted semi-structured virtual interviews with care team members involved in making feeding decisions at 10 US hospitals from June 2022 to March 2023. Eligible participants included 1 nurse, respiratory therapist, speech language pathologist, and physician from each site. Interviews were audio-recorded, transcribed, and conducted until reaching sufficiency. Three researchers analyzed transcript data using content analysis guided by the Systems Engineering Initiative for Patient Safety 2.0 model., Results: We interviewed 29 participants, including 19 nurses, respiratory therapists, and speech language pathologists and 10 physicians. Participants identified 11 factors influencing feeding decisions related to hospital work systems and processes outlined in the Systems Engineering Initiative for Patient Safety model, including people (child and parent characteristics, care team experience), tools and technology (guideline, protocol, ordersets), organization (institutional culture, education), environment (time of day, care location), task (interventions to optimize feeding), and process (clinical assessment, feeding trial, communication)., Conclusions: Our findings suggest that feeding decisions are driven by factors related to the child, care team experience, institutional tools, and culture. These key factors may inform local improvement efforts to decrease variation in feeding children with bronchiolitis requiring HFNC., (Copyright © 2024 by the American Academy of Pediatrics.)

Objective: A high-flow nasal cannula is a practical and safe instrument that can be used for children with asthma exacerbation and promotes beneficial outcomes such as improved asthma severity scores and reduced hospitalization durations, salbutamol use, and oxygen use. To evaluate and compare the efficacy of high-flow nasal cannula treatment and that of bilevel positive airway pressure treatment as respiratory physiotherapy interventions for pediatric patients who are hospitalized because of asthma exacerbation., Methods: During a randomized clinical trial, treatment was performed using a high-flow nasal cannula and bilevel positive airway pressure for hospitalized children with asthma. After randomization, data regarding lung function, vital signs, and severity scores (pulmonary index, pediatric asthma severity, and pediatric asthma scores) were collected., Results: Fifty patients were included in this study (25 in the Bilevel Group and 25 in the high-flow nasal cannula group). After 45 minutes of therapy, an improvement in the forced expiratory volume in 1 second was observed. The high-flow nasal cannula group required fewer days of oxygen (O2) use, used fewer bronchodilators (number of salbutamol puffs), and required shorter hospitalization periods than the Bilevel Group (6.1±1.9 versus 4.3±1.3 days; 95% confidence interval, -5.0 to -0.6)., Conclusion: A high-flow nasal cannula is a viable option for the treatment of asthma exacerbation because it can reduce the hospitalization period and the need for O2 and bronchodilators. Additionally, it is a safe and comfortable treatment modality that is as effective as bilevel positive airway pressure.ClinicalTrials.gov Identifier: NCT04033666.

Long-term oxygen therapy (LTOT) is a treatment that involves the provision of supplemental oxygen to individuals with respiratory disease to correct hypoxemia in the post-acute care environment. Over 1.5 million adults in the United States use supplemental oxygen for various respiratory disorders. This paper explores literature published on LTOT from September 2022-September 2023. Upon the conclusion of this literature review, 4 distinct categories emerged. This paper highlights the significant findings associated with the 4 categories: supplemental oxygen and COVID-19, telemonitoring, LTOT equipment, and in-home high-flow nasal cannula., Competing Interests: Ms Wiles discloses a relationship with Drive Medical, and was a sponsored speaker for medtrade October 2022., (Copyright © 2024 by Daedalus Enterprises.)

Background: When treating acute respiratory failure, both hypoxemia and hyperoxemia should be avoided. S pO 2 should be monitored closely and O 2 flows adjusted accordingly. Achieving this goal might be easier with automated O 2 titration compared with manual titration of fixed-flow O 2 . We evaluated the feasibility of using an automated O 2 titration device in subjects treated for acute hypoxemic respiratory failure in a tertiary care hospital., Methods: Health-care workers received education and training about oxygen therapy, and were familiarized with an automated O 2 titration device (FreeO 2, ). A coordinator was available from 8:00 am to 5:00 pm during weekdays to provide technical assistance. The ability of the device to maintain S pO 2 within the prescribed therapeutic window was recorded. Basic clinical information was recorded., Results: Subjects were enrolled from November 2020 to August 2022. We trained 508 health-care workers on the use of automated O 2 titration, which was finally used on 872 occasions in 763 subjects, distributed on the respiratory, COVID-19, and thoracic surgery wards, and in the emergency department. Clinical information could be retrieved for 609 subjects (80%) who were on the system for a median (interquartile range) of 3 (2-6) d, which represented 2,567 subject-days of clinical experience with the device. In the 82 subjects (14%) for whom this information was available, the system maintained S pO 2 within the prescribed targets 89% of the time. Ninety-six subjects experienced clinical deterioration as defined by the need to be transferred to the ICU and/or requirement of high flow nasal oxygen but none of these events were judged to be related to the O 2 device., Conclusions: Automated O 2 titration could be successfully implemented in hospitalized subjects with hypoxemic respiratory failure from various causes. This experience should foster further improvement of the device and recommendations for an optimized utilization., Competing Interests: Drs Simon, Lacasse, Lellouche, and Maltais are shareholders of Oxynov, the maker of FreeO2; Dr Lellouche is co-founder of Oxynov., (Copyright © 2024 by Daedalus Enterprises.)

Objective: Optimal timing of continuous positive airway pressure (CPAP) cessation in preterm infants remains undetermined. We hypothesised that CPAP extension compared with weaning to low-flow nasal cannula (NC) reduces intermittent hypoxaemia (IH) and respiratory instability in preterm infants meeting criteria to discontinue CPAP., Design: Single-centre randomised clinical trial., Setting: Level 4 neonatal intensive care unit., Patients: 36 infants <34 weeks' gestation receiving CPAP≤5 cmH 2 O and fraction of inspired oxygen (FiO 2 ) ≤0.30 and meeting respiratory stability criteria., Interventions: Extended CPAP was compared with weaning to low-flow NC (0.5 L/kg/min with a limit of 1.0 L/min) for 24 hours., Outcomes: The primary outcome was IH (number of episodes with SpO 2 <85% lasting ≥10 s). Secondary outcomes included: coefficient of variability of SpO 2 , proportion of time in various SpO 2 ranges, episodes (≥10 s) with SpO 2 <80%, median cerebral and renal oxygenation, median effective FiO 2 , median transcutaneous carbon dioxide and bradycardia (<100/min for≥10 s)., Results: The median (IQR) episodes of IH per 24-hour period was 20 (6-48) in the CPAP group and 76 (18-101) in the NC group (p=0.03). Infants continued on CPAP had less bradycardia, time with SpO 2 <91% and <85%, and lower FiO 2 (all p<0.05). There were no statistically significant differences in IH<80%, median transcutaneous carbon dioxide or median cerebral or renal oxygenation., Conclusion: In preterm infants meeting respiratory stability criteria for CPAP cessation, extended CPAP decreased IH, bradycardia and other hypoxaemia measures compared with weaning to low-flow NC during the 24-hour intervention., Trial Registration Number: NCT04792099., Competing Interests: Competing interests: NA is on the advisory board for Radiometer, Shire and Resbiotic. CPT has applied for a patent with the USPTO for a bradycardia predictor and interrupter unrelated to the current study., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: The aims were twofold: (a) to map tools documented in the literature to evaluate comfort among patients undergoing high flow nasal cannula (HFNC) treatment; and (b) to assess if the retrieved tools have been validated for this purpose., Methods: A scoping review, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR). In July 2023, PubMed, Scopus, CINAHL and Cochrane Library were consulted. Studies assessing comfort in adult, paediatric, and neonatal patients undergoing HFNC were included., Results: Seventy-four articles were included, among which nine (12.2 %) investigated comfort as the primary aim. Twenty-five different tools were found, classifiable into 14 types, mostly unidimensional and originating from those measuring pain. The most widely used was the Visual Analogic Scale (n = 27, 35.6 %) followed by the Numerical Rating Scale (n = 11, 14.5 %) and less defined generic tools (n = 10, 13.2 %) with different metrics (e.g. 0-5, 0-10, 0-100). Only the General Comfort Questionnaire and the Comfort Scale were specifically validated for the assessment of comfort among adults and children, respectively., Conclusion: Although the comfort of patients undergoing HFNC is widely investigated in the literature, there is a scarcity of tools specifically validated in this field. Those used have been validated mainly to assess pain, suggesting the need to inform patients to prevent confusion while measuring comfort during HFNC and to develop more research in the field., Implications for Clinical Practice: Comfort assessment is an important aspect of nursing care. Given the lack of validation studies in the field, efforts in research are recommended., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Objectives: To compare high-flow nasal cannula (HFNC) versus nasal prong bubble continuous positive airway pressure (b-CPAP) in children with moderate to severe acute bronchiolitis., Design: A randomized controlled trial was carried out from August 2019 to February 2022. (Clinical Trials Registry of India number CTRI/2019/07/020402)., Setting: Pediatric emergency ward and ICU within a tertiary care center in India., Patients: Children 1-23 months old with moderate to severe acute bronchiolitis., Intervention: Comparison of HFNC with b-CPAP, using a primary outcome of treatment failure within 24 hours of randomization, as defined by any of: 1) a 1-point increase in modified Wood's clinical asthma score (m-WCAS) above baseline, 2) a rise in respiratory rate (RR) greater than 10 per minute from baseline, and 3) escalation in respiratory support. The secondary outcomes were success rate after crossover, if any, need for mechanical ventilation (invasive/noninvasive), local skin lesions, length of hospital stay, and complications., Results: In 118 children analyzed by intention-to-treat, HFNC ( n = 59) versus b-CPAP ( n = 59) was associated with a lower failure rate (23.7% vs. 42.4%; relative risk [95% CI], RR 0.56 [95% CI, 0.32-0.97], p = 0.031). The Cox proportion model confirmed a lower hazard of treatment failure in the HFNC group (adjusted hazard ratio 0.48 [95% CI, 0.25-0.94], p = 0.032). No crossover was noted. A lower proportion escalated to noninvasive ventilation in the HFNC group (15.3%) versus the b-CPAP group (15.3% vs. 39% [RR 0.39 (95% CI, 0.20-0.77)], p = 0.004). The HFNC group had a longer median (interquartile range) duration of oxygen therapy (4 [3-6] vs. 3 [3-5] d; p = 0.012) and hospital stay (6 [5-8.5] vs. 5 [4-7] d, p = 0.021). No significant difference was noted in other secondary outcomes., Conclusion: In children aged one to 23 months with moderate to severe acute bronchiolitis, the use of HFNC therapy as opposed to b-CPAP for early respiratory support is associated with a lower failure rate and, secondarily, a lower risk of escalation to mechanical ventilation., Competing Interests: The authors have disclosed that they do not have any potential conflicts of interest., (Copyright © 2024 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.)

Introduction: The effectiveness of home high flow nasal cannula (HFNC) for the treatment of chronic respiratory failure in patients with chronic respiratory diseases (CRDs) has not been summarized. We aimed to conduct a systematic review of the effectiveness, adherence, and safety of HFNC in the long-term treatment of patients with chronic respiratory diseases and respiratory failure., Methods: A systematic review was conducted. PubMed, Web of science, and SCOPUS were search up to August 2023. Long-term HFNC studies (≥4 weeks) reporting dyspnea; exacerbations, hospitalizations; peripheral oxygen saturation (SpO 2 ), comfort; patient experience, health-related quality of life or partial pressure of carbon dioxide (paCO 2 ) were included., Results: Thirteen articles (701 patients) based on 10 studies were selected: randomized control trials (n=3), randomized crossover trials (n=2), crossover (n=3) and retrospective (n=2) studies. COPD (n=6), bronchiectasis (n=2), COPD/bronchiectasis (n=1) and ILD (n=1) were the underlined CRDs. HFNC reduced exacerbations when compared to usual care/home respiratory therapies (n=6). Quality of life outcomes were also in favor of HFNC in patients with COPD and bronchiectasis (n=6). HFNC had significant effects on hospitalizations, paCO 2 , and lung function. Adherence ranged from 5.2 to 8.6h/day (n=5). Three studies reported no events, 3 non-serious events and 2 no differences compared with other home respiratory therapies., Conclusions: HFNC seems more effective than usual care or other home respiratory therapies in reducing exacerbations and improving quality of life in patients with COPD and bronchiectasis, while presenting good adherence and being safe. Its apparently superior effectiveness needs to be better studied in future real-world pragmatic trials., (Copyright © 2024 The Authors. Published by Elsevier España, S.L.U. All rights reserved.)