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FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com




Wednesday, June 17, 2015

Cánula nasal de flujo alto (HFNC)

PulmCrit: Pulmonary Intensivist's Blog
PulmCrit - May 24, 2015
"Pneumonia is extremely common. Nonetheless, there is surprisingly little evidence about supporting pneumonia patients using bi-level positive airway pressure (BiPAP) or high-flow nasal cannula (HFNC). The recent FLORALI study offers new insight into this. This post will explore how BiPAP and HFNC compare for pneumonia patients, prior evidence, and the FLORALI study."

The Botton Line - May 18 2015
  • "This study demonstrates that high-flow oxygen via nasal cannula is non-inferior to oxygen delivered by a non-rebreather facemask and BiPAP in reducing the subsequent need for intubation.
  • High flow oxygen reduces ICU and 90 day mortality compared with the other strategies. It also subjectively improves dyspnoea and respiratory discomfort at one hour compared with the other oxygen delivery devices.
  • Further studies are required to confirm whether high flow oxygen is beneficial in pulmonary and extra pulmonary causes of hypoxaemia and to determine its efficacy in ARDS."
"Jean-Pierre Frat describes the rationale and findings from his long-awaited trial on ventilation of patients with acute lung injury in this icTV interview. The FLORALI study is a randomised multicentric study which compared three strategies of ventilation support: standard oxygen therapy, NHFO, and NHFO with NIV in patients admitted to the ICU for acute hypoxemic respiratory failure."

Intensive Care Medicine Working Knowledge - May 28, 2015
"High flow humidified nasal oxygen provides a tolerable way of delivering a small amount of PEEP, maybe helps clear CO2, and is at least beneficial as a first line therapy in the more severely hypoxaemic patient. The questions of whether early intubation is beneficial, whether NIV is actually detrimental.
Many of us extrapolate the benefits beyond the tight confines of this trial already, but studies now need to focus on the subgroups in the exclusion set."

EM nerd - May 27, 2015
"In patients with non-hypercapnic, non-cardiogenic, hypoxic respiratory failure high-flow oxygen therapy decreases both mortality and the rate of intubation when compared to face-mask oxygenation. Additionally the use of BPAP does not decrease the rate of intubation and may in fact increase mortality in a subset of the sickest patients."