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Salvatore Maurizio Maggiore - One of the best experts on this subject based on the ideXlab platform.
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nasal high flow versus Venturi Mask oxygen therapy after extubation effects on oxygenation comfort and clinical outcome
American Journal of Respiratory and Critical Care Medicine, 2014Co-Authors: Salvatore Maurizio Maggiore, Luca Montini, Federica Antonicelli, A Cataldo, Rossano Festa, Francesco Idone, Rosanna Vaschetto, Andrea De Gaetano, Paolo Navalesi, M AntonelliAbstract:RATIONALE: Oxygen is commonly administered after extubation. Although several devices are available, data about their clinical efficacy are scarce. OBJECTIVES: To compare the effects of the Venturi Mask and the nasal high-flow (NHF) therapy on PaO2/FiO2SET ratio after extubation. Secondary endpoints were to assess effects on patient discomfort, adverse events, and clinical outcomes. METHODS: Randomized, controlled, open-label trial on 105 patients with a PaO2/FiO2 ratio less than or equal to 300 immediately before extubation. The Venturi Mask (n = 52) or NHF (n = 53) were applied for 48 hours postextubation. MEASUREMENTS AND MAIN RESULTS: PaO2/FiO2SET, patient discomfort caused by the interface and by symptoms of airways dryness (on a 10-point numerical rating scale), interface displacements, oxygen desaturations, need for ventilator support, and reintubation were assessed up to 48 hours after extubation. From the 24th hour, PaO2/FiO2SET was higher with the NHF (287 ± 74 vs. 247 ± 81 at 24 h; P = 0.03). Discomfort related both to the interface and to airways dryness was better with NHF (respectively, 2.6 ± 2.2 vs. 5.1 ± 3.3 at 24 h, P = 0.006; 2.2 ± 1.8 vs. 3.7 ± 2.4 at 24 h, P = 0.002). Fewer patients had interface displacements (32% vs. 56%; P = 0.01), oxygen desaturations (40% vs. 75%; P < 0.001), required reintubation (4% vs. 21%; P = 0.01), or any form of ventilator support (7% vs. 35%; P < 0.001) in the NHF group. CONCLUSIONS: Compared with the Venturi Mask, NHF results in better oxygenation for the same set FiO2 after extubation. Use of NHF is associated with better comfort, fewer desaturations and interface displacements, and a lower reintubation rate. Clinical trial registered with www.clinicaltrials.gov (NCT 01575353).
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nasal high flow versus Venturi Mask oxygen therapy after extubation effects on oxygenation comfort and clinical outcome
American Journal of Respiratory and Critical Care Medicine, 2014Co-Authors: Salvatore Maurizio Maggiore, Luca Montini, Federica Antonicelli, A Cataldo, Rossano Festa, Francesco Idone, Rosanna Vaschetto, Andrea De Gaetano, Paolo Navalesi, M AntonelliAbstract:Rationale Oxygen is commonly administered after extubation. Although several devices are available, data about their clinical efficacy are scarce. Objectives To compare the effects of the Venturi Mask and the nasal high-flow (NHF) therapy on PaO2/FiO2SET ratio after extubation. Secondary endpoints were to assess effects on patient discomfort, adverse events, and clinical outcomes. Methods Randomized, controlled, open-label trial on 105 patients with a PaO2/FiO2 ratio less than or equal to 300 immediately before extubation. The Venturi Mask (n = 52) or NHF (n = 53) were applied for 48 hours postextubation. Measurements and main results PaO2/FiO2SET, patient discomfort caused by the interface and by symptoms of airways dryness (on a 10-point numerical rating scale), interface displacements, oxygen desaturations, need for ventilator support, and reintubation were assessed up to 48 hours after extubation. From the 24th hour, PaO2/FiO2SET was higher with the NHF (287 ± 74 vs. 247 ± 81 at 24 h; P = 0.03). Discomfort related both to the interface and to airways dryness was better with NHF (respectively, 2.6 ± 2.2 vs. 5.1 ± 3.3 at 24 h, P = 0.006; 2.2 ± 1.8 vs. 3.7 ± 2.4 at 24 h, P = 0.002). Fewer patients had interface displacements (32% vs. 56%; P = 0.01), oxygen desaturations (40% vs. 75%; P Conclusions Compared with the Venturi Mask, NHF results in better oxygenation for the same set FiO2 after extubation. Use of NHF is associated with better comfort, fewer desaturations and interface displacements, and a lower reintubation rate. Clinical trial registered with www.clinicaltrials.gov (NCT 01575353).
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Influence of lung collapse distribution on the physiologic response to recruitment maneuvers during noninvasive continuous positive airway pressure
Intensive Care Medicine, 2011Co-Authors: Gianmaria Cammarota, Salvatore Maurizio Maggiore, Rosanna Vaschetto, Emilia Turucz, Fabrizio Dellapiazza, Davide Colombo, Cristiana Blando, Francesco Della Corte, Paolo NavalesiAbstract:Purpose Noninvasive continuous positive airway pressure (n-CPAP) has been proposed for the treatment of hypoxemic acute respiratory failure (h-ARF). Recruitment maneuvers were shown to improve oxygenation, i.e., the ratio of arterial oxygen tension to inspiratory oxygen fraction (PaO_2/FiO_2), during either invasive mechanical ventilation, and n-CPAP, with a response depending on the distribution of lung collapse. We hypothesized that, during n-CPAP, early h-ARF patients with bilateral (B_L) distribution of lung involvement would benefit from recruitment maneuvers more than those with unilateral (U_L) involvement. Methods To perform a recruitment maneuver, once a minute we increased the pressure applied to the airway from 10 cmH_2O to 25 cmH_2O for 8 s (SIGH). We enrolled 24 patients with h-ARF (12 B_L and 12 U_L) who underwent four consecutive trials: (1) 30 min breathing through a Venturi Mask (V_Mask), (2) 1 h n-CPAP (n-CPAP_1), (3) 1 h n-CPAP plus SIGH (n-CPAP_SIGH), and (4) 1 h n-CPAP (n-CPAP_2). Results Compared to V_Mask, n-CPAP at 10 cmH_2O delivered via a helmet, increased PaO_2/FiO_2 and decreased dyspnea in both B_L and U_L; furthermore, it reduced the respiratory rate and brought PaCO_2 up to normal in B_L only. Compared to n-CPAP, n-CPAP_SIGH significantly improved PaO_2/FiO_2 in B_L (225 ± 88 vs. 308 ± 105, respectively), whereas it produced no further improvement in PaO_2/FiO_2 in U_L (232 ± 72 vs. 231 ± 77, respectively). SIGH did not affect hemodynamics in both groups. Conclusions Compared to n-CPAP, n-CPAP_SIGH further improved arterial oxygenation in B_L patients, whereas it produced no additional benefit in those with U_L.
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high flow oxygen therapy through nasal cannulae versus low flow oxygen therapy via Venturi Mask after extubation in adult critically ill patients
Critical Care, 2011Co-Authors: Federica Antonicelli, A Cataldo, Rossano Festa, Francesco Idone, A Moccaldo, M Antonelli, Salvatore Maurizio MaggioreAbstract:Oxygen therapy, usually delivered with the Venturi Mask, is frequently used in critically ill patients after extubation. This device delivers low-flow oxygen with cold humidification. Recently available is a new device for oxygen therapy through nasal cannulae (NHF). Such a device delivers up to 60 l/minute oxygen, with heated humidification. The aim of this study was to compare the effects of these two devices for oxygen therapy on arterial blood gases, discomfort and adverse events in critically ill patients after extubation.
M Antonelli - One of the best experts on this subject based on the ideXlab platform.
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nasal high flow versus Venturi Mask oxygen therapy after extubation effects on oxygenation comfort and clinical outcome
American Journal of Respiratory and Critical Care Medicine, 2014Co-Authors: Salvatore Maurizio Maggiore, Luca Montini, Federica Antonicelli, A Cataldo, Rossano Festa, Francesco Idone, Rosanna Vaschetto, Andrea De Gaetano, Paolo Navalesi, M AntonelliAbstract:RATIONALE: Oxygen is commonly administered after extubation. Although several devices are available, data about their clinical efficacy are scarce. OBJECTIVES: To compare the effects of the Venturi Mask and the nasal high-flow (NHF) therapy on PaO2/FiO2SET ratio after extubation. Secondary endpoints were to assess effects on patient discomfort, adverse events, and clinical outcomes. METHODS: Randomized, controlled, open-label trial on 105 patients with a PaO2/FiO2 ratio less than or equal to 300 immediately before extubation. The Venturi Mask (n = 52) or NHF (n = 53) were applied for 48 hours postextubation. MEASUREMENTS AND MAIN RESULTS: PaO2/FiO2SET, patient discomfort caused by the interface and by symptoms of airways dryness (on a 10-point numerical rating scale), interface displacements, oxygen desaturations, need for ventilator support, and reintubation were assessed up to 48 hours after extubation. From the 24th hour, PaO2/FiO2SET was higher with the NHF (287 ± 74 vs. 247 ± 81 at 24 h; P = 0.03). Discomfort related both to the interface and to airways dryness was better with NHF (respectively, 2.6 ± 2.2 vs. 5.1 ± 3.3 at 24 h, P = 0.006; 2.2 ± 1.8 vs. 3.7 ± 2.4 at 24 h, P = 0.002). Fewer patients had interface displacements (32% vs. 56%; P = 0.01), oxygen desaturations (40% vs. 75%; P < 0.001), required reintubation (4% vs. 21%; P = 0.01), or any form of ventilator support (7% vs. 35%; P < 0.001) in the NHF group. CONCLUSIONS: Compared with the Venturi Mask, NHF results in better oxygenation for the same set FiO2 after extubation. Use of NHF is associated with better comfort, fewer desaturations and interface displacements, and a lower reintubation rate. Clinical trial registered with www.clinicaltrials.gov (NCT 01575353).
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nasal high flow versus Venturi Mask oxygen therapy after extubation effects on oxygenation comfort and clinical outcome
American Journal of Respiratory and Critical Care Medicine, 2014Co-Authors: Salvatore Maurizio Maggiore, Luca Montini, Federica Antonicelli, A Cataldo, Rossano Festa, Francesco Idone, Rosanna Vaschetto, Andrea De Gaetano, Paolo Navalesi, M AntonelliAbstract:Rationale Oxygen is commonly administered after extubation. Although several devices are available, data about their clinical efficacy are scarce. Objectives To compare the effects of the Venturi Mask and the nasal high-flow (NHF) therapy on PaO2/FiO2SET ratio after extubation. Secondary endpoints were to assess effects on patient discomfort, adverse events, and clinical outcomes. Methods Randomized, controlled, open-label trial on 105 patients with a PaO2/FiO2 ratio less than or equal to 300 immediately before extubation. The Venturi Mask (n = 52) or NHF (n = 53) were applied for 48 hours postextubation. Measurements and main results PaO2/FiO2SET, patient discomfort caused by the interface and by symptoms of airways dryness (on a 10-point numerical rating scale), interface displacements, oxygen desaturations, need for ventilator support, and reintubation were assessed up to 48 hours after extubation. From the 24th hour, PaO2/FiO2SET was higher with the NHF (287 ± 74 vs. 247 ± 81 at 24 h; P = 0.03). Discomfort related both to the interface and to airways dryness was better with NHF (respectively, 2.6 ± 2.2 vs. 5.1 ± 3.3 at 24 h, P = 0.006; 2.2 ± 1.8 vs. 3.7 ± 2.4 at 24 h, P = 0.002). Fewer patients had interface displacements (32% vs. 56%; P = 0.01), oxygen desaturations (40% vs. 75%; P Conclusions Compared with the Venturi Mask, NHF results in better oxygenation for the same set FiO2 after extubation. Use of NHF is associated with better comfort, fewer desaturations and interface displacements, and a lower reintubation rate. Clinical trial registered with www.clinicaltrials.gov (NCT 01575353).
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high flow oxygen therapy through nasal cannulae versus low flow oxygen therapy via Venturi Mask after extubation in adult critically ill patients
Critical Care, 2011Co-Authors: Federica Antonicelli, A Cataldo, Rossano Festa, Francesco Idone, A Moccaldo, M Antonelli, Salvatore Maurizio MaggioreAbstract:Oxygen therapy, usually delivered with the Venturi Mask, is frequently used in critically ill patients after extubation. This device delivers low-flow oxygen with cold humidification. Recently available is a new device for oxygen therapy through nasal cannulae (NHF). Such a device delivers up to 60 l/minute oxygen, with heated humidification. The aim of this study was to compare the effects of these two devices for oxygen therapy on arterial blood gases, discomfort and adverse events in critically ill patients after extubation.
Luca Montini - One of the best experts on this subject based on the ideXlab platform.
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early nasal high flow versus Venturi Mask oxygen therapy after lung resection a randomized trial
Critical Care, 2019Co-Authors: Mariano Alberto Pennisi, Giuseppe Bello, Maria Teresa Congedo, Luca Montini, Dania Nachira, Gian Maria Ferretti, Gennaro De Pascale, Elisabetta Gualtieri, Elisa Meacci, Domenico Luca GriecoAbstract:Background Data on high-flow nasal oxygen after thoracic surgery are limited and confined to the comparison with low-flow oxygen. Different from low-flow oxygen, Venturi Masks provide higher gas flow at a predetermined fraction of inspired oxygen (FiO2). We conducted a randomized trial to determine whether preemptive high-flow nasal oxygen reduces the incidence of postoperative hypoxemia after lung resection, as compared to Venturi Mask oxygen therapy.
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Early nasal high-flow versus Venturi Mask oxygen therapy after lung resection: a randomized trial
BMC, 2019Co-Authors: Mariano Alberto Pennisi, Giuseppe Bello, Maria Teresa Congedo, Luca Montini, Dania Nachira, Gian Maria Ferretti, Gennaro De Pascale, Elisabetta Gualtieri, Elisa Meacci, Domenico Luca GriecoAbstract:Abstract Background Data on high-flow nasal oxygen after thoracic surgery are limited and confined to the comparison with low-flow oxygen. Different from low-flow oxygen, Venturi Masks provide higher gas flow at a predetermined fraction of inspired oxygen (FiO2). We conducted a randomized trial to determine whether preemptive high-flow nasal oxygen reduces the incidence of postoperative hypoxemia after lung resection, as compared to Venturi Mask oxygen therapy. Methods In this single-center, randomized trial conducted in a teaching hospital in Italy, consecutive adult patients undergoing thoracotomic lung resection, who were not on long-term oxygen therapy, were randomly assigned to receive high-flow nasal or Venturi Mask oxygen after extubation continuously for two postoperative days. The primary outcome was the incidence of postoperative hypoxemia (i.e., ratio of the partial pressure of arterial oxygen to FiO2 (PaO2/FiO2) lower than 300 mmHg) within four postoperative days. Results Between September 2015 and April 2018, 96 patients were enrolled; 95 patients were analyzed (47 in high-flow group and 48 in Venturi Mask group). In both groups, 38 patients (81% in the high-flow group and 79% in the Venturi Mask group) developed postoperative hypoxemia, with an unadjusted odds ratio (OR) for the high-flow group of 1.11 [95% confidence interval (CI) 0.41–3] (p = 0.84). No inter-group differences were found in the degree of dyspnea nor in the proportion of patients needing oxygen therapy after treatment discontinuation (OR 1.34 [95% CI 0.60–3]), experiencing pulmonary complications (OR 1.29 [95% CI 0.51–3.25]) or requiring ventilatory support (OR 0.67 [95% CI 0.11–4.18]). Post hoc analyses revealed that PaO2/FiO2 during the study was not different between groups (p = 0.92), but patients receiving high-flow nasal oxygen had lower arterial pressure of carbon dioxide, with a mean inter-group difference of 2 mmHg [95% CI 0.5–3.4] (p = 0.009), and were burdened by a lower risk of postoperative hypercapnia (adjusted OR 0.18 [95% CI 0.06–0.54], p = 0.002). Conclusions When compared to Venturi Mask after thoracotomic lung resection, preemptive high-flow nasal oxygen did not reduce the incidence of postoperative hypoxemia nor improved other analyzed outcomes. Further adequately powered investigations in this setting are warranted to establish whether high-flow nasal oxygen may yield clinical benefit on carbon dioxide clearance. Trial registration ClinicalTrials.gov, NCT02544477. Registered 9 September 2015
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nasal high flow versus Venturi Mask oxygen therapy after extubation effects on oxygenation comfort and clinical outcome
American Journal of Respiratory and Critical Care Medicine, 2014Co-Authors: Salvatore Maurizio Maggiore, Luca Montini, Federica Antonicelli, A Cataldo, Rossano Festa, Francesco Idone, Rosanna Vaschetto, Andrea De Gaetano, Paolo Navalesi, M AntonelliAbstract:Rationale Oxygen is commonly administered after extubation. Although several devices are available, data about their clinical efficacy are scarce. Objectives To compare the effects of the Venturi Mask and the nasal high-flow (NHF) therapy on PaO2/FiO2SET ratio after extubation. Secondary endpoints were to assess effects on patient discomfort, adverse events, and clinical outcomes. Methods Randomized, controlled, open-label trial on 105 patients with a PaO2/FiO2 ratio less than or equal to 300 immediately before extubation. The Venturi Mask (n = 52) or NHF (n = 53) were applied for 48 hours postextubation. Measurements and main results PaO2/FiO2SET, patient discomfort caused by the interface and by symptoms of airways dryness (on a 10-point numerical rating scale), interface displacements, oxygen desaturations, need for ventilator support, and reintubation were assessed up to 48 hours after extubation. From the 24th hour, PaO2/FiO2SET was higher with the NHF (287 ± 74 vs. 247 ± 81 at 24 h; P = 0.03). Discomfort related both to the interface and to airways dryness was better with NHF (respectively, 2.6 ± 2.2 vs. 5.1 ± 3.3 at 24 h, P = 0.006; 2.2 ± 1.8 vs. 3.7 ± 2.4 at 24 h, P = 0.002). Fewer patients had interface displacements (32% vs. 56%; P = 0.01), oxygen desaturations (40% vs. 75%; P Conclusions Compared with the Venturi Mask, NHF results in better oxygenation for the same set FiO2 after extubation. Use of NHF is associated with better comfort, fewer desaturations and interface displacements, and a lower reintubation rate. Clinical trial registered with www.clinicaltrials.gov (NCT 01575353).
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nasal high flow versus Venturi Mask oxygen therapy after extubation effects on oxygenation comfort and clinical outcome
American Journal of Respiratory and Critical Care Medicine, 2014Co-Authors: Salvatore Maurizio Maggiore, Luca Montini, Federica Antonicelli, A Cataldo, Rossano Festa, Francesco Idone, Rosanna Vaschetto, Andrea De Gaetano, Paolo Navalesi, M AntonelliAbstract:RATIONALE: Oxygen is commonly administered after extubation. Although several devices are available, data about their clinical efficacy are scarce. OBJECTIVES: To compare the effects of the Venturi Mask and the nasal high-flow (NHF) therapy on PaO2/FiO2SET ratio after extubation. Secondary endpoints were to assess effects on patient discomfort, adverse events, and clinical outcomes. METHODS: Randomized, controlled, open-label trial on 105 patients with a PaO2/FiO2 ratio less than or equal to 300 immediately before extubation. The Venturi Mask (n = 52) or NHF (n = 53) were applied for 48 hours postextubation. MEASUREMENTS AND MAIN RESULTS: PaO2/FiO2SET, patient discomfort caused by the interface and by symptoms of airways dryness (on a 10-point numerical rating scale), interface displacements, oxygen desaturations, need for ventilator support, and reintubation were assessed up to 48 hours after extubation. From the 24th hour, PaO2/FiO2SET was higher with the NHF (287 ± 74 vs. 247 ± 81 at 24 h; P = 0.03). Discomfort related both to the interface and to airways dryness was better with NHF (respectively, 2.6 ± 2.2 vs. 5.1 ± 3.3 at 24 h, P = 0.006; 2.2 ± 1.8 vs. 3.7 ± 2.4 at 24 h, P = 0.002). Fewer patients had interface displacements (32% vs. 56%; P = 0.01), oxygen desaturations (40% vs. 75%; P < 0.001), required reintubation (4% vs. 21%; P = 0.01), or any form of ventilator support (7% vs. 35%; P < 0.001) in the NHF group. CONCLUSIONS: Compared with the Venturi Mask, NHF results in better oxygenation for the same set FiO2 after extubation. Use of NHF is associated with better comfort, fewer desaturations and interface displacements, and a lower reintubation rate. Clinical trial registered with www.clinicaltrials.gov (NCT 01575353).
Paolo Navalesi - One of the best experts on this subject based on the ideXlab platform.
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High-flow oxygen therapy in hypercapnic patients recovering from an episode of acute-on-chronic respiratory failure
European Respiratory Journal, 2017Co-Authors: Federico Longhini, Paolo Navalesi, Stefano Nava, Lara Pisani, Ramona Lungu, Vittoria Comellini, Gianmaria Cammarota, Andrea Bruni, Eugenio Garofalo, Maria Laura VegaAbstract:Background: High-Flow Oxygen Therapy (HFOT) has assumed a key role in the management of de novo acute respiratory failure (ARF). Little is known, however, about the effects of HFNO in acute-on-chronic ARF. Aim: To compare HFOT with standard oxygen therapy through a Venturi Mask (VM) in patients treated for at least 24 hours with noninvasive ventilation (NIV) for acute-on-chronic ARF. Methods: 27 patients on NIV with pH>7.34 and respiratory rate ≤30 breaths/min underwent five 20-minute trials: NIV1, VM, NIV2, HFOT and NIV3. VM and HFOT were randomly applied. NIV was delivered by face Mask using ventilators equipped with NIV software. HFONC flow was set at 60 L/min. At the end of each trial, we measured by ultrasound diaphragm displacement (DD) and thickening fraction (DTF), patients9 dyspnoea and comfort and arterial blood gases. Data are expressed as median [25th-75th IQR]. Results: DD was no different among the 5 trials, while DTF was significantly higher (p Conclusions: Compared to VM, HFOT reduces DTF and is better tolerated, while slightly improving oxygenation and dyspnoea.
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nasal high flow versus Venturi Mask oxygen therapy after extubation effects on oxygenation comfort and clinical outcome
American Journal of Respiratory and Critical Care Medicine, 2014Co-Authors: Salvatore Maurizio Maggiore, Luca Montini, Federica Antonicelli, A Cataldo, Rossano Festa, Francesco Idone, Rosanna Vaschetto, Andrea De Gaetano, Paolo Navalesi, M AntonelliAbstract:Rationale Oxygen is commonly administered after extubation. Although several devices are available, data about their clinical efficacy are scarce. Objectives To compare the effects of the Venturi Mask and the nasal high-flow (NHF) therapy on PaO2/FiO2SET ratio after extubation. Secondary endpoints were to assess effects on patient discomfort, adverse events, and clinical outcomes. Methods Randomized, controlled, open-label trial on 105 patients with a PaO2/FiO2 ratio less than or equal to 300 immediately before extubation. The Venturi Mask (n = 52) or NHF (n = 53) were applied for 48 hours postextubation. Measurements and main results PaO2/FiO2SET, patient discomfort caused by the interface and by symptoms of airways dryness (on a 10-point numerical rating scale), interface displacements, oxygen desaturations, need for ventilator support, and reintubation were assessed up to 48 hours after extubation. From the 24th hour, PaO2/FiO2SET was higher with the NHF (287 ± 74 vs. 247 ± 81 at 24 h; P = 0.03). Discomfort related both to the interface and to airways dryness was better with NHF (respectively, 2.6 ± 2.2 vs. 5.1 ± 3.3 at 24 h, P = 0.006; 2.2 ± 1.8 vs. 3.7 ± 2.4 at 24 h, P = 0.002). Fewer patients had interface displacements (32% vs. 56%; P = 0.01), oxygen desaturations (40% vs. 75%; P Conclusions Compared with the Venturi Mask, NHF results in better oxygenation for the same set FiO2 after extubation. Use of NHF is associated with better comfort, fewer desaturations and interface displacements, and a lower reintubation rate. Clinical trial registered with www.clinicaltrials.gov (NCT 01575353).
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nasal high flow versus Venturi Mask oxygen therapy after extubation effects on oxygenation comfort and clinical outcome
American Journal of Respiratory and Critical Care Medicine, 2014Co-Authors: Salvatore Maurizio Maggiore, Luca Montini, Federica Antonicelli, A Cataldo, Rossano Festa, Francesco Idone, Rosanna Vaschetto, Andrea De Gaetano, Paolo Navalesi, M AntonelliAbstract:RATIONALE: Oxygen is commonly administered after extubation. Although several devices are available, data about their clinical efficacy are scarce. OBJECTIVES: To compare the effects of the Venturi Mask and the nasal high-flow (NHF) therapy on PaO2/FiO2SET ratio after extubation. Secondary endpoints were to assess effects on patient discomfort, adverse events, and clinical outcomes. METHODS: Randomized, controlled, open-label trial on 105 patients with a PaO2/FiO2 ratio less than or equal to 300 immediately before extubation. The Venturi Mask (n = 52) or NHF (n = 53) were applied for 48 hours postextubation. MEASUREMENTS AND MAIN RESULTS: PaO2/FiO2SET, patient discomfort caused by the interface and by symptoms of airways dryness (on a 10-point numerical rating scale), interface displacements, oxygen desaturations, need for ventilator support, and reintubation were assessed up to 48 hours after extubation. From the 24th hour, PaO2/FiO2SET was higher with the NHF (287 ± 74 vs. 247 ± 81 at 24 h; P = 0.03). Discomfort related both to the interface and to airways dryness was better with NHF (respectively, 2.6 ± 2.2 vs. 5.1 ± 3.3 at 24 h, P = 0.006; 2.2 ± 1.8 vs. 3.7 ± 2.4 at 24 h, P = 0.002). Fewer patients had interface displacements (32% vs. 56%; P = 0.01), oxygen desaturations (40% vs. 75%; P < 0.001), required reintubation (4% vs. 21%; P = 0.01), or any form of ventilator support (7% vs. 35%; P < 0.001) in the NHF group. CONCLUSIONS: Compared with the Venturi Mask, NHF results in better oxygenation for the same set FiO2 after extubation. Use of NHF is associated with better comfort, fewer desaturations and interface displacements, and a lower reintubation rate. Clinical trial registered with www.clinicaltrials.gov (NCT 01575353).
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Influence of lung collapse distribution on the physiologic response to recruitment maneuvers during noninvasive continuous positive airway pressure
Intensive Care Medicine, 2011Co-Authors: Gianmaria Cammarota, Salvatore Maurizio Maggiore, Rosanna Vaschetto, Emilia Turucz, Fabrizio Dellapiazza, Davide Colombo, Cristiana Blando, Francesco Della Corte, Paolo NavalesiAbstract:Purpose Noninvasive continuous positive airway pressure (n-CPAP) has been proposed for the treatment of hypoxemic acute respiratory failure (h-ARF). Recruitment maneuvers were shown to improve oxygenation, i.e., the ratio of arterial oxygen tension to inspiratory oxygen fraction (PaO_2/FiO_2), during either invasive mechanical ventilation, and n-CPAP, with a response depending on the distribution of lung collapse. We hypothesized that, during n-CPAP, early h-ARF patients with bilateral (B_L) distribution of lung involvement would benefit from recruitment maneuvers more than those with unilateral (U_L) involvement. Methods To perform a recruitment maneuver, once a minute we increased the pressure applied to the airway from 10 cmH_2O to 25 cmH_2O for 8 s (SIGH). We enrolled 24 patients with h-ARF (12 B_L and 12 U_L) who underwent four consecutive trials: (1) 30 min breathing through a Venturi Mask (V_Mask), (2) 1 h n-CPAP (n-CPAP_1), (3) 1 h n-CPAP plus SIGH (n-CPAP_SIGH), and (4) 1 h n-CPAP (n-CPAP_2). Results Compared to V_Mask, n-CPAP at 10 cmH_2O delivered via a helmet, increased PaO_2/FiO_2 and decreased dyspnea in both B_L and U_L; furthermore, it reduced the respiratory rate and brought PaCO_2 up to normal in B_L only. Compared to n-CPAP, n-CPAP_SIGH significantly improved PaO_2/FiO_2 in B_L (225 ± 88 vs. 308 ± 105, respectively), whereas it produced no further improvement in PaO_2/FiO_2 in U_L (232 ± 72 vs. 231 ± 77, respectively). SIGH did not affect hemodynamics in both groups. Conclusions Compared to n-CPAP, n-CPAP_SIGH further improved arterial oxygenation in B_L patients, whereas it produced no additional benefit in those with U_L.
Domenico Luca Grieco - One of the best experts on this subject based on the ideXlab platform.
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early nasal high flow versus Venturi Mask oxygen therapy after lung resection a randomized trial
Critical Care, 2019Co-Authors: Mariano Alberto Pennisi, Giuseppe Bello, Maria Teresa Congedo, Luca Montini, Dania Nachira, Gian Maria Ferretti, Gennaro De Pascale, Elisabetta Gualtieri, Elisa Meacci, Domenico Luca GriecoAbstract:Background Data on high-flow nasal oxygen after thoracic surgery are limited and confined to the comparison with low-flow oxygen. Different from low-flow oxygen, Venturi Masks provide higher gas flow at a predetermined fraction of inspired oxygen (FiO2). We conducted a randomized trial to determine whether preemptive high-flow nasal oxygen reduces the incidence of postoperative hypoxemia after lung resection, as compared to Venturi Mask oxygen therapy.
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Early nasal high-flow versus Venturi Mask oxygen therapy after lung resection: a randomized trial
BMC, 2019Co-Authors: Mariano Alberto Pennisi, Giuseppe Bello, Maria Teresa Congedo, Luca Montini, Dania Nachira, Gian Maria Ferretti, Gennaro De Pascale, Elisabetta Gualtieri, Elisa Meacci, Domenico Luca GriecoAbstract:Abstract Background Data on high-flow nasal oxygen after thoracic surgery are limited and confined to the comparison with low-flow oxygen. Different from low-flow oxygen, Venturi Masks provide higher gas flow at a predetermined fraction of inspired oxygen (FiO2). We conducted a randomized trial to determine whether preemptive high-flow nasal oxygen reduces the incidence of postoperative hypoxemia after lung resection, as compared to Venturi Mask oxygen therapy. Methods In this single-center, randomized trial conducted in a teaching hospital in Italy, consecutive adult patients undergoing thoracotomic lung resection, who were not on long-term oxygen therapy, were randomly assigned to receive high-flow nasal or Venturi Mask oxygen after extubation continuously for two postoperative days. The primary outcome was the incidence of postoperative hypoxemia (i.e., ratio of the partial pressure of arterial oxygen to FiO2 (PaO2/FiO2) lower than 300 mmHg) within four postoperative days. Results Between September 2015 and April 2018, 96 patients were enrolled; 95 patients were analyzed (47 in high-flow group and 48 in Venturi Mask group). In both groups, 38 patients (81% in the high-flow group and 79% in the Venturi Mask group) developed postoperative hypoxemia, with an unadjusted odds ratio (OR) for the high-flow group of 1.11 [95% confidence interval (CI) 0.41–3] (p = 0.84). No inter-group differences were found in the degree of dyspnea nor in the proportion of patients needing oxygen therapy after treatment discontinuation (OR 1.34 [95% CI 0.60–3]), experiencing pulmonary complications (OR 1.29 [95% CI 0.51–3.25]) or requiring ventilatory support (OR 0.67 [95% CI 0.11–4.18]). Post hoc analyses revealed that PaO2/FiO2 during the study was not different between groups (p = 0.92), but patients receiving high-flow nasal oxygen had lower arterial pressure of carbon dioxide, with a mean inter-group difference of 2 mmHg [95% CI 0.5–3.4] (p = 0.009), and were burdened by a lower risk of postoperative hypercapnia (adjusted OR 0.18 [95% CI 0.06–0.54], p = 0.002). Conclusions When compared to Venturi Mask after thoracotomic lung resection, preemptive high-flow nasal oxygen did not reduce the incidence of postoperative hypoxemia nor improved other analyzed outcomes. Further adequately powered investigations in this setting are warranted to establish whether high-flow nasal oxygen may yield clinical benefit on carbon dioxide clearance. Trial registration ClinicalTrials.gov, NCT02544477. Registered 9 September 2015
