HFOT for the management of acute respiratory failure Webinar Editorial Review
High-flow oxygen therapy (HFOT), an emerging innovation in hospital respiratory care, is considered an alternative therapy to standard oxygen and non-invasive ventilation (NIV) in the landscape of ARF. The webinar coordinated by Philips Sleep and Respiratory Care “High Flow Oxygen Therapy for the Management of Acute Respiratory Failure Patients ” on Wednesday, 3 Nov 2020, discusses the recent clinical evidence for HFOT, as well as its uses in hypoxemic and hypercapnic ARF and when to choose HFOT or NIV for ARF. This webinar brings together experts in respiratory failure - Dr Mark Elliott, Consultant Physician in Respiratory Medicine at St James’s University Hospital, United Kingdom, Prof Arnaud W Thille, Head of Intensive Care Unit at University Hospital of Poitiers, France and Dr Jens Braunlich, Director of Medical Clinical Emden, Germany.
In light of the COVID-19 global health crisis and its unprecedented spread, it would be of greater interest for healthcare professionals to focus on current findings underlying different COVID-19-induced ARF scenarios. The various clinical representations of ARF were comprehensively discussed by Prof. Arnaud Thille, with HFOT favoured over standard oxygen therapy and NIV in specific scenarios. One such scenario is de novo ARF. The multicenter FLORALI study recruited a significant patient cohort with hypoxemic ARF, and the patients were randomly assigned to HFOT, standard oxygen therapy or NIV. Results were in favour of HFOT with regards to respiratory rate, sensation of dyspnea and mortality at 90 days. Moreover, post-hoc analysis of the study reveals that treatment of hypoxemic ARF with NIV may be potentially harmful due to elevated risks of intubation and mortality in patients. Clinical scenarios in support of the sole use of HFOT or combinatorial NIV and HFOT therapy are listed as such.
Similarly, Dr Jens Braunlich demonstrated better reintubation results when using both NIV and high flow nasal oxygen compared with high flow nasal oxygen alone in patients with acute hypercapnic respiratory failure. Comparison of HFOT against other modes of oxygenation therapies suggest that HFOT gives rise to lower mortality rates. However, this observation stems from limited data in case studies in Italy and France. More concrete evidence, such as results from randomized control trials, is warranted to objectively assess the superiority of HFOT in COVID-19-induced respiratory failure. Concerns are also raised pertaining to the high gas flow in HFOT, which is assumed to increase transmission of infectious agents thus augmenting the risks of COVID-19 infection. These concerns are unfounded as evidence shows that the bio-aerosol dispersion distance is similar between the usage of HFOT and conventional oxygen masks. Nevertheless, there is an additional benefit for COVID-19 patients to wear a surgical mask on top of receiving HFOT. Overall, the miscellaneous forms of ARF put forth a clinical conundrum in the treatment of this medical condition. To address this, clinicians should keep up to date with the latest evidence so as to treat ARF in an effective manner, be it with HFOT or other therapeutic strategies.
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