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Table 1 Summary of findings in studies of the HFNT with regard to dyspnea, comfort, and respiratory rate

From: Effect of high-flow nasal therapy on dyspnea, comfort, and respiratory rate

Study Type Design Intervention (N) Control (N) Treatment methods Measurement method Dyspnea Comfort Respiratory rate
Bell N. [6]
Emerg Med Australas 2015
AHRF RCT HFNT (48) COT (52) HFNT: flow 50 L/m, FiO2 30% titrated to SpO2 95%
COT: discretion of the treating physician
Dyspnea: Borg Scale
Comfort: Likert Scale
HFNT§ HFNT§ (1 h) HFNT§ (2 h)
Frat J.P. [7]
N Engl J Med 2015
AHRF RCT HFNT (106) COT (94)
NIV (110)
HFNT: flow 50 L/m, FiO2 100% then titrated to SpO2 92%
COT: O2 titrated to SpO2 92%
NIV: PSV PEEP from 2 up to 10 fiO2 adjusted to SpO2 92%
Dyspnea: Likert Scale
Comfort: VAS
HFNT§ HFNT§ HFNT§ (1 h)
Lemiale V. [8]
Crit Care 2015
AHRF
(Immunocompromised)
RCT HFNT (52) COT (52) HFNT: flow from 40 up to 50 L/m, FiO2 titrated to SpO2 95%
COT: O2 titrated to SpO2 95%
Dyspnea: VAS
Comfort: VAS
NS NS NS
Jones P.G. [9]
Respir Care 2016
AHRF RCT HFNT (172) COT (150) HFNT: flow 40 L/m, 37 °C, FiO2 28%
COT: FiO2 titrated to clinical needs
Dyspnea: Survey questions
Comfort: Survey questions
NS Overall comfort: NS
“Dry my nose”: HFNT§
“In future I prefer”: COT§
“This method is worst”: HFNT§
NS
Doshi P. [10]
Ann Emergency Med 2017
AHRF RCT HFNT (104) NIV (112) HFNT: flow from 35 L/m up to 40 L/m, T° between 35 and 37 °C
NIV: IPAP from 10 up to 20 cmH20, EPAP from 5 up to 10 cmH20, FiO2 100%
Dyspnea: Borg Scale
Comfort: NA
NA NA NA
Makdee O. [11]
Ann Emergency Med 2017
AHRF
(CPE)
RCT HFNT (63) COT (65) HFNT: flow from 35 up to 60 L/m, FiO2 titrated to SpO2 95%
COT: O2 titrated to SpO2 95%
Dyspnea: VAS
Comfort: NA
NS NA HFNT§
(15, 30, 60 min)
Azoulay E. [12]
JAMA 2018
AHRF
(Immunocompromised)
RCT HFNT (388) COT (388) HFNT: flow 50 L/min, FiO2 titrated to SpO2 95%
COT: O2 titrated to SpO2 95%
Dyspnea: Dyspnea Score
Comfort: VAS
NS NS HFNC§ (6 h)
Spoletini G. [13]
J Crit Care 2018
AHRF
(On NIV)
RCT HFNT (23) COT (24) HFNT: flow 35 L/m, FiO2 titrated to SpO2 92% (hypoxic) or to 88–92%(hypercapnic)
COT: flow adjusted to maintain the same SpO2
Dyspnea: Borg Scale
Comfort: VAS
NS HFNT§ NS
Cuquemelle E. [14]
Respir Care 2012
AHRF Crossover HFNT (37) COT (37) HFNT: flow 40 L/m, FiO2 titrated to SpO2 95%
COT: O2 titrated to SpO2 95%
Dyspnea: NA
Comfort: Dryness
NA HFNT§ NA
Schwabbauer N. [15]
BMC Anesthesiol 2014
AHRF Crossover HFNT (14) COT (14)
NIV (14)
HFNT: flow 55 L/m, FiO2 60%
COT: Venturi mask FiO2 60%
NIV: PSV FiO2 60% PEEP 5 cmH20 PS 6-8 ml/kg PBW
Dyspnea: Borg Scale
Comfort: NRS
HFNT vs. COT
HFNT§ vs. NIV
HFNT vs. COT
HFNT§ vs. NIV
HFNT vs. COT
HFNT vs. NIV
COT vs. NIV§
Vargas F. [16]
Respir Care 2015
AHRF Crossover HFNT
(n = 12)
COT (12)
CPAP (12)
HFNT: flow 60 L/m, T 37 °C, FiO2 same as COT
COT: O2 titrated to SpO2 90%
CPAP: 5 cmH20 FiO2 same as COT
Dyspnea: Dyspnea Score
Comfort: NRS
NS NS HFNT§ vs. COT
HFNT vs. CPAP
Mauri T. [17]
Am J Respir Crit Care Med 2017
AHRF Crossover HFNT (15) COT (15) HFNT: flow 40 L/m, FiO2 titrated to SpO2 90–95%
COT: Airvo2 face mask 12 L/min same FiO2
Dyspnea: DeltaPes
Comfort: NA
HFNT§ NA HFNT§
Sklar M.C. [18]
Ann Intensive Care 2018
ARF
(Exacerbation of cystic fibrosis)
Crossover HFNT (15) NIV (15) HFNT: flow 55 L/m, T° 34 or 37 °C FiO2 titrated to SpO2 92%
NIV: FiO2 titrated to SpO2 92%, setting as previously adjusted
Dyspnea: VAS
Comfort: VAS
NS NS NS
Parke R. [19]
Br J Anaesth 2013
Post-extubation
(Cardiac surgery)
RCT HFNT (169) COT (171) HFNT: flow 45 L/m, FiO2 titrated to SpO2 93%
COT: O2 titrated to SpO2 93%
Dyspnea: NA
Comfort: NRS
NA HFNT§ NA
Maggiore S.M. [20]
Am J Respir Crit Care Med 2014
Post-extubation RCT HFNT (53) COT (52) HFNT: flow 50 L/m, FiO2 titrated to SpO2 92–98% (hypoxic) or to 88–95%(hypercapnic)
COT: O2 titrated to SpO2 92–98% (hypoxic) or 88–95%(hypercapnic)
Dyspnea: NA
Comfort: NRS
NA Interface:
HFNT§ (from 12 h)
Dryness:
HFNT§ (from 24 h)
HFNT§ (from 1 h)
Corley A. [21]
Intensive Care Med 2015
Post-extubation
(Cardiac)
RCT HFNT (81) COT (74) HFNT: flow 35 up to 50 L/min, T 37 °C, FiO2 titrated to SpO2 95%
COT: O2 titrated to SpO2 95%
Dyspnea: Borg Scale
Comfort: NA
COT§ (8 h) NA NS
Stephan F. [22]
JAMA 2015
Post-extubation
(Cardiac)
RCT HFNT (414) NIV (416) HFNT: flow 50 L/m, FiO2 titrated to SpO2 92–98%
NIV: PEEP and PS adjusted to RR < 25/min and TV 8 ml/kg, FiO2
SpO2 92–98%
Dyspnea: Dyspnea Score
Comfort: NRS
NS NS HFNT§(1 h, 1 day, 2 days, 3 days)
Futier E. [23]
Intensive Care Med 2016
Post-extubation
(Abdominal or thoracic)
RCT HFNT (108) COT (112) HFNT: flow 50–60 L/m, FiO2 titrated to SpO2 95%
COT: O2 titrated to SpO2 95%
Dyspnea: NA
Comfort: NRS
NA NS NA
Hernandez G. (a) [24]
JAMA 2016
Post-extubation
(Low-risk extubation failure)
RCT HFNT (264) COT (263) HFNT: flow 10 L/m titrated in 5 L step until discomfort, FiO2 to SpO2 92%, T 37 °C
COT: O2 titrated to SpO2 92%
Dyspnea: NA
Comfort: NA
NA NA NA
Hernandez G. (b) [25]
JAMA 2016
Post-extubation
(High-risk extubation failure)
RCT HFNT (290) NIV (314) HFNT: flow 10 L/m titrated in 5 L step until discomfort, FiO2 to SpO2 92%, T 37 °C
NIV: PEEP and PS adjusted to RR 25/min, SpO2 92%, pH 7.35
Dyspnea: NA
Comfort: NA
NA NA NA
Fernandez R. [26]
Ann Intensive Care 2017
Post-extubation
(High-risk extubation failure)
RCT HFNT (78) COT (77) HFNT: flow 40 L/min (adjusted on tolerance), T 37 or 34 °C, FiO2 titrated to SpO2 92–95%
COT: O2 titrated to SpO2 92–95%
Dyspnea: NA
Comfort: NA
NA NA NA
Yu Y. [27]
Can Respir J 2017
Post-extubation
(Thoracic)
RCT HFNT (56) COT (54) HFNT: flow from 35 to 60 L/m, FiO2 titrated to SpO2 95%
COT: O2 titrated to SpO2 95%
Dyspnea: NA
Comfort: Rates of throat/nasal pain
NA HFNT§ HFNT§
(1 h, 2 h, 6 h, 24 h, 48 h, 72 h)
Song H.Z. [28]
Clinics (Sao Paulo) 2017
post-extubation RCT HFNT (30) COT (30) HFNT: flow 60 L/m, FiO2 titrated to SpO2 94–98% (hypoxic) or to 88–92% (hypercapnic)
COT: O2 titrated to SpO2 94–98% (hypoxic) or 88–92%(hypercapnic)
Dyspnea: NA
Comfort: VAS
NA HFNT§ (interface)
HFNT§ (dryness)
HFNT§
Rittayamai N. [29]
Respir Care 2014
post-extubation Crossover HFNT (17) COT (17) HFNT: flow 35 L/m, FiO2 titrated to SpO2 94%
COT: O2 titrated to SpO2 94%
Dyspnea: VAS
Comfort: VAS
HFNT§
(10, 15, 30 min)
NS HFNT§
(5, 10, 15, 30 min)
  1. AHFR acute hypoxemic respiratory failure, ARF acute respiratory failure, CPAP continuous positive airway pressure, COT conventional oxygen therapy, HFNT high-flow nasal treatment, h hours, IPAP inspiratory positive airway pressure, N number of patients, NA not available, NIV noninvasive ventilation, NS not statistically significant, PES esophageal pressure, PSV pressure support ventilation, RCT randomized controlled trial, VAS visual analog scale
  2. §Comparison between intervention and control with a statistically significant p value in favor of (the specified intervention)