TY - JOUR
T1 - Nasal high flow reduces hypercapnia by clearance of anatomical dead space in a COPD patient
AU - Fricke, Kathrin
AU - Tatkov, Stanislav
AU - Domanski, Ulrike
AU - Franke, Karl Josef
AU - Nilius, Georg
AU - Schneider, Hartmut
N1 - Funding Information:
This work was supported by the National Institutes of Health ( NIHR01HL105546 ) and the medical technology company Heinen und Löwenstein GmbH&Co .
Publisher Copyright:
© 2016 The Authors
PY - 2016
Y1 - 2016
N2 - Chronic obstructive pulmonary disease (COPD) with hypercapnia is associated with increased mortality. Non-invasive ventilation (NIV) can lower hypercapnia and ventilator loads but is hampered by a low adherence rate leaving a majority of patients insufficiently treated. Recently, nasal high flow (NHF) has been introduced in the acute setting in adults, too. It is an open nasal cannula system for delivering warm and humidified air or oxygen at high flow rates (2–50 L/min) assisting ventilation. It was shown that this treatment can improve hypercapnia. The mechanism of reducing arterial carbon dioxide (CO2) is proposed through a reduction in nasal dead space ventilation, but there are no studies in which dead space volume was measured in spontaneously breathing subjects. In our case report we measured in a tracheostomized COPD patient CO2 and pressure via sealed ports in the tracheostomy cap and monitored transcutaneous CO2 and tidal volumes. NHF (30 L/min mixed with 3 L/min oxygen) was administered repeatedly at 15-minutes intervals. Inspired CO2 decreased instantly with onset of NHF, followed by a reduction in transcutaneous/arterial CO2. Minute ventilation on nasal high flow was also reduced by 700 ml, indicating that nasal high flow led to a reduction of dead space ventilation thereby improving alveolar ventilation. In conclusion, NHF assist ventilation through clearance of anatomical dead space, which improves alveolar ventilation. Since the reduction in hypercapnia was similar to that reported with effective NIV treatment NHF may become an alternative to NIV in hypercapnic respiratory failure.
AB - Chronic obstructive pulmonary disease (COPD) with hypercapnia is associated with increased mortality. Non-invasive ventilation (NIV) can lower hypercapnia and ventilator loads but is hampered by a low adherence rate leaving a majority of patients insufficiently treated. Recently, nasal high flow (NHF) has been introduced in the acute setting in adults, too. It is an open nasal cannula system for delivering warm and humidified air or oxygen at high flow rates (2–50 L/min) assisting ventilation. It was shown that this treatment can improve hypercapnia. The mechanism of reducing arterial carbon dioxide (CO2) is proposed through a reduction in nasal dead space ventilation, but there are no studies in which dead space volume was measured in spontaneously breathing subjects. In our case report we measured in a tracheostomized COPD patient CO2 and pressure via sealed ports in the tracheostomy cap and monitored transcutaneous CO2 and tidal volumes. NHF (30 L/min mixed with 3 L/min oxygen) was administered repeatedly at 15-minutes intervals. Inspired CO2 decreased instantly with onset of NHF, followed by a reduction in transcutaneous/arterial CO2. Minute ventilation on nasal high flow was also reduced by 700 ml, indicating that nasal high flow led to a reduction of dead space ventilation thereby improving alveolar ventilation. In conclusion, NHF assist ventilation through clearance of anatomical dead space, which improves alveolar ventilation. Since the reduction in hypercapnia was similar to that reported with effective NIV treatment NHF may become an alternative to NIV in hypercapnic respiratory failure.
KW - Chronic obstructive pulmonary disease
KW - Dead space ventilation
KW - Hypercapnic respiratory failure
KW - Nasal high flow
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U2 - 10.1016/j.rmcr.2016.08.010
DO - 10.1016/j.rmcr.2016.08.010
M3 - Article
C2 - 27668173
AN - SCOPUS:84986557900
SN - 2213-0071
VL - 19
SP - 115
EP - 117
JO - Respiratory Medicine Case Reports
JF - Respiratory Medicine Case Reports
ER -