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A Journal on Anesthesiology, Resuscitation, Analgesia and Intensive Care
Minerva Anestesiologica 2013 December;79(12):1344-55
Comparison of three high flow oxygen therapy delivery devices: a clinical physiological cross-over study
Chanques G. 1, 2, Riboulet F. 1, Molinari N. 3, Carr J. 1, Jung B. 1, 2, Prades A. 1, Galia F. 1, Futier E. 1, 4, Constantin J.-M. 4, Jaber S. 1, 2 ✉
1 Anesthesiology and Intensive Care Department (DAR), University of Montpellier Saint Eloi Hospital, Montpellier, France;
2 Unité U1046 de l’Institut National de la Santé et de la Recherche Médicale (INSERM), University of Montpellier 1, University of Montpellier 2, Montpellier, France;
3 Department of Statistics, University of Montpellier Lapeyronie Hospital, Montpellier, France;
4 Adult Intensive Care Unit, Estaing University Hospital, Clermont-Ferrand, France
Aim: High-flow-oxygen-therapy is provided by various techniques and patient interfaces, resulting in various inspired-fraction of oxygen (FiO2) and airway-pressure levels. However, tracheal measurements have never been performed.
Methods: Three oxygen-delivery-devices were evaluated: 1) standard-high-flow-oxygen-facemask with reservoir-bag, 2) OptiflowTM-high-flow-nasal-cannulae and 3) BoussignacTM-oxygen-therapy-system. Main judgment criteria were airway-pressure and FiO2 measured in the trachea. The three devices were randomly evaluated in cross-over in 10 Intensive-Care-Unit patients using three oxygen flow-rates (15, 30 and 45 L/min) and two airway-tightness conditions (open and closed mouth). Airway-pressures and FiO2 were measured by a tracheal-catheter inserted through the hole of a tracheotomy tube. Comfort was evaluated by self-reporting. Data are presented as median [25-75th].
Results: 1) Regarding oxygen-delivery devices, BoussignacTM provided the highest mean tracheal pressure (13.9 [10.4-14.5] cmH20) compared to OptiflowTM (2 [1-2.3] cmH2O, P<0.001). BoussignacTM provided both positive inspiratory and expiratory airway-pressures, whereas OptiflowTM provided only positive expiratory airway-pressure. Reservoir-bag-facemask provided airway pressure close to zero. For FiO2, highest value was obtained for both OptiflowTM and facemask (90%) compared to BoussignacTM (80%), P<0.01. 2) Regarding oxygen-flow, airway-pressure and FiO2 systematically increased with oxygen-flow with the three devices except airway-pressure for the facemask. 3) Regarding the open-mouth position, mean airway-pressure decreased with OptiflowTM only (2 [1.2-3.3] vs. 0.6 [0.3-1] cmH2O, P<0.001). Opening the mouth had little impact on FiO2. 4) finally, discomfort-intensities were low for both OptiflowTM and reservoir-bag-facemask compared to BoussignacTM, P<0.01.
Conclusion: On one hand, BoussignacTM is the only device that generates a relevant positive-airway-pressure during both inspiration-and-expiration, independently of mouth-position. OptiflowTM provides a low positive-airway-pressure (<4 cmH2O), highly dependent of mouth-closing. The reservoir-bag-facemask provides no positive-airway-pressure. On the other hand, FiO2 are slightly but significantly higher for OptiflowTM and reservoir-bag-facemask than for BoussignacTM. Discomfort was lesser for OptiflowTM and reservoir-bag-facemask.