{"id":22933,"date":"2022-12-06T04:50:00","date_gmt":"2022-12-05T20:50:00","guid":{"rendered":"http:\/\/csccm.org.cn\/?p=22933"},"modified":"2022-12-06T05:45:21","modified_gmt":"2022-12-05T21:45:21","slug":"chest%e5%8f%91%e8%a1%a8%e8%ae%ba%e6%96%87%ef%bc%9a%e9%ab%98%e6%b5%81%e9%87%8f%e9%bc%bb%e5%af%bc%e7%ae%a1%e6%b0%a7%e7%96%97%e5%b9%b6%e9%9d%9e%e6%80%bb%e6%98%af%e9%80%9a%e8%bf%87peep%e6%95%88%e5%ba%94","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=22933","title":{"rendered":"[Chest\u53d1\u8868\u8bba\u6587]\uff1a\u9ad8\u6d41\u91cf\u9f3b\u5bfc\u7ba1\u6c27\u7597\u5e76\u975e\u603b\u662f\u901a\u8fc7PEEP\u6548\u5e94\u964d\u4f4e\u5438\u6c14\u52aa\u529b"},"content":{"rendered":"\n

EDUCATION AND CLINICAL PRACTICE: ORIGINAL RESEARCH| VOLUME 162, ISSUE 4<\/a>, P861-871, OCTOBER 01, 2022<\/p>\n\n\n\n

High-Flow Nasal Cannula Reduces Effort of Breathing But Not Consistently via Positive End-Expiratory Pressure<\/h1>\n\n\n\n

Robert D. Guglielmo, Justin C. Hotz, Patrick A. Ross,\u00a0et al<\/h3>\n\n\n\n

Chest 2022; 162: 861-871<\/h3>\n\n\n\n

Background<\/h3>\n\n\n\n

High-flow nasal cannula (HFNC) therapy reduces the effort of breathing in patients with bronchiolitis, but the mechanisms are not understood. Theorized mechanisms include dead space washout and positive end-expiratory pressure (PEEP) application.<\/p>\n\n\n\n

Research Question<\/h3>\n\n\n\n

What are the mechanisms of action of HFNC therapy in patients with bronchiolitis?<\/p>\n\n\n\n

Study Design and Methods<\/h3>\n\n\n\n

Prospective, single-center study of children 3 years of age or younger with bronchiolitis from January 2020 through March 2021. Flow was titrated between 0.5 and 2 L\/kg\/min. Electrical impedance tomography measured end-expiratory lung impedance (EELZ) change as an end-expiratory lung volume (EELV) change surrogate and change in tidal impedance difference (\u0394Z) as a tidal volume (VT<\/sub>) surrogate. A subset showed manometry measuring esophageal pressure change (\u0394Pes; transpulmonary pressure surrogate) and pressure rate product (PRP; effort of breathing metric). We hypothesized that EELV and VT<\/sub>\u00a0would not change and that effort would reduce via respiratory rate (not \u0394Pes). Measurements were reported as the difference from 0.5 L\/kg\/min.<\/p>\n\n\n\n

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Results<\/h3>\n\n\n\n

We studied 22 patients in total, 10 with esophageal manometry. Median EELZ increased by 0.36 arbitrary unit (AU), 2.42 AU, and 4.8 AU at 1 L\/kg\/min, 1.5 L\/kg\/min, and 2 L\/kg\/min (P<\/em>\u00a0= .01, 2 L\/kg\/min vs\u00a00.5 L\/kg\/min), which corresponded to a median increase in EELV of 1.8\u00a0mL\/kg between 0.5 and 2 L\/kg\/min. Seven patients showed an increase in EELZ of > 5 AU, 12 showed no change in EELZ (\u00b1 5 AU), and three showed a decrease in EELZ of > 5 AU. \u0394Z (ie, VT<\/sub>) did not change from 0.5 L\/kg\/min to 2 L\/kg\/min (median change, 0.29 AU;\u00a0P<\/em>\u00a0= .48). Median PRP decreased by 78\u00a0cm H2<\/sub>O\/min from 0.5 L\/kg\/min to 2 L\/kg\/min (P<\/em>\u00a0= .02), with all patients demonstrating a reduction in PRP, with a nonsignificant change in \u0394Pes (P<\/em>\u00a0= .68).<\/p>\n\n\n\n

Interpretation<\/h3>\n\n\n\n

Increasing HFNC in children with bronchiolitis reduces the effort of breathing, but no consistent increase occurs in end-expiratory lung volume and no significant change occurs in VT<\/sub> or transpulmonary pressure. This suggests that PEEP application is not the primary mechanism of action of HFNC in children with bronchiolitis.<\/p>\n","protected":false},"excerpt":{"rendered":"

EDUCATION AND CLINICAL PRACTICE: ORIGINAL RESEARCH|&nbs […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[32,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/22933"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=22933"}],"version-history":[{"count":2,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/22933\/revisions"}],"predecessor-version":[{"id":23261,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/22933\/revisions\/23261"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=22933"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=22933"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=22933"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}