Asymmetrical Versus Conventional High-flow Nasal Cannula in Acute Respiratory Failure

Launched by SIRIRAJ HOSPITAL · Jan 3, 2024

Keywords

ClinConnect Summary

This clinical trial is studying two types of high-flow nasal cannulas, which are devices that help patients breathe better when they have serious breathing issues. The trial is comparing an asymmetrical nasal cannula, which has a different design, to a conventional nasal cannula. The main goal is to see if the new design helps patients breathe with less effort and improves their overall breathing patterns, gas exchange (how oxygen and carbon dioxide move in and out of the body), and heart function compared to the conventional device.

To participate in this study, patients must be over 18 years old and have been hospitalized for acute respiratory failure within the last week. They should have low oxygen levels in their blood (hypoxemia) or be experiencing difficulty breathing due to chronic obstructive pulmonary disease (COPD). Participants will randomly receive one of the two nasal cannulas at different flow rates during the trial. This study is currently recruiting participants, so if you or someone you know meets the eligibility criteria, this could be an opportunity to help improve treatment options for respiratory failure.

Gender

ALL

Eligibility criteria

• • Patients with acute hypoxemia respiratory failure
• Inclusion Criteria:
• • Age \> 18 years old
• • Acute respiratory failure within 7 days of hospital admission?
• • Hypoxemia defined by arterial partial pressure of oxygen (PaO2)/FiO2 \< 300 mmHg or SpO2/FiO2 \< 315
• • Already supported with HFNC device
• Exclusion Criteria:
• • Respiratory acidosis: pH \< 7.30 and PaCO2 \> 45 mmHg
• • Hemodynamic instability requiring vasopressor initiation
• • Diminished level of consciousness or uncooperative
• • Active hemoptysis or pneumothorax requiring a chest tube
• • Chronic severe neuromuscular disease
• • Pregnancy
• • Patients with acute hypercapnic COPD Inclusion criteria
• • Age \> 40 years old
• • Diagnosed COPD according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guideline (postbronchodilator forced expiratory volume at 1 second (FEV1)/forced vital capacity (FVC) \< 70%)
• • Exacerbation requiring hospitalization; at least 2 of the following criteria
• • 1. Respiratory rate \> 24/min
• • 2. Use of respiratory accessory muscles or paradoxical motion of the abdomen
• • 3. Acute respiratory acidosis with arterial or venous pH \< 7.35 and/or PaCO2 \> 45 mmHg
• • Exclusion criteria
• • pH \< 7.25
• • Hemodynamic instability requiring vasopressor initiation
• • Persistent hypoxemia despite supplemental oxygen therapy
• • Diminished level of consciousness or uncooperative
• • Active hemoptysis or pneumothorax requiring a chest tube
• • Associated severe chronic neuromuscular disease
• • Pregnancy