Home High-Flow Therapy in Patients with Chronic Respiratory Diseases: Physiological Rationale and Clinical Results
Abstract
:1. Introduction
2. The Potential Mechanisms by Which HHFT May Offer Advantages to Stable Hypoxemic and/or Hypercapnic Patients
- A—improved lung mucociliary clearance and decreased inspiratory resistance by providing heated and humidified gas;
- B—washout of anatomic dead space;
- C—mild distending pressure; and
- D—increased alveolar PO2.
2.1. A—Improvement in Lung Mucociliary Clearance and Attenuation of Inspiratory Resistance Provided by Heated and Humidified Gas
2.2. B—Dead Space Washout
2.3. C—Provide a Mild Distending Pressure
2.4. D—Increased Alveolar PO2
3. Effects of HHFT on COPD Exacerbations and Economic Impact
4. HFT Role in the Management of Palliative Patients
5. Differences between Home and Hospital Implementation and Types of Home Devices
6. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Study Population | Study Design | HFT Settings | Outcomes | Results | Hypothesized Physiologic Effect | |
---|---|---|---|---|---|---|
Rea et al. (2010) [9] | 108 stable patients diagnosed with COPD or bronchiectasis. | Randomized open-label controlled trial: HFT vs. usual care. | Flow: 20–25 L/m. HFT use: 1.6 ± 0.67 h/d. Temperature: 37 °C. | Exacerbation rate, time to first exacerbation, number of exacerbated days and hospital admissions, change in QoL scores, lung function, 6MWT, and inflammatory markers (sputum cell counts) over 12 months. | HFT reduced exacerbation rate, increased time to first exacerbation, reduced exacerbation frequency, improved QoL scores and lung function. | Improvement in mucociliary clearance. Washout of dead space. PEEP effect. |
Hasani et al. (2008) [10] | 10 patients diagnosed with idiopathic bronchiectasis in stable phase. | Physiologic study: HFT in bronchiectasis patients. | Flow: 20–25 L/m. HFT use: >3 h/d. Temperature: 37 °C. | Clearance of radioactively tagged 99mTc-polystyrene aerosolized particles. | HFT improved lung mucociliary clearance. | Improvement in mucociliary clearance. |
Nagata et al. (2018) [11] | 32 patients diagnosed with stable hypercapnic COPD. | Multicenter, randomized crossover trial: HFT + LTOT vs. LTOT (6 weeks for each trial). | Flow: 29.2 ± 1.9 L/min (group A); 30.3 ± 4.6 L/min (group B). HFT use: 7.1 ± 1.5 h/d (group A); 8.6 ± 2.9 h/d (group B). | Variations in QoL scores, dyspnea scores, ABG, nocturnal PtcCO2, SpO2, PFTs, 6MWT, and physical activity. AECOPD. | HFT improved QoL scores, PaCO2, pH, and nocturnal PtcCO2. | Dead space washout. |
Fraser et al. (2016) [12] | 30 stable COPD patients in LTOT | Randomized physiologic crossover trial: HFT vs. LTOT (20 min for each period). | Flow: 30 L/m. | Variations in TcO2, TcCO2, SpO2, Vt, MV, RR, I:E ratio, EELI, HR, dyspnea, and comfort. | HFT reduced TcO2, TcCO2, RR, and I:E ratio. HFT increased Vt and EELI. | Dead space washout, PEEP effect. |
Storgaard et al. (2018) [13] | 200 COPD patients with chronic hypoxemic respiratory failure. | Randomized clinical trial: HFT + LTOT vs. LTOT. | Flow: 20 L/m. HFT use: 6h/d. Temperature: not available. | Rate of AECOPD, hospital admissions, variations in dyspnea, QoL scores, PaCO2, all-cause mortality and exercise performance at 12 months. | HFT reduced AECOPD rate, improved dyspnea, QoL scores, and 6MWT distance. HFT decreased PaCO2 at 12 months. | Improvement in mucociliary clearance. |
Storgaard et al. (2020) [14] | 74 COPD patients with persistent hypercapnic failure. | Post-hoc analysis of Ref [13]: HFT + LTOT vs. LTOT. | Flow: 20 L/m. HFT use: 6.9 h/d. Temperature: not available. | PaCO2 decreased in HFT + LTOT group while it increased in LTOT group. | Clearance of CO2 from the anatomical dead space. | |
Pisani et al. (2020) [15] | 50 COPD or COPD/OSA hypercapnic patients recovered from an acute exacerbation. | Interventional study: HFT in persistent hypercapnia following acute exacerbation. | Flow: 33.5 ± 3.2 L/min. HFT use: 8h/d + night-time. | Variations in ABG, RR. | HFT reduced RR. HFT reduced pCO2 only in pure COPD patients. | Dead space washout. |
Bräunlich et al. (2019) [16] | 102 COPD patients with stable daytime hypercapnia. | Multi-centered, randomized controlled crossover trial: HFT vs. NIV (6 weeks for each trial). | Flow: 19.8 ± 0.6 L/min. | Variations in pCO2, lung function, QoL scores, 6MWT, and duration of device use. | HFT was effective as NIV in terms of pCO2 reduction (slight tendency in favor of NIV) and QoL scores. | Dead space washout. |
Harada et al. (2022) [17] | 24 patients diagnosed with IPF and exercise-induced oxygen desaturation. | Prospective, randomized crossover trial: HFT vs. SOT (Venturi mask). | Flow: 60 L/m. FiO2: 50%. Temperature: 37 °C. | Endurance time, SpO2, dyspnea leg fatigue, HR, comfort. | HFT improved exercise duration, leg fatigue, and minimum SpO2. | Ensured adequate inspiratory flow. |
Nagata et al. (2022) [18] | 104 patients diagnosed with COPD (GOLD 2-4). | Randomized clinical trial: HFT + LTOT vs. LTOT. | Flow: 28.5 ± 4.57 L/min. HFT use: 7.3 ± 3.0 h/d. Temperature: 37 °C; modified according to patient’s comfort. | Moderate/severe AECOPD rate. Variations in ABG, pulmonary function, QoL scores. | HFT reduced the rate of moderate/severe AECOPD, improved time to first exacerbation, QoL scores, and pulmonary function. | Improvement in secretory clearance. Improve muscle weakness. |
Good et al. (2020) [19] | 45 patients diagnosed with bronchiectasis. | Post-hoc analysis of Ref [9]: HFT vs. usual care. | Flow: 20–25 L/m. HFT use: 1.7 h/d. Temperature: 37 °C. | HFT reduced exacerbation rate and improved QoL scores. | Improvement in mucociliary clearance. | |
Hui et al. (2020) [20] | 44 non-hypoxemic patients diagnosed with cancer involving the lung. | Double-blind, randomized clinical trial: HFox vs. HFair vs. LFox vs. LFair. | HFox Flow: 48 ± 12 L/m. HFair flow: 46 ± 11 L/minute. Temperature: 35 °C. | Dyspnea, exercise duration, leg discomfort during exercise test. | HFox and LFox reduced exertional dyspnea compared to LFair. HFox improved exercise capacity compared to LFair. |
FiO2 * | Flow (L/m) | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|
15 | 20 | 25 | 30 | 35 | 40 | 45 | 50 | 55 | 60 | ||
Concentrator oxygen flow rate in L/m | 1 | 26 | 25 | 24 | 24 | 23 | 23 | 23 | 23 | 22 | 22 |
2 | 32 | 29 | 27 | 26 | 26 | 25 | 25 | 24 | 24 | 24 | |
3 | 37 | 33 | 31 | 29 | 28 | 27 | 26 | 26 | 25 | 25 | |
4 | 42 | 37 | 34 | 32 | 30 | 29 | 28 | 27 | 27 | 26 | |
5 | 47 | 41 | 37 | 34 | 32 | 31 | 30 | 29 | 28 | 28 | |
6 | 53 | 45 | 40 | 37 | 35 | 33 | 32 | 31 | 30 | 29 | |
7 | 58 | 49 | 43 | 40 | 37 | 35 | 33 | 32 | 31 | 30 | |
8 | 63 | 53 | 46 | 42 | 39 | 37 | 35 | 34 | 33 | 32 | |
9 | 68 | 56 | 50 | 45 | 42 | 39 | 37 | 35 | 34 | 33 | |
10 | 73 | 60 | 53 | 47 | 44 | 41 | 39 | 37 | 36 | 34 | |
11 | 78 | 64 | 56 | 50 | 46 | 43 | 41 | 39 | 37 | 36 | |
12 | 82 | 68 | 59 | 53 | 48 | 45 | 42 | 40 | 38 | 37 | |
13 | 87 | 71 | 62 | 55 | 50 | 47 | 44 | 42 | 40 | 38 | |
14 | 92 | 75 | 65 | 58 | 53 | 49 | 46 | 43 | 41 | 40 | |
15 | 93 | 79 | 68 | 60 | 55 | 51 | 47 | 45 | 43 | 41 |
MyAirvo™ (Fisher and Paykel) | Lumis™ HFT (ResMed) | H-FLOW™ (Medical Products Research S.r.l.) | |
---|---|---|---|
Flow range | 10–60 L/min. | 15–40 L/min. | 10–60 L/min. |
Concentrator oxygen flow rate | Up to 15 L/m. | Up to 15 L/m. | Up 15 L/m. |
Humidification and temperature settings | Pass-over system. Reusable or auto-fill water chamber. Heated breathing tube T° target setting = 31 °C, 34 °C, 37 °C. Humidity performance of 33 mg/L at 37 °C, and of 12 mg/L at 31 °C and 34 °C. | Pass-over system. Reusable water chamber. Heated breathing tube (ClimateLineAir™ + tube cover) T° target setting of 31 °C, 34 °C, 37 °C). Humidity level from 1 to 5 (from the lowest to the highest humidity). | Pass-over system. Reusable or auto-fill water chamber. Heated breathing tube T° target setting = 31 °C, 34 °C, 37 °C. Humidity performance of 33 mg/L at 37 °C, and of 12 mg/L at 31 °C and 34 °C. |
Interface | Optiflow +™ nasal cannula (3 sizes). Optiflow Tracheostomy™ interface. | AcuCare™ nasal cannula or generic high-flow nasal cannula (note: tracheostomy use is contraindicated for Lumis HFT). | Generic high-flow nasal cannula. Generic high-flow tracheostomy interface. |
Alarms | Yes. | Messages and warnings. | Yes. |
Patient compliance monitoring | USB port for data download therapy, Infosmart™. | SD card for data download therapy (ResScan™ and Airview™- telemonitoring). Soon, the ability to remotely edit settings will be available. | SD card. |
Possibility of connecting a built-in oximeter | No. | Yes, Air10 oximeter adapter (Nonin-XPod®, Global Headquarters, Plymouth, UK). | Yes. |
Weight | 2.2 kg. | 1.29 kg. | 3 kg. |
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© 2023 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Vega Pittao, M.L.; Schifino, G.; Pisani, L.; Nava, S. Home High-Flow Therapy in Patients with Chronic Respiratory Diseases: Physiological Rationale and Clinical Results. J. Clin. Med. 2023, 12, 2663. https://doi.org/10.3390/jcm12072663
Vega Pittao ML, Schifino G, Pisani L, Nava S. Home High-Flow Therapy in Patients with Chronic Respiratory Diseases: Physiological Rationale and Clinical Results. Journal of Clinical Medicine. 2023; 12(7):2663. https://doi.org/10.3390/jcm12072663
Chicago/Turabian StyleVega Pittao, Maria Laura, Gioacchino Schifino, Lara Pisani, and Stefano Nava. 2023. "Home High-Flow Therapy in Patients with Chronic Respiratory Diseases: Physiological Rationale and Clinical Results" Journal of Clinical Medicine 12, no. 7: 2663. https://doi.org/10.3390/jcm12072663