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VOLUME 23 , ISSUE 10 ( October, 2019 ) > List of Articles

Original Article

Role of High-flow Nasal Oxygen Therapy in Cases with Pulmonary Hypertension in an Intensive Care Unit Setting

Bhavna Gupta, Kamna Kakkar, Lalit Gupta

Keywords : High-flow nasal cannula, High-flow nasal oxygen therapy, Pulmonary hypertension

Citation Information : Gupta B, Kakkar K, Gupta L. Role of High-flow Nasal Oxygen Therapy in Cases with Pulmonary Hypertension in an Intensive Care Unit Setting. Indian J Crit Care Med 2019; 23 (10):458-461.

DOI: 10.5005/jp-journals-10071-23264

License: CC BY-NC 4.0

Published Online: 01-08-2019

Copyright Statement:  Copyright © 2019; The Author(s).


High-flow nasal oxygen therapy warms and humidifies gases, allows better clearance of secretions, along with providing added benefits like preventing dehydration of airway surface, while decreasing atelectasis and thereby, offering comfort to the patient. While its effect on critically ill patients is still in its pioneering phase, there is lack of substantial evidence on the use of high-flow nasal cannula in cardiac patients with type I respiratory failure. We found it worthwhile to share our experience of its use in elderly and postpartum patients with moderate-to-severe pulmonary hypertension, with associated comorbidities and type I respiratory failure, with do-not-intubate or defer intubation status. In patients with pulmonary hypertension (PHT) and respiratory failure, endotracheal intubation followed by initiation of mechanical ventilation may have detrimental hemodynamic effects. Increase in lung volumes and decrease in functional residual capacity lead to increase in pulmonary hypertension and right ventricle afterload. If a patient has right heart failure, lung hyperinflation can fatally reduce cardiac output. High-flow nasal oxygen therapy may be of an advantage in these scenarios.

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  1. D'Alonzo GE, Barst RJ, Ayres SM, Bergofsky EH, Brundage BH, Detre KM et al. Survival in patients with primary pulmonary hypertension: results from a national prospective registry. Ann Intern Med 1991;115:343–349.
  2. Lai HC, Lai HC, Wang KY, Lee WL, Ting CT, Liu TJ. Severe pulmonary hypertension complicates postoperative outcome of non-cardiac surgery. Br J Anaesth 2007;99:184–190.
  3. Hoeper MM, Granton J. Intensive care unit management of patients with severe pulmonary hypertension and right heart failure. Am J Respir Crit Care Med 2011;184:1114–1124.
  4. Wiensen J, Ornstein M, Tonelli AR, Menon V, Ashton RW. State of evidence: mechanical ventilation with PEEP in patients with cardiogenic shock. Heart 2103;99(24):1812–1817
  5. Disselkamp M, Adkins D, Pandey S, Coz Yataco AO. Physiologic approach to mechanical ventilation in right ventricular failure. Ann Am Thorac Soc 2018;15(3):383–389
  6. Moloney ED, Evans TW. Pathophysiology and pharmacological treatment of pulmonary hypertension in acute respiratory distress syndrome. Eur Respir J 2003;21:720–727.
  7. Chua MT, Kuan WS. The use of high flow nasal cannula in acute decompensated heart failure: ready for prime time yet? J Emerg Crit Care Med 2017;1:22
  8. Roca O, Pérez-Terán P, Masclans JR, Galve E, Evangelista A, Rello J. Patients with New York Heart Association class III heart failure may benefit with high flow nasal cannula supportive therapy: high flow nasal cannula in heart failure. J Crit Care 2013;28:741–746.
  9. Jardin F, Vieillard-Baron A. Right ventricular function and positive pressure ventilation in clinical practice: from hemodynamic subsets to respiratory settings. Intensive Care Med 2003;29:1426–1434.
  10. Koutsogiannidis CP, Ampatzidou FC, Ananiadou OG, Karaiskos TE, Drossos GE. Noninvasive ventilation for post-pneumonectomy severe hypoxemia. Respir Care 2012;57:1514–1516.
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