• Journal of critical care · Oct 2013

    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.

    • Jordi Rello, Oriol Roca, Purificación Pérez-Terán, Lourdes Pérez, and Enrique Galve.
    • Critical Care Department and CRIPS investigators, Vall d'Hebron University Hospital, Institut de Recerca Vall d'Hebron - VHIR, Universitat Autònoma Barcelona, Barcelona, Spain; CibeRes (Ciber de Enfermedades Respiratorias), Instituto de Salud Carlos III, Madrid, Spain.
    • J Crit Care. 2013 Oct 1;28(5):741-6.

    PurposeHigh flow nasal cannula (HFNC) may decrease preload being associated with beneficial hemodynamic and respiratory effects in adults with heart failure.MethodsThis is a sequential intervention prospective study including 10 adults with New York Heart Association (NYHA) class III and left ventricle ejection fraction 45% or less. High flow gas was administered (fraction of inspired oxygen, 0.21) through nasal cannula (Optiflow(TM); Fisher & Paykel, Auckland, New Zealand). Sequential echocardiographies were performed at baseline, using HFNC with 20 lpm and 40 lpm and post-HFNC. A reduction greater than 20% in the estimated inspiratory collapse of the inferior vena cava (IVC) from baseline was considered clinically significant.ResultsTen patients were included, with median age of 57 (44-65) years; 6 (60%) were female, and 8 (80%) had dilated cardiomyopathy. Median IVC inspiratory significantly (P<.05) decreased from baseline (37%) to HFNC with 20 lpm (28%) and HFNC with 40 lpm (21%), representing mean attributable reductions of 20% (95% confidence interval, 6-55) and 53% (95% confidence interval, 36-67) from baseline. Changes in the IVC inspiratory collapse were reversible after HFNC withdrawal. Respiratory rate was significantly reduced from 23 breaths per minute at baseline to 17 breaths per minute at HFNC with 20 lpm and 13 breaths per minute at HFNC with 40 lpm. In contrast, no significant changes in other echocardiographic or clinical variables were documented.ConclusionThese findings suggest that patients with NYHA class III heart failure may benefit with HFNC supportive therapy.Copyright © 2013 Elsevier Inc. All rights reserved.

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