Thesis (Ph.D)-Cairo University, 2024.

Bibliography: pages 103-114.

Background: Respiratory failure is a clinical condition that happens when the respiratory system fails to maintain its main function, which is gas exchange, in which PaO2 is lower than 60mmHg and/or PaCO2 is higher than 50mmHg. Dyspnea and acute respiratory failure are among the top 5 reasons for patients to present to the emergency department. NIV is used in this setting because of its ability to support both type I (hypoxic) and type II (hypercapnic) respiratory failure and avoid IMV side effects. HiVNI, a form of high-flow nasal cannula that utilize small bore nasal cannula to generate higher velocities of gas delivery than its counterparts using large bore HFNC, has the ability to accomplish complete purge of extra thoracic dead space at flow rates of 35 liters/min and may be able to provide ventilatory support in patients with acute hypercapnic respiratory failure in addition to oxygenation support, Experience and preclinical data suggest that HiVNI may be effective in patients requiring ventilatory support as well. Therefore, it is important to assess whether HiVNI can be used in the early management of respiratory distress patients in the same manner as noninvasive positive-pressure ventilation.
Aim of work: Assess the effect of HiVNI in cases with undifferentiated respiratory failure compared with NIV regarding improvement of oxygenation in type I RF and improvement of PCO2 level in type II RF.
Methods: The cases included in the study were classified into four groups. group I (n=16) was patients with respiratory failure type I treated with HiVNI, group II (n=15) was patients with respiratory failure type II treated with HiVNI, group III (n=13) was patients with respiratory failure type I treated with NIV, group IV (n=14) was patients with respiratory failure type II treated with NIV.
All patients were subjected to the following: complete history taking and clinical examination, BMI, Vital signs [heart rate, respiratory rate (RR), oxygen saturation (SO2)] assessed on admission and after 20min ,1 and 4 hours of treatment, and as needed according to the patient condition, Conscious level (GCS) assessed on admission. ABG at baseline, 1, 4 hours after initiation of NIV or HiVNI and as needed according to the patient condition, CBC, INR, KFT and LFTs.
Results: Type1 respiratory failure: the HiVNI and NIV groups showed similar trends in vital signs and blood gas tests, particularly in oxygenation indicators (PO2, SO2).

There was no statistically significant difference in the intubation rate between the HiVNI and NIV groups. The majority of patients, particularly those in the HiVNI group, stay stable for longer than a day. But in terms of mortality, the NIV group had a higher rate than the HIVNI group, although there was no statistically significant difference.
Type II respiratory failure: the HiVNI and NIV groups showed similar trends in vital signs and blood gas tests, particularly (PCO2, PH). But NIV was better in obese cases because more pressure is needed .
Additionally, there was no statistically significant difference in the rate of intubation between the HiVNI and NIV groups. However, the majority of patients in the HiVNI group stay stable for more than a day. But in terms of mortality, the NIV group had a higher rate than the HiVNI group, although there was no statistically significant difference.
Regarding crossover between the two devices there were 4 patients (26.7%) shifted to NIV in HiVNI group patients but there are no cases shifted from NIV to HiVNI. All the 4 patients were shifted after 6 hours, this may be explained by more experience of the physicians to NIV more than HiVNI, so we need to increase the use of HiVNI to get more experience.
Conclusion: The study shows that HiVNI device has satisfactory results in management of both type I and type II respiratory failure and can be used equal to NIV except in obese cases

الهدف من الدراسة: تم اجراء هذه الدراسة بهدف مقارنة جهاز النفخ الانفي عالي السرعة والتدفق بجهاز التنفس الاصطناعي اللااختراقي في علاج حالات الفشل التنفسي الغير متمايز من حيث تحسين مستوى الاكسجين في حالات نقص الاكسجة وتقليل مستوي ثاني اسيد الكربون في حالات فرط مستوى ثاني أكسيد الكربون بالدم.
المرضى وطرق البحث: إجراء دراسة مستقبلية على ٥٨ مريضًا لديهم فشل تنفسي من النوع الأول والثاني تم حضورهم لمستشفي القصر العيني و القصر العيني الجديد خلال فبراير2022 حتى نوفمبر 2023 . وقد تم عمل التالي لجميع المرضى:
اخذ التاريخ المرضي والفحص السريري الكامل، مؤشر كتلة الجسم ،العلامات الحيوية (معدل ضربات القلب ، معدل التنفس ، تشبع الأكسجين ، يتم تقييمها عند الدخول وبعد 20 دقيقة و ١ و ٤ ساعات من العلاج ، وحسب الحاجة وفقا لحالة المريض، المستوى الواعي الذي يتم تقييمه عند القبول ، تحليل غازات الدم عند الدخول ، ١ ، ٤ ساعات بعد بدء جهاز التنفس الاصطناعي اللااختراقي أو جهاز النفخ الانفي عالي السرعة، وحسب الحاجة وفقا لحالة المريض، صورة دم كاملة ،النسبة الدولية المسواة ، اختبارات وظائف الكلى والكبد ،سجل علم وظائف الأعضاء الحاد وتقييم الصحة المزمنة ٢.
النتائج: يمكن استخدام جهاز النفخ الانفي عالي السرعة والتدفق كبديل لجهاز التنفس الصناعي اللااختراقي في حلاج حالات الفشل التنفسي من الانوع الأول او النوع الثاني.

Issues also as CD.

Text in English and abstract in Arabic & English.