Key Findings Very low-quality evidence suggests lower mortality (based on five observational studies) but higher failure rate of respiratory support (based on two observational studies) in COVID-19 patients given high-flow nasal cannula (HFNC) oxygen compared with noninvasive ventilation (NIV) and conventional oxygenation therapy. Randomized controlled trials (RCT) are urgently needed in this area. • Respiratory failure accounts for about half of deaths in patients with COVID-19. • High-flow nasal cannula (HFNC) oxygen therapy reduces the need for escalating respiratory support and improves patient comfort compared with conventional oxygen therapy among those with acute respiratory failure. • Mortality was consistently lower in COVID-19 patients who received HFNC rather than NIV or conventional oxygen therapy (COT) across 5 very low-quality retrospective observational studies from China. • Several international guidelines recommend the use of HFNC oxygen therapy in COVID-19 patients who develop acute hypoxemic respiratory failure. However, local guidelines from the Philippine Society for Microbiology and Infectious Diseases (PSMID) and the Philippine College of Chest Physicians (PCCP) recommend against HFNC due to risks of transmission and paucity of direct evidence for efficacy. • Additional infection control precautions, i.e. wearing a surgical mask over the cannula, and locating in a negative pressure room, are recommended whenever using HFNC or NIV. • There are at least two ongoing trials due to be completed by the second quarter of 2021 comparing HFNC oxygenation with NIV or COT in COVID-19 patients.
Cannula ; Noninvasive Ventilation ; COVID-19 ; Coronavirus

Posterior dislocation of an intraocular lens into the vitreous cavity is uncommon but is a difficult problem to manage. Various techniques have been described but most of them entail the use of specially manufactured expensive instruments. The aim of this study, therefore, is to develop a low-cost surgical snare in retrieving a dislocated posterior chamber intraocular lens (PCIOL). The snare consists of a 6.0 polypropylene suture threaded into a 21-gauge flute cannula. The loop of suture formed is used to secure the haptics of the lens. This is used after a pars plana vitrectomy to retrieve the dislocated PCIOL. The snare is easy to make with inexpensive disposable surgical materials. (Author)
Human ; Male ; Middle Aged ; SURGERY ; CANNULA

Cannula ; Catheters ; Drainage ; Duodenal Diseases ; Humans ; Intestinal Fistula/surgery*

Difficulty in swallowing is a common symptom in stroke patients, and nasogastric tubes are routinely used to solve the nutritional support problem of these patients. The existing nasogastric tube have the disadvantages of causing aspiration pneumonia and patient discomfort. The traditional transoral gastric tube has no one-way valve switch and gastric content storage device, and cannot be fixed in the stomach, resulting in reflux of gastric contents, inability to fully understand the digestion and absorption of gastric contents, and accidental dislocation of the gastric tube, affecting further feeding and gastric content detection. For these reasons, the medical staff of the department of gastroenterology and colorectal surgery of Jilin University China-Japan Union Hospital designed a new transoral gastric tube that can extract and store gastric contents, and was granted a national utility model patent of China (ZL 2020 2 1704393.1). The device consists of collection, cannula and fixation modules. The collection module includes three parts. Gastric contents storage capsule, which can clearly visualize the gastric contents; three-way switch, which can be controlled by rotating the pathway, makes the pathway exist in different states, which is convenient for medical personnel to extract gastric juice, as well as perform intermittent oral tube feeding on the patient or close the pipeline, and reduce contamination and prolong the service life of the gastric tube; one-way valve, which can effectively avoid the contents of the reflux back into the stomach. The tube insertion module includes three parts. A graduated tube, which can enable the medical staff to effectively identify the insertion depth; a solid guide head, which makes the insertion of the tube through the mouth more smoothly; the gourd-shaped passageway, which effectively avoids the blockage of the tube. The fixation module is a water-filled balloon, which is properly filled with water and air. After the pipe is inserted through the mouth, it can be injected with water and gas properly to avoid accidental withdrawal of the gastric tube. Intermittent oroesophageal tube feeding of patients with dysphagia after stroke through a transoral gastric tube that can extract and store gastric contents can not only accelerate the recovery process of patients and shorten the hospitalization time, but also transoral enteral nutrition can effectively promote the recovery of patients' systemic systems, which has certain clinical use value.
Humans ; Enteral Nutrition ; Aircraft ; Cannula ; China ; Drug Contamination

OBJECTIVE: To determine the high-risk factors for early failure of high-flow nasal cannula (HFNC) oxygen therapy in children with acute respiratory insufficiency (ARI). METHODS: The clinical data of 123 children with ARI were reviewed who received HFNC oxygen therapy in the pediatric intensive care unit from January to June, 2018. The children who did not require an upgrade of respiratory support during hospitalization and were successfully weaned from HFNC were classified as HFNC success group (69 cases). Of the remaining children (54 cases) who required an upgrade of their respiratory support during hospitalization, those that needed to upgrade their respiratory support within 48 hours of receiving HFNC were classified as early HFNC failure group (46 cases). Risk factors for early failure of HFNC were determined using multivariate logistic regression analysis. RESULTS: The incidence rates of shock, sepsis, intracranial hypertension syndrome, and multiple organ dysfunction syndrome were significantly higher in the early HFNC failure group than in the HFNC success group (P<0.05). Before implementation of respiratory support, the early HFNC failure group had significantly lower Glasgow coma score, pH value, and oxygenation index and significantly higher Pediatric Risk of Mortality (PRISM) score and PaCO/PaO ratio than the HFNC success group (P<0.05). Multivariate logistic regression analysis showed that PRISM score >4.5 and PaCO/PaO ratio >0.64 were independent risk factors for early HFNC failure (OR=5.535 and 9.089 respectively; P<0.05). CONCLUSIONS Pediatric ARI patients with PRISM score >4.5 or PaCO/PaO ratio >0.64 have relatively high risk of early HFNC failure.
Cannula ; Child ; Humans ; Oxygen ; Oxygen Inhalation Therapy ; Respiratory Insufficiency ; Risk Factors

OBJECTIVE: To systematically evaluate the efficacy and safety of high-flow nasal cannula (HFNC) therapy versus nasal continuous positive airway pressure (nCPAP) in the treatment of respiratory distress syndrome (RDS) in neonates. METHODS: PubMed, Embase, Cochrane Library, Web of Science, China Biology Medicine disc, Wanfang Database, CNKI, and Weipu Database were searched for the randomized controlled trials (RCTs) of HFNC versus nCPAP in the treatment of neonatal RDS published up to April 1, 2020. RevMan5.3 software was used to perform a Meta analysis of the eligible RCTs. RESULTS: A total of 12 RCTs were included, with 2 861 neonates in total, among whom 2 698 neonates (94.30%) had a gestational age of ≥28 weeks and 163 (5.70%) had a gestational age of <28 weeks. For primary respiratory support, the HFNC group had a significantly higher rate of treatment failure than the nCPAP group (RR=1.86, 95%CI: 1.53-2.25, P<0.001), but there were no significant differences between the two groups in the rate of invasive mechanical ventilation (P=0.40) and the rate of use of pulmonary surfactant (P=0.77). For post-extubation respiratory support, there were no significant differences between the two groups in the treatment failure rate, reintubation rate, and total oxygen supply time (P>0.05). For primary respiratory support and post-extubation respiratory support, the HFNC group had a significantly lower incidence rate of nasal injury than the nCPAP group (P<0.001), and there were no significant differences between the two groups in the mortality rate and incidence rates of the complications such as air leak syndrome, bronchopulmonary dysplasia, and necrotizing enterocolitis (P>0.05). CONCLUSIONS Based on the current clinical evidence, HFNC has a higher failure rate than nCPAP when used as primary respiratory support for neonates with RDS, and therefore it is not recommended to use HFNC as the primary respiratory support for neonates with RDS. In RDS neonates with a gestational age of ≥28 weeks, HFNC can be used as post-extubation respiratory support in the weaning phase.
Cannula ; China ; Continuous Positive Airway Pressure ; Humans ; Infant, Newborn ; Infant, Premature ; Respiratory Distress Syndrome, Newborn/therapy*

Acute respiratory failure due to acute hypoxemia is the major manifestation in severe coronavirus disease 2019 (COVID-19). Rational and effective respiratory support is crucial in the management of COVID-19 patients. High-flow nasal cannula (HFNC) has been utilized widely due to its superiority over other non-invasive respiratory support techniques. To avoid HFNC failure and intubation delay, the key issues are proper patients, timely application and improving compliance. It should be noted that elder patients are vulnerable for failed HFNC. We applied HFNC for oxygen therapy in severe and critical ill COVID-19 patients and summarized the following experiences. Firstly, to select the proper size of nasal catheter, to locate it at suitable place, and to confirm the nose and the upper respiratory airway unobstructed. Secondly, an initial ow of 60 L/min and 37℃ should be given immediately for patients with obvious respiratory distress or weak cough ability; otherwise, low-level support should be given first and the level gradually increased. Thirdly, to avoid hypoxia or hypoxemia, the treatment goal of HFNC should be maintained the oxygen saturation (SpO) above 95% for patients without chronic pulmonary disease. Finally, patients should wear a surgical mask during HFNC treatment to reduce the risk of virus transmission through droplets or aerosols.
Aged ; Betacoronavirus ; isolation & purification ; Cannula ; Coronavirus Infections ; therapy ; Humans ; Oxygen ; administration & dosage ; Pandemics ; Pneumonia, Viral ; therapy

INTRODUCTION: Evidence regarding the efficacy of high-flow nasal cannula (HFNC) oxygenation for preoxygenation and apnoeic oxygenation is conflicting. Our objective is to evaluate whether HFNC oxygenation for preoxygenation and apnoeic oxygenation maintains higher oxygen saturation (SpO₂) during rapid sequence intubation (RSI) in ED patients compared to usual care. METHODS: This was a multicentre, open-label, randomised controlled trial in adult ED patients requiring RSI. Patients were randomly assigned 1:1 to either intervention (HFNC oxygenation at 60L/min) group or control (non-rebreather mask for preoxygenation and nasal prongs of at least 15L/min oxygen flow for apnoeic oxygenation) group. Primary outcome was lowest SpO₂ during the first intubation attempt. Secondary outcomes included incidence of SpO₂ falling below 90% and safe apnoea time. RESULTS: One hundred and ninety patients were included, with 97 in the intervention and 93 in the control group. Median lowest SpO₂ during the first intubation attempt was 100% in both groups. Incidence of SpO₂ falling below 90% was lower in the intervention group (15.5%) compared to the control group (22.6%) (adjusted relative risk=0.68, 95% confidence interval [CI] 0.37-1.25). Post hoc quantile regression analysis showed that the first quartile of lowest SpO₂ during the first intubation attempt was greater by 5.46% (95% CI 1.48-9.45%, P=0.007) in the intervention group. CONCLUSION Use of HFNC for preoxygenation and apnoeic oxygenation, when compared to usual care, did not improve lowest SpO₂ during the first intubation attempt but may prolong safe apnoea time.
Adult ; Cannula ; Emergency Service, Hospital ; Humans ; Intubation, Intratracheal ; Rapid Sequence Induction and Intubation ; Respiration, Artificial

INTRODUCTION: Despite adhering to criteria for extubation, up to 20% of intensive care patients require re-intubation, even with use of post-extubation high-flow nasal cannula (HFNC). This study aims to identify independent predictors and outcomes of extubation failure in patients who failed post-extubation HFNC. METHODS: We conducted a multicentre observational study involving 9 adult intensive care units (ICUs) across 5 public hospitals in Singapore. We included patients extubated to HFNC following spontaneous breathing trials. We compared patients who were successfully weaned off HFNC with those who failed HFNC (defined as re-intubation ≤7 days following extubation). Generalised additive logistic regression analysis was used to identify independent risk factors for failed HFNC. RESULTS: Among 244 patients (mean age: 63.92±15.51 years, 65.2% male, median APACHE II score 23.55±7.35), 41 (16.8%) failed HFNC; hypoxia, hypercapnia and excessive secretions were primary reasons. Stroke was an independent predictor of HFNC failure (odds ratio 2.48, 95% confidence interval 1.83-3.37). Failed HFNC, as compared to successful HFNC, was associated with increased median ICU length of stay (14 versus 7 days, CONCLUSION Post-extubation HFNC failure, especially in patients with stroke as a comorbidity, remains a clinical challenge and predicts poorer clinical outcomes. Our observational study highlights the need for future prospective trials to better identify patients at high risk of post-extubation HFNC failure.
Adult ; Airway Extubation ; Cannula ; Critical Care ; Female ; Humans ; Intensive Care Units ; Male ; Middle Aged ; Respiratory Insufficiency/therapy* ; Singapore/epidemiology*

Objective: To compare the efficacy of high-flow nasal cannula oxygen therapy (HFNC) and non-rebreather face mask (NRFM) in the treatment of mild acute carbon monoxide poisoning (ACOP) in reducing carboxyhemoglobin (COHb) , and to explore the feasibility of HFNC in the treatment of ACOP. Methods: Patients with mild ACOP with COHb >10% who were admitted to the emergency department of Northern Jiangsu People's Hospital from January 2015 to December 2020 were analyzed, and those with altered consciousness, mechanical ventilation and those requiring hyperbaric oxygen therapy were excluded. The patients were divided into HFNC group and NRFM group according to the oxygen therapy used in the emergency department. The COHb decline value and COHb half-life in the two groups were observed. Results: Seventy-one patients were enrolled, including 39 in the NRFM group and 32 in the HFNC group. The baseline COHb in the HFNC group was 24.8%±8.3%, and that in the NRFM group was 22.5%±7.1%, with no significant difference between the two groups (t=1.27, P=0.094) . At 60 min, 90 min and 120 min of treatment, COHb in both groups decreased, but the COHb in HFNC group was lower than that in NRFM group at the same time point (P<0.05) . After 1 h of treatment, the COHb decrease in the HFNC group (16.9%±4.5%) was significantly higher than that in the NRFM group (10.1%±7.8%) (t=4.32, P=0.013) . The mean half-life of COHb in the HFNC group (39.3 min) was significantly lower than that in the NRFM group (61.4 min) (t=4.69, P=0.034) . Conclusion: HFNC treatment of mild ACOP can rapidly reduce blood COHb level, it is a potential oxygen therapy method for clinical treatment of ACOP.
Humans ; Carbon Monoxide Poisoning/therapy* ; Cannula ; Respiration, Artificial ; Masks ; Oxygen Inhalation Therapy/methods* ; Carboxyhemoglobin ; Oxygen/therapeutic use* ; Respiratory Insufficiency/therapy*