High-flow Nasal Cannula Ventilatory Modalities | Archivos de Bronconeumología

array:23 ["pii" => "S0300289623003137" "issn" => "03002896" "doi" => "10.1016/j.arbres.2023.09.016" "estado" => "S300" "fechaPublicacion" => "2024-02-01" "aid" => "3413" "copyright" => "SEPAR" "copyrightAnyo" => "2023" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Arch Bronconeumol. 2024;60:122-3" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "itemSiguiente" => array:18 [ "pii" => "S030028962300409X" "issn" => "03002896" "doi" => "10.1016/j.arbres.2023.12.007" "estado" => "S300" "fechaPublicacion" => "2024-02-01" "aid" => "3453" "copyright" => "SEPAR" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Arch Bronconeumol. 2024;60:124" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:9 [ "idiomaDefecto" => true "cabecera" => "Letter to the Director" "titulo" => "Diagnostic Difficulties in Hemorrhagic Hereditary Telangiectasia Presenting With Respiratory Failure and a De Novo Mutation in ENG Gene" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "124" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Alfonso Gutiérrez-Macías, Begoña Salinas-Lasa, Julen Agirre-Castillero" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Alfonso" "apellidos" => "Gutiérrez-Macías" ] 1 => array:2 [ "nombre" => "Begoña" "apellidos" => "Salinas-Lasa" ] 2 => array:2 [ "nombre" => "Julen" "apellidos" => "Agirre-Castillero" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S030028962300409X?idApp=UINPBA00003Z" "url" => "/03002896/0000006000000002/v3_202406051408/S030028962300409X/v3_202406051408/en/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S0300289623004167" "issn" => "03002896" "doi" => "10.1016/j.arbres.2023.12.011" "estado" => "S300" "fechaPublicacion" => "2024-02-01" "aid" => "3457" "copyright" => "The Author(s)" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Arch Bronconeumol. 2024;60:119-21" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "Scientific Letter" "titulo" => "COPD Patients Display Increased Peripheral Blood Somatic Mutations Which Associate With the Prevalence of Co-morbidities" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "119" "paginaFinal" => "121" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 3290 "Ancho" => 2925 "Tamanyo" => 578673 ] ] "descripcion" => array:1 [ "en" => "Higher prevalence of somatic mutations in COPD patients compared to healthy controls and associations with COPD co-morbidities. (A) Flow chart of differentially prevalent mutated genes identified in our study. (B) The top-10 genes that displayed the highest differential prevalence of somatic mutations in COPD patients compared to healthy controls. The white bars represent the percentage of the COPD group that had a putative somatic mutation within the gene, the gray bars represent the percentage of mutations within the control group. The delta between percentage mutations in the COPD and control group is depicted above the white bars. (C) The prevalence of gene mutations of HLA-A, LGALS9C, ORT2T or KIF26B in COPD patients (n=165) with or without osteoporosis (n=15), hypertension (n=51) or myocardial infarction (n=11). (D) The gene expression levels of HLA-A and MRPL4 in COPD patients (n=165) with or without osteoporosis (n=15) or hypertension (n=51). The somatic mutation data was obtained from peripheral blood, while the gene expression data was obtained from bronchial biopsies. Statistical differences were tested using a Mann–Whitney U test, nominal p values are shown on top of the graph." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Alen Faiz, Valerie R. Wiersma, Jonas B. Salzbrunn, Corry-Anke Brandsma, Wim Timens, Janette K. Burgess, Maarten van den Berge, Dirk-Jan Slebos, Victor Guryev, Simon D. Pouwels" "autores" => array:10 [ 0 => array:2 [ "nombre" => "Alen" "apellidos" => "Faiz" ] 1 => array:2 [ "nombre" => "Valerie R." "apellidos" => "Wiersma" ] 2 => array:2 [ "nombre" => "Jonas B." "apellidos" => "Salzbrunn" ] 3 => array:2 [ "nombre" => "Corry-Anke" "apellidos" => "Brandsma" ] 4 => array:2 [ "nombre" => "Wim" "apellidos" => "Timens" ] 5 => array:2 [ "nombre" => "Janette K." "apellidos" => "Burgess" ] 6 => array:2 [ "nombre" => "Maarten" "apellidos" => "van den Berge" ] 7 => array:2 [ "nombre" => "Dirk-Jan" "apellidos" => "Slebos" ] 8 => array:2 [ "nombre" => "Victor" "apellidos" => "Guryev" ] 9 => array:2 [ "nombre" => "Simon D." "apellidos" => "Pouwels" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289623004167?idApp=UINPBA00003Z" "url" => "/03002896/0000006000000002/v3_202406051408/S0300289623004167/v3_202406051408/en/main.assets" ] "en" => array:14 [ "idiomaDefecto" => true "cabecera" => "Letter to the Director" "titulo" => "High-flow Nasal Cannula Ventilatory Modalities" "tieneTextoCompleto" => true "saludo" => "To the Director," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "122" "paginaFinal" => "123" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Salvador Díaz Lobato, José Manuel Carratalá Perales, Guillermo Montiel, José Miguel Alonso Íñigo" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Salvador" "apellidos" => "Díaz Lobato" "email" => array:1 [ 0 => "sdiazlobato@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "José Manuel" "apellidos" => "Carratalá Perales" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Guillermo" "apellidos" => "Montiel" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "José Miguel" "apellidos" => "Alonso Íñigo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "d" "identificador" => "aff0020" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "HLA Hospital Universitario Moncloa, Universidad Europea, Nippon Gases Healthcare, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Unidad de Corta Estancia, Servicio de Urgencias, Hospital General de Alicante, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Anestesiología y Reanimación, Hospital Universitario y Politécnico La Fe, Valencia, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Servicio de Neumonología, Hospital J.A. Fernández, Buenos Aires, Argentina" "etiqueta" => "d" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 495 "Ancho" => 1508 "Tamanyo" => 91557 ] ] "descripcion" => array:1 [ "en" => "High-flow nasal cannula ventilatory modalities. HFNC: high-flow nasal cannula." ] ] ] "textoCompleto" => "Currently, high-flow nasal cannula therapy (HFNC) is considered as a non-invasive respiratory support therapy suitable for patients experiencing both hypoxemic and hypercapnic respiratory failure. At first glance, setting HFNC seems to be very simple to use. The main menu of the HFNC devices offers only three key parameters: flow, temperature and FiO2. However, several studies have also shown us that setting HFNC may not be as simple as it initially seems, opening the door to defining HFNC ventilatory modalities similar to those used in non-invasive ventilation.We could categorize the HFNC effects into three groups: 1. humidification and warming effects, which are common to all HFNC patients, impacting mucociliary clearance, patient comfort and tolerance, 2. airway pressurization effects, particularly significant for hypoxemic ARF patients, and 3. CO2 washout effects, relevant for hypercapnic ARF patients. Can HFNC settings be customized to prioritize certain mechanisms over others? Existing evidence suggests that customization is feasible.From the beginnings of HFNC, it has been clear that there is a direct correlation between the administered flow rate and the resultant airway pressure.<a class="elsevierStyleCrossRef" href="#bib0030">1</a> However, factors beyond flow rate can also influence pressurization. The first one is related to the degree of elastance of the rib cage (with a constant flow, elastance that determines the airway pressure). Secondly, the size of the cannula (larger cannulas covering a larger nares surface area increase airway pressure<a class="elsevierStyleCrossRef" href="#bib0035">2</a>). Thirdly, the patient's breathing pattern (the pressure is higher with mouth-closed breathing<a class="elsevierStyleCrossRef" href="#bib0040">3</a>). Fourthly, the type of gas used (lower-density inspired gas as helium–oxygen mixture, leads to lower airway pressure<a class="elsevierStyleCrossRef" href="#bib0045">4</a>). Finally, the airway access (pressure is lower when HFNC is administered through tracheostomy vs nasal cannula). Studies conducted during the COVID-19 pandemic have also highlighted additional HFNC optimization techniques, including prone maneuvers and surgical mask placement.<a class="elsevierStyleCrossRef" href="#bib0050">5</a>Conversely, certain circumstances enhance CO2 washout. Different studies have shown that CO2 washout increase when the patient breathes with an open mouth<a class="elsevierStyleCrossRef" href="#bib0040">3</a> or when smaller cannulas leave more space in the nostrils.<a class="elsevierStyleCrossRef" href="#bib0035">2</a> It is worth noting that the density of the inspired gas, whether it is ambient air, O2 or a helium–O2 mixture, does not alter CO2 washout.In summary, we could clearly differentiate three ventilatory strategies or modalities when setting up a HFNC (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). In hypoxemic ARF patients it would be advisable to use high-flow rates and cannulas covering more than 50% of the nares, encourage mouth-closed breathing, avoid low-density gases, and consider mask placement and prone maneuvers for oxygenation. In hypercapnic ARF patients, lower flow rates and cannulas that occlude less than 50% of the nares should be more appropriate. Advise open-mouth breathing and consider low-density gas mixtures if needed. Finally, for patients with compromised mucociliar clearance, high flows are unnecessary, and the focus should primarily be on gas humidification and warming.<elsevierMultimedia ident="fig0005"></elsevierMultimedia>To our knowledge, this is the first time that ventilatory modalities applied to HFNC have been described. Future studies are necessary to enhance our understanding of HFNC and the impact of different HFNC settings on clinical outcomes.Conflict of InterestThe authors do not have any conflict of interest related to this manuscript." "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflict of Interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 495 "Ancho" => 1508 "Tamanyo" => 91557 ] ] "descripcion" => array:1 [ "en" => "High-flow nasal cannula ventilatory modalities. HFNC: high-flow nasal cannula." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Nasal high-flow therapy delivers low level positive airway pressure" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "R. Parke" 1 => "S. McGuinness" 2 => "M. Eccleston" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/bja/aep280" "Revista" => array:5 [ "tituloSerie" => "Br J Anaesth" "fecha" => "2009" "volumen" => "103" "paginaInicial" => "886" "paginaFinal" => "890" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0035" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effect of flow and cannula size on generated pressure during nasal high flow" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M. Pinkham" 1 => "S. Tatkov" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/s13054-020-02980-w" "Revista" => array:5 [ "tituloSerie" => "Crit Care" "fecha" => "2020" "volumen" => "24" "paginaInicial" => "248" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32448344" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0040" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A high-flow nasal cannula system with relatively low flow effectively washes out CO2 from the anatomical dead space in a sophisticated respiratory model made by a 3D printer" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "Y. Onodera" 1 => "R. Akimoto" 2 => "H. Suzuki" 3 => "M. Okada" 4 => "M. Nakane" 5 => "K. Kawamae" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/s40635-018-0172-7" "Revista" => array:4 [ "tituloSerie" => "Intensive Care Med Exp" "fecha" => "2018" "volumen" => "6" "paginaInicial" => "7" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0045" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "High flow nasal cannula: influence of gas type and flow rate on airway pressure and CO2 clearance in adult nasal airway replicas" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "C.P. Moore" 1 => "I.M. Katz" 2 => "M. Pichelin" 3 => "G. Caillibotte" 4 => "W.H. Finlay" 5 => "A.R. Martin" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.clinbiomech.2019.04.004" "Revista" => array:6 [ "tituloSerie" => "Clin Biomech (Bristol, Avon)" "fecha" => "2019" "volumen" => "65" "paginaInicial" => "73" "paginaFinal" => "80" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30991233" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Surgical mask on top of high-flow nasal cannula improves oxygenation in critically ill COVID-19 patients with hypoxemic respiratory failure" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "V. Montiel" 1 => "A. Robert" 2 => "A. Robert" 3 => "A. Nabaoui" 4 => "T. Marie" 5 => "N.M. Mestre" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/s13613-020-00744-x" "Revista" => array:5 [ "tituloSerie" => "Ann Intensive Care" "fecha" => "2020" "volumen" => "10" "paginaInicial" => "125" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32990864" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/03002896/0000006000000002/v3_202406051408/S0300289623003137/v3_202406051408/en/main.assets" "Apartado" => array:4 [ "identificador" => "94562" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Letters to the Director" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/03002896/0000006000000002/v3_202406051408/S0300289623003137/v3_202406051408/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289623003137?idApp=UINPBA00003Z"]

Statistics

Letter to the Director

High-flow Nasal Cannula Ventilatory Modalities

Salvador Díaz Lobatoa,

Corresponding author

sdiazlobato@gmail.com

Corresponding author.

, José Manuel Carratalá Peralesb, Guillermo Montielc, José Miguel Alonso Íñigod

a HLA Hospital Universitario Moncloa, Universidad Europea, Nippon Gases Healthcare, Madrid, Spain

b Unidad de Corta Estancia, Servicio de Urgencias, Hospital General de Alicante, Spain

c Servicio de Anestesiología y Reanimación, Hospital Universitario y Politécnico La Fe, Valencia, Spain

d Servicio de Neumonología, Hospital J.A. Fernández, Buenos Aires, Argentina

Read

2376

Times
was read the article

781

Total PDF

1595

Total HTML

Share statistics

 array:23 [
  "pii" => "S0300289623003137"
  "issn" => "03002896"
  "doi" => "10.1016/j.arbres.2023.09.016"
  "estado" => "S300"
  "fechaPublicacion" => "2024-02-01"
  "aid" => "3413"
  "copyright" => "SEPAR"
  "copyrightAnyo" => "2023"
  "documento" => "simple-article"
  "crossmark" => 1
  "subdocumento" => "cor"
  "cita" => "Arch Bronconeumol. 2024;60:122-3"
  "abierto" => array:3 [
    "ES" => false
    "ES2" => false
    "LATM" => false
  ]
  "gratuito" => false
  "lecturas" => array:1 [
    "total" => 0
  ]
  "itemSiguiente" => array:18 [
    "pii" => "S030028962300409X"
    "issn" => "03002896"
    "doi" => "10.1016/j.arbres.2023.12.007"
    "estado" => "S300"
    "fechaPublicacion" => "2024-02-01"
    "aid" => "3453"
    "copyright" => "SEPAR"
    "documento" => "simple-article"
    "crossmark" => 1
    "subdocumento" => "cor"
    "cita" => "Arch Bronconeumol. 2024;60:124"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:1 [
      "total" => 0
    ]
    "en" => array:9 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Director</span>"
      "titulo" => "Diagnostic Difficulties in Hemorrhagic Hereditary Telangiectasia Presenting With Respiratory Failure and a <span class="elsevierStyleItalic">De Novo</span> Mutation in ENG Gene"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:1 [
          "paginaInicial" => "124"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Alfonso Guti&#233;rrez-Mac&#237;as, Bego&#241;a Salinas-Lasa, Julen Agirre-Castillero"
          "autores" => array:3 [
            0 => array:2 [
              "nombre" => "Alfonso"
              "apellidos" => "Guti&#233;rrez-Mac&#237;as"
            ]
            1 => array:2 [
              "nombre" => "Bego&#241;a"
              "apellidos" => "Salinas-Lasa"
            ]
            2 => array:2 [
              "nombre" => "Julen"
              "apellidos" => "Agirre-Castillero"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S030028962300409X?idApp=UINPBA00003Z"
    "url" => "/03002896/0000006000000002/v3_202406051408/S030028962300409X/v3_202406051408/en/main.assets"
  ]
  "itemAnterior" => array:18 [
    "pii" => "S0300289623004167"
    "issn" => "03002896"
    "doi" => "10.1016/j.arbres.2023.12.011"
    "estado" => "S300"
    "fechaPublicacion" => "2024-02-01"
    "aid" => "3457"
    "copyright" => "The Author&#40;s&#41;"
    "documento" => "simple-article"
    "crossmark" => 1
    "subdocumento" => "crp"
    "cita" => "Arch Bronconeumol. 2024;60:119-21"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:1 [
      "total" => 0
    ]
    "en" => array:10 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Scientific Letter</span>"
      "titulo" => "COPD Patients Display Increased Peripheral Blood Somatic Mutations Which Associate With the Prevalence of Co-morbidities"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "119"
          "paginaFinal" => "121"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0005"
          "etiqueta" => "Fig&#46; 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 3290
              "Ancho" => 2925
              "Tamanyo" => 578673
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Higher prevalence of somatic mutations in COPD patients compared to healthy controls and associations with COPD co-morbidities&#46; &#40;A&#41; Flow chart of differentially prevalent mutated genes identified in our study&#46; &#40;B&#41; The top-10 genes that displayed the highest differential prevalence of somatic mutations in COPD patients compared to healthy controls&#46; The white bars represent the percentage of the COPD group that had a putative somatic mutation within the gene&#44; the gray bars represent the percentage of mutations within the control group&#46; The delta between percentage mutations in the COPD and control group is depicted above the white bars&#46; &#40;C&#41; The prevalence of gene mutations of <span class="elsevierStyleItalic">HLA-A</span>&#44; <span class="elsevierStyleItalic">LGALS9C</span>&#44; <span class="elsevierStyleItalic">ORT2T</span> or <span class="elsevierStyleItalic">KIF26B</span> in COPD patients &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>165&#41; with or without osteoporosis &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>15&#41;&#44; hypertension &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>51&#41; or myocardial infarction &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>11&#41;&#46; &#40;D&#41; The gene expression levels of <span class="elsevierStyleItalic">HLA-A</span> and <span class="elsevierStyleItalic">MRPL4</span> in COPD patients &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>165&#41; with or without osteoporosis &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>15&#41; or hypertension &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>51&#41;&#46; The somatic mutation data was obtained from peripheral blood&#44; while the gene expression data was obtained from bronchial biopsies&#46; Statistical differences were tested using a Mann&#8211;Whitney <span class="elsevierStyleItalic">U</span> test&#44; nominal <span class="elsevierStyleItalic">p</span> values are shown on top of the graph&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Alen Faiz, Valerie R&#46; Wiersma, Jonas B&#46; Salzbrunn, Corry-Anke Brandsma, Wim Timens, Janette K&#46; Burgess, Maarten van den Berge, Dirk-Jan Slebos, Victor Guryev, Simon D&#46; Pouwels"
          "autores" => array:10 [
            0 => array:2 [
              "nombre" => "Alen"
              "apellidos" => "Faiz"
            ]
            1 => array:2 [
              "nombre" => "Valerie R&#46;"
              "apellidos" => "Wiersma"
            ]
            2 => array:2 [
              "nombre" => "Jonas B&#46;"
              "apellidos" => "Salzbrunn"
            ]
            3 => array:2 [
              "nombre" => "Corry-Anke"
              "apellidos" => "Brandsma"
            ]
            4 => array:2 [
              "nombre" => "Wim"
              "apellidos" => "Timens"
            ]
            5 => array:2 [
              "nombre" => "Janette K&#46;"
              "apellidos" => "Burgess"
            ]
            6 => array:2 [
              "nombre" => "Maarten"
              "apellidos" => "van den Berge"
            ]
            7 => array:2 [
              "nombre" => "Dirk-Jan"
              "apellidos" => "Slebos"
            ]
            8 => array:2 [
              "nombre" => "Victor"
              "apellidos" => "Guryev"
            ]
            9 => array:2 [
              "nombre" => "Simon D&#46;"
              "apellidos" => "Pouwels"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289623004167?idApp=UINPBA00003Z"
    "url" => "/03002896/0000006000000002/v3_202406051408/S0300289623004167/v3_202406051408/en/main.assets"
  ]
  "en" => array:14 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Director</span>"
    "titulo" => "High-flow Nasal Cannula Ventilatory Modalities"
    "tieneTextoCompleto" => true
    "saludo" => "<span class="elsevierStyleItalic">To the Director</span>&#44;"
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "122"
        "paginaFinal" => "123"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Salvador D&#237;az Lobato, Jos&#233; Manuel Carratal&#225; Perales, Guillermo Montiel, Jos&#233; Miguel Alonso &#205;&#241;igo"
        "autores" => array:4 [
          0 => array:4 [
            "nombre" => "Salvador"
            "apellidos" => "D&#237;az Lobato"
            "email" => array:1 [
              0 => "sdiazlobato@gmail.com"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "Jos&#233; Manuel"
            "apellidos" => "Carratal&#225; Perales"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "Guillermo"
            "apellidos" => "Montiel"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
            ]
          ]
          3 => array:3 [
            "nombre" => "Jos&#233; Miguel"
            "apellidos" => "Alonso &#205;&#241;igo"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">d</span>"
                "identificador" => "aff0020"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:4 [
          0 => array:3 [
            "entidad" => "HLA Hospital Universitario Moncloa&#44; Universidad Europea&#44; Nippon Gases Healthcare&#44; Madrid&#44; Spain"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Unidad de Corta Estancia&#44; Servicio de Urgencias&#44; Hospital General de Alicante&#44; Spain"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
          2 => array:3 [
            "entidad" => "Servicio de Anestesiolog&#237;a y Reanimaci&#243;n&#44; Hospital Universitario y Polit&#233;cnico La Fe&#44; Valencia&#44; Spain"
            "etiqueta" => "c"
            "identificador" => "aff0015"
          ]
          3 => array:3 [
            "entidad" => "Servicio de Neumonolog&#237;a&#44; Hospital J&#46;A&#46; Fern&#225;ndez&#44; Buenos Aires&#44; Argentina"
            "etiqueta" => "d"
            "identificador" => "aff0020"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Fig&#46; 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 495
            "Ancho" => 1508
            "Tamanyo" => 91557
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">High-flow nasal cannula ventilatory modalities&#46; HFNC&#58; high-flow nasal cannula&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Currently&#44; high-flow nasal cannula therapy &#40;HFNC&#41; is considered as a non-invasive respiratory support therapy suitable for patients experiencing both hypoxemic and hypercapnic respiratory failure&#46; At first glance&#44; setting HFNC seems to be very simple to use&#46; The main menu of the HFNC devices offers only three key parameters&#58; flow&#44; temperature and FiO<span class="elsevierStyleInf">2</span>&#46; However&#44; several studies have also shown us that setting HFNC may not be as simple as it initially seems&#44; opening the door to defining HFNC ventilatory modalities similar to those used in non-invasive ventilation&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">We could categorize the HFNC effects into three groups&#58; 1&#46; humidification and warming effects&#44; which are common to all HFNC patients&#44; impacting mucociliary clearance&#44; patient comfort and tolerance&#44; 2&#46; airway pressurization effects&#44; particularly significant for hypoxemic ARF patients&#44; and 3&#46; CO<span class="elsevierStyleInf">2</span> washout effects&#44; relevant for hypercapnic ARF patients&#46; Can HFNC settings be customized to prioritize certain mechanisms over others&#63; Existing evidence suggests that customization is feasible&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">From the beginnings of HFNC&#44; it has been clear that there is a direct correlation between the administered flow rate and the resultant airway pressure&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> However&#44; factors beyond flow rate can also influence pressurization&#46; The first one is related to the degree of elastance of the rib cage &#40;with a constant flow&#44; elastance that determines the airway pressure&#41;&#46; Secondly&#44; the size of the cannula &#40;larger cannulas covering a larger nares surface area increase airway pressure<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a>&#41;&#46; Thirdly&#44; the patient&#39;s breathing pattern &#40;the pressure is higher with mouth-closed breathing<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a>&#41;&#46; Fourthly&#44; the type of gas used &#40;lower-density inspired gas as helium&#8211;oxygen mixture&#44; leads to lower airway pressure<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a>&#41;&#46; Finally&#44; the airway access &#40;pressure is lower when HFNC is administered through tracheostomy vs nasal cannula&#41;&#46; Studies conducted during the COVID-19 pandemic have also highlighted additional HFNC optimization techniques&#44; including prone maneuvers and surgical mask placement&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Conversely&#44; certain circumstances enhance CO<span class="elsevierStyleInf">2</span> washout&#46; Different studies have shown that CO<span class="elsevierStyleInf">2</span> washout increase when the patient breathes with an open mouth<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> or when smaller cannulas leave more space in the nostrils&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> It is worth noting that the density of the inspired gas&#44; whether it is ambient air&#44; O<span class="elsevierStyleInf">2</span> or a helium&#8211;O<span class="elsevierStyleInf">2</span> mixture&#44; does not alter CO<span class="elsevierStyleInf">2</span> washout&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">In summary&#44; we could clearly differentiate three ventilatory strategies or modalities when setting up a HFNC &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; In hypoxemic ARF patients it would be advisable to use high-flow rates and cannulas covering more than 50&#37; of the nares&#44; encourage mouth-closed breathing&#44; avoid low-density gases&#44; and consider mask placement and prone maneuvers for oxygenation&#46; In hypercapnic ARF patients&#44; lower flow rates and cannulas that occlude less than 50&#37; of the nares should be more appropriate&#46; Advise open-mouth breathing and consider low-density gas mixtures if needed&#46; Finally&#44; for patients with compromised mucociliar clearance&#44; high flows are unnecessary&#44; and the focus should primarily be on gas humidification and warming&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">To our knowledge&#44; this is the first time that ventilatory modalities applied to HFNC have been described&#46; Future studies are necessary to enhance our understanding of HFNC and the impact of different HFNC settings on clinical outcomes&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflict of Interest</span><p id="par0035" class="elsevierStylePara elsevierViewall">The authors do not have any conflict of interest related to this manuscript&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:2 [
        0 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Conflict of Interest"
        ]
        1 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "multimedia" => array:1 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Fig&#46; 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 495
            "Ancho" => 1508
            "Tamanyo" => 91557
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">High-flow nasal cannula ventilatory modalities&#46; HFNC&#58; high-flow nasal cannula&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:5 [
            0 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Nasal high-flow therapy delivers low level positive airway pressure"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "R&#46; Parke"
                            1 => "S&#46; McGuinness"
                            2 => "M&#46; Eccleston"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/bja/aep280"
                      "Revista" => array:5 [
                        "tituloSerie" => "Br J Anaesth"
                        "fecha" => "2009"
                        "volumen" => "103"
                        "paginaInicial" => "886"
                        "paginaFinal" => "890"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effect of flow and cannula size on generated pressure during nasal high flow"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "M&#46; Pinkham"
                            1 => "S&#46; Tatkov"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/s13054-020-02980-w"
                      "Revista" => array:5 [
                        "tituloSerie" => "Crit Care"
                        "fecha" => "2020"
                        "volumen" => "24"
                        "paginaInicial" => "248"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32448344"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A high-flow nasal cannula system with relatively low flow effectively washes out CO<span class="elsevierStyleInf">2</span> from the anatomical dead space in a sophisticated respiratory model made by a 3D printer"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "Y&#46; Onodera"
                            1 => "R&#46; Akimoto"
                            2 => "H&#46; Suzuki"
                            3 => "M&#46; Okada"
                            4 => "M&#46; Nakane"
                            5 => "K&#46; Kawamae"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/s40635-018-0172-7"
                      "Revista" => array:4 [
                        "tituloSerie" => "Intensive Care Med Exp"
                        "fecha" => "2018"
                        "volumen" => "6"
                        "paginaInicial" => "7"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "High flow nasal cannula&#58; influence of gas type and flow rate on airway pressure and CO<span class="elsevierStyleInf">2</span> clearance in adult nasal airway replicas"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "C&#46;P&#46; Moore"
                            1 => "I&#46;M&#46; Katz"
                            2 => "M&#46; Pichelin"
                            3 => "G&#46; Caillibotte"
                            4 => "W&#46;H&#46; Finlay"
                            5 => "A&#46;R&#46; Martin"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.clinbiomech.2019.04.004"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Biomech &#40;Bristol&#44; Avon&#41;"
                        "fecha" => "2019"
                        "volumen" => "65"
                        "paginaInicial" => "73"
                        "paginaFinal" => "80"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30991233"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Surgical mask on top of high-flow nasal cannula improves oxygenation in critically ill COVID-19 patients with hypoxemic respiratory failure"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "V&#46; Montiel"
                            1 => "A&#46; Robert"
                            2 => "A&#46; Robert"
                            3 => "A&#46; Nabaoui"
                            4 => "T&#46; Marie"
                            5 => "N&#46;M&#46; Mestre"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/s13613-020-00744-x"
                      "Revista" => array:5 [
                        "tituloSerie" => "Ann Intensive Care"
                        "fecha" => "2020"
                        "volumen" => "10"
                        "paginaInicial" => "125"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32990864"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/03002896/0000006000000002/v3_202406051408/S0300289623003137/v3_202406051408/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "94562"
    "tipo" => "SECCION"
    "es" => array:2 [
      "titulo" => "Letters to the Director"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "es"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/03002896/0000006000000002/v3_202406051408/S0300289623003137/v3_202406051408/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289623003137?idApp=UINPBA00003Z"
]

Article information

ISSN: 03002896
Original language: English

DOI:10.1016/j.arbres.2023.09.016

The statistics are updated each day

Year/Month	Html	Pdf	Total

2024 October	1	2	3
2024 August	2	0	2
2024 July	1	0	1
2024 June	3	2	5
2024 May	3	6	9
2024 April	5	1	6
2024 March	15	5	20
2024 February	90	40	130
2024 January	48	33	81
2023 December	72	27	99
2023 November	235	176	411
2023 October	1120	489	1609

Indexed in:

Follow us:

Subscribe:

Statistics

Indexed in:

Follow us:

Subscribe:

Statistics

Subscribe to our newsletter