Letter to the Editor
High-flow Nasal Cannula Oxygen Therapy: Preliminary Study in Hospitalized Patients
Oxigenoterapia de alto flujo con cánula nasal: estudio preliminar en pacientes hospitalizados
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The (+) and (−) signs indicate the positive or negative feedback induced by each cell or cytokine under normal circumstances. The main sites where glatiramer acetate (GA) directly participates are marked with a black dot (•) and arrow to indicate the induced effect (increase or decrease). It directly affects macrophage activation (M act) by inhibiting T-helper 1 (Th1) response and thus, reducing levels of circulating interferon (IFN) γ, which plays an important role in their activation. It inhibits production of interleukin (IL) 12 which amplifies the Th1 response.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">3</span></a> The IL-10 production is increased, directly inhibiting macrophage activation, and blocking the effects of dendritic cells (DC) and the differentiation of naive T cells into Th1 cells.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">4</span></a> It blocks the migration of Th1 cells from lymph nodes back to the lungs, and inhibits the expression and release of tumor necrosis factor (TNF)-α.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">4</span></a> Finally, it stimulates T-regulatory (T-reg) cells which also block the Th1 response.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">4</span></a></p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Pablo Sanchez-Salcedo, Juan P. de-Torres" "autores" => array:2 [ 0 => array:2 [ "nombre" => "Pablo" "apellidos" => "Sanchez-Salcedo" ] 1 => array:2 [ "nombre" => "Juan P." "apellidos" => "de-Torres" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0300289615001313" "doi" => "10.1016/j.arbres.2015.03.016" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289615001313?idApp=UINPBA00003Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212915001469?idApp=UINPBA00003Z" "url" => "/15792129/0000005100000012/v1_201512080104/S1579212915001469/v1_201512080104/en/main.assets" ] "en" => array:14 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "High-flow Nasal Cannula Oxygen Therapy: Preliminary Study in Hospitalized Patients" "tieneTextoCompleto" => true "saludo" => "To the Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "657" "paginaFinal" => "659" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Pablo Demelo-Rodríguez, María Olmedo Samperio, Daniel Germán Gaitán Tocora, Juan Carlos Cano Ballesteros, Juan Antonio Andueza Lillo" "autores" => array:5 [ 0 => array:4 [ "nombre" => "Pablo" "apellidos" => "Demelo-Rodríguez" "email" => array:1 [ 0 => "pbdemelo@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "María" "apellidos" => "Olmedo Samperio" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Daniel Germán" "apellidos" => "Gaitán Tocora" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "Juan Carlos" "apellidos" => "Cano Ballesteros" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "Juan Antonio" "apellidos" => "Andueza Lillo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Departamento de Medicina Interna, Hospital General Universitario Gregorio Marañón, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Urgencias, Hospital General Universitario Gregorio Marañón, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Oxigenoterapia de alto flujo con cánula nasal: estudio preliminar en pacientes hospitalizados" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">High flow nasal cannula (HFNC) oxygen therapy is a recently introduced alternative to conventional oxygen therapy. It uses a system that mixes oxygen and air to administer an FIO<span class="elsevierStyleInf">2</span> of 21%–100% at flow velocities of up to 60 lpm. To avoid condensation, the mixture of oxygen and air passes through a humidifier to a heated inspiratory circuit. This mixture is then administered to the patient by way of wide-bore nasal cannulae. The most important feature of HFNC is that it can be used to administer a humidified flow higher than the maximum inspiratory flow, and, moreover, the real FIO<span class="elsevierStyleInf">2</span> can be more reliably assessed.</p><p id="par0010" class="elsevierStylePara elsevierViewall">We report 3 patients with acute respiratory failure despite conventional oxygen therapy, who received HFNC in a hospital ward using an Optiflow<span class="elsevierStyleSup">®</span> device, AIRVO 2<span class="elsevierStyleSup">®</span> model (Fisher & Paykel).</p><p id="par0015" class="elsevierStylePara elsevierViewall">Patient 1 was a 71-year-old man with a history of stage IIIA epidermoid lung cancer, treated with right upper lobectomy, hilar and mediastinal lymphadenectomy, chemotherapy and radiation therapy. Areas of honeycombing indicative of radiation-induced fibrosis were seen on successive tomography follow-ups. The patient was admitted for an episode of respiratory infection. He received conventional oxygen therapy (COT) via nasal prongs, antibiotics, nebulized bronchodilators and intravenous corticosteroid therapy. On day 10 of admission, the patient's respiratory status declined, and he developed heart failure with hypoxemic respiratory failure (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). Treatment began with high flow oxygen therapy at an initial FIO<span class="elsevierStyleInf">2</span> of 100% and a flow of 50<span class="elsevierStyleHsp" style=""></span>lpm. The patient tolerated the device well, and reported greater comfort compared with nasal prongs (9/10 compared to 6/10, respectively) and an absence of mouth dryness. His respiratory situation improved significantly, and the device was withdrawn 48<span class="elsevierStyleHsp" style=""></span>hours later.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Patient 2 was an 85-year-old woman with a history of obesity, cardiac hypertension and Dana Point group 2 pulmonary hypertension, receiving home oxygen therapy. She was admitted for a clinical picture of fever, cough with greenish expectoration, increased basal dyspnea, and signs of decompensated heart failure. Treatment began with oxygen therapy using a Ventimask® face mask with an FIO<span class="elsevierStyleInf">2</span> of 50%, antibiotics, diuretics, nebulized bronchodilators, and systemic corticosteroid therapy. Twenty-four hours after admission, she continued to show increased work of breathing and developed hypoxemic respiratory failure (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>), so HFNC was introduced at an initial FIO<span class="elsevierStyleInf">2</span> of 100% and a flow of 50 lpm. The patient tolerated the device well, and reported greater comfort compared with the face mask (8/10 compared to 2/10, respectively) and an absence of mouth dryness. Her clinical progress and blood gas parameters were favorable, and the patient was switched to COT via nasal prongs 72<span class="elsevierStyleHsp" style=""></span>hours later.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Patient 3 was a 74-year-old woman, former smoker, with a history of idiopathic pulmonary fibrosis. She had been diagnosed with lung cancer 7 months previously, treated with chemotherapy and radiation therapy. She was admitted for an episode of progressive dyspnea, until breathing difficulties were present at rest, in addition to fever and symptoms of lower respiratory tract infection. Treatment began with antibiotics, bronchodilators and a corticosteroid, plus concomitant oxygen therapy via a Ventimask® face mask at an initial FIO<span class="elsevierStyleInf">2</span> of 50%. Respiratory failure worsened, and the patient developed marked hypoxemic respiratory failure (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>) despite the use of a reservoir mask, so on day 8 of admission, HFNC was introduced, at an initial FIO<span class="elsevierStyleInf">2</span> of 95% and a flow of 40 lpm. The patient tolerated the device well, and reported greater comfort compared with the reservoir mask (9/10 compared to 1/10, respectively) and an absence of mouth dryness. The device was used for 7 days, after which the patient was switched to COT via nasal prongs.</p><p id="par0030" class="elsevierStylePara elsevierViewall">In adults, HFNC has been studied in many situations, including bronchoscopies, weaning from intubation, patients who are not candidates for invasive ventilation, acute respiratory failure in emergency settings or intensive care, etc.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1,2</span></a> However, this evidence is based largely on observational studies and case series. Lenglet et al.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a> found a significant reduction in respiratory rate, less dyspnea on the Borg scale, and increased PaO<span class="elsevierStyleInf">2</span> in a group of patients with acute respiratory failure treated in an emergency department. The same group (Sztrymf et al.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a>) found similar results in patients with acute respiratory failure refractory to oxygen therapy in an intensive care unit.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Our patients tolerated the device better than conventional oxygen therapy. The heated humidification provided by the HFNC appears to improve patient comfort and tolerance, compared to face masks, as shown in recent studies.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">5</span></a> This may benefit patients with borderline respiratory capacity, whose hypoxemia levels can fall when the mask is removed for eating, drinking or expectorating. Comparative studies have focused on patients with hypoxemic respiratory failure, while excluding those with hypercapnic respiratory failure. Although the results from preliminary studies appear promising, with no significant increases in PCO<span class="elsevierStyleInf">2</span> or pH, the use of HFNC is not approved in these patients, so more research is needed.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">To conclude, we report our initial experience with the use of high-flow nasal cannula with heated humidification in an acute hospitalization unit. To date, most publications in adults have focused on emergency departments and intensive care units, but no data are available on the use of these devices in hospitalized patients.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Demelo-Rodríguez P, Olmedo Samperio M, Gaitán Tocora DG, Cano Ballesteros JC, Andueza Lillo JA. Oxigenoterapia de alto flujo con cánula nasal: estudio preliminar en pacientes hospitalizados. Arch Bronconeumol. 2015;51:657–659.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">BR: breathing rate; HFNC: High Flow Nasal Cannula Oxygen Therapy; HR: heart rate; PAFI: PaO<span class="elsevierStyleInf">2</span>/FIO<span class="elsevierStyleInf">2</span> ratio; PCO<span class="elsevierStyleInf">2</span>: CO<span class="elsevierStyleInf">2</span> partial pressure.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">BR Before \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">BR a 24<span class="elsevierStyleHsp" style=""></span>h \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">HR Before \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">HR at 24<span class="elsevierStyleHsp" style=""></span>h \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">pH Before \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">pH at 24<span class="elsevierStyleHsp" style=""></span>h \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">PAFI Before \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">PAFI at 24<span class="elsevierStyleHsp" style=""></span>h \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">PCO<span class="elsevierStyleInf">2</span> Before \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">PCO<span class="elsevierStyleInf">2</span> at 24<span class="elsevierStyleHsp" style=""></span>h \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Outcome \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Patient 1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">26 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">120 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">99 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7.44 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7.43 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">141 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">34 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">35 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Withdrawn (48<span class="elsevierStyleHsp" style=""></span>h) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Patient 2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">25 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">105 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">88 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7.44 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7.39 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">90 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">122 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">43 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">42 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Withdrawn (72<span class="elsevierStyleHsp" style=""></span>h) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Patient 3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">112 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">90 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7.44 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7.44 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">57 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">119 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">33 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">45 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Withdrawn (168<span class="elsevierStyleHsp" style=""></span>h) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab958652.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Clinical Parameters of Patients Before and 24<span class="elsevierStyleHsp" style=""></span>Hours After Starting HFNC.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0035" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "High-flow oxygen administration by nasal cannula for adult and perinatal patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J.J. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 10 | 4 | 14 |
| 2024 October | 81 | 27 | 108 |
| 2024 September | 81 | 21 | 102 |
| 2024 August | 105 | 35 | 140 |
| 2024 July | 94 | 25 | 119 |
| 2024 June | 81 | 38 | 119 |
| 2024 May | 105 | 38 | 143 |
| 2024 April | 73 | 45 | 118 |
| 2024 March | 39 | 24 | 63 |
| 2024 February | 37 | 25 | 62 |
| 2023 March | 10 | 3 | 13 |
| 2023 February | 47 | 22 | 69 |
| 2023 January | 34 | 52 | 86 |
| 2022 December | 52 | 45 | 97 |
| 2022 November | 55 | 44 | 99 |
| 2022 October | 51 | 51 | 102 |
| 2022 September | 52 | 35 | 87 |
| 2022 August | 38 | 40 | 78 |
| 2022 July | 49 | 43 | 92 |
| 2022 June | 51 | 35 | 86 |
| 2022 May | 70 | 49 | 119 |
| 2022 April | 76 | 44 | 120 |
| 2022 March | 95 | 67 | 162 |
| 2022 February | 74 | 38 | 112 |
| 2022 January | 59 | 31 | 90 |
| 2021 December | 58 | 45 | 103 |
| 2021 November | 69 | 60 | 129 |
| 2021 October | 73 | 58 | 131 |
| 2021 September | 72 | 51 | 123 |
| 2021 August | 52 | 43 | 95 |
| 2021 July | 64 | 46 | 110 |
| 2021 June | 98 | 58 | 156 |
| 2021 May | 90 | 68 | 158 |
| 2021 April | 198 | 117 | 315 |
| 2021 March | 144 | 64 | 208 |
| 2021 February | 127 | 64 | 191 |
| 2021 January | 111 | 38 | 149 |
| 2020 December | 120 | 40 | 160 |
| 2020 November | 119 | 39 | 158 |
| 2020 October | 138 | 37 | 175 |
| 2020 September | 179 | 23 | 202 |
| 2020 August | 183 | 41 | 224 |
| 2020 July | 141 | 49 | 190 |
| 2020 June | 141 | 34 | 175 |
| 2020 May | 86 | 32 | 118 |
| 2020 April | 114 | 41 | 155 |
| 2020 March | 75 | 50 | 125 |
| 2020 February | 56 | 30 | 86 |
| 2020 January | 56 | 37 | 93 |
| 2019 December | 66 | 30 | 96 |
| 2019 November | 55 | 37 | 92 |
| 2019 October | 59 | 27 | 86 |
| 2019 September | 62 | 25 | 87 |
| 2019 August | 64 | 32 | 96 |
| 2019 July | 51 | 26 | 77 |
| 2019 June | 97 | 37 | 134 |
| 2019 May | 121 | 31 | 152 |
| 2019 April | 151 | 35 | 186 |
| 2019 March | 69 | 28 | 97 |
| 2019 February | 55 | 10 | 65 |
| 2019 January | 58 | 15 | 73 |
| 2018 December | 54 | 26 | 80 |
| 2018 November | 88 | 21 | 109 |
| 2018 October | 83 | 30 | 113 |
| 2018 September | 47 | 11 | 58 |
| 2018 May | 26 | 2 | 28 |
| 2018 April | 47 | 6 | 53 |
| 2018 March | 58 | 9 | 67 |
| 2018 February | 57 | 6 | 63 |
| 2018 January | 164 | 9 | 173 |
| 2017 December | 137 | 5 | 142 |
| 2017 November | 46 | 6 | 52 |
| 2017 October | 35 | 5 | 40 |
| 2017 September | 26 | 25 | 51 |
| 2017 August | 31 | 11 | 42 |
| 2017 July | 31 | 9 | 40 |
| 2017 June | 45 | 15 | 60 |
| 2017 May | 45 | 14 | 59 |
| 2017 April | 33 | 9 | 42 |
| 2017 March | 42 | 8 | 50 |
| 2017 February | 39 | 9 | 48 |
| 2017 January | 26 | 4 | 30 |
| 2016 December | 32 | 6 | 38 |
| 2016 November | 46 | 9 | 55 |
| 2016 October | 44 | 21 | 65 |
| 2016 September | 28 | 8 | 36 |
| 2016 August | 35 | 11 | 46 |
| 2016 July | 35 | 10 | 45 |
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