Atwood Charles, Sethi Jigme, Bergeski Amy, Dungan George C, Volakis Leonithas I, Whittle Jessica S
Pulmonary and Sleep Medicine, VA Pittsburgh Healthcare System, Pittsburgh, PA.
University of Tennessee Health Science Center, Chattanooga, TN.
Crit Care Explor. 2025 Feb 12;7(2):e1209. doi: 10.1097/CCE.0000000000001209. eCollection 2025 Feb 1.
High velocity therapy (HVT), a form of high-flow oxygen therapy, utilizing a small-bore nasal cannula has been widely used in acute care settings. A new dual-prong (newDP) cannula made using more comfortable material and a single-prong (SP) cannula were evaluated to compare comfort and functionality as measured by relief of dyspnea of patients with chronic obstructive pulmonary disease (COPD) receiving HVT therapy.
Randomized crossover evaluation.
Outpatient and in patient critical care setting.
Patients with hypercapnic COPD presenting with dyspnea above baseline.
HVT therapy was provided using an existing HVT dual-prong nasal cannula (traditional) to determine the most efficacious flow rate. Patients were then randomized to receive either the newDP cannula, or the SP cannula, and retitrated for optimal flow rate. During each session of therapy, Rated Perceived Dyspnea (RPD) scores, vital signs, transcutaneous carbon dioxide partial pressure (PTCco2) levels, and clinician/ patient perceptions were documented.
Of 31 enrolled, 26 patients completed the trial. The median flow rate that relieved dyspnea for the traditional, newDP, and SP cannulas were 25 L/min (20-30 L/min), 25 L/min (19.1-30 L/min), and 15 L/min (13-17 L/min), respectively. The change in RPD from baseline for traditional, newDP, and SP were -1 (-1 to 0), -1 (-2 to -1), and -1 (-2 to -1). Change in RPD from baseline for newDP and SP compared with the traditional cannula was significantly different (p = 0.044 and p = 0.01, respectively). Changes in vital signs and PTCco2 were similar between the three cannula types compared with baseline. The SP cannula provided comparable therapeutic efficacy at significantly lower flow rates (traditional vs. SP; p < 0.0001 and newDP vs. SP; p < 0.0001).
The new cannula designs provided comparable relief of dyspnea. The single-prong cannula provided comparable efficacy at significantly lower flow rates (traditional vs. SP; p < 0.0001 and newDP vs. SP; p < 0.0001). The use of a single-prong cannula with HVT warrants further study.
高速疗法（HVT）是一种高流量氧疗形式，使用细孔鼻导管，已在急性护理环境中广泛应用。对一种采用更舒适材料制成的新型双叉（newDP）导管和一种单叉（SP）导管进行了评估，以比较接受HVT治疗的慢性阻塞性肺疾病（COPD）患者呼吸困难缓解情况所衡量的舒适度和功能。
随机交叉评估。
门诊和住院重症监护环境。
基线以上出现呼吸困难的高碳酸血症型COPD患者。
使用现有的HVT双叉鼻导管（传统型）提供HVT治疗，以确定最有效的流速。然后将患者随机分为接受newDP导管或SP导管，并重新调整至最佳流速。在每次治疗期间，记录主观呼吸困难评分（RPD）、生命体征、经皮二氧化碳分压（PTCco2）水平以及临床医生/患者的感受。
31名入组患者中，26名完成了试验。传统导管、newDP导管和SP导管缓解呼吸困难的中位流速分别为25升/分钟（20 - 30升/分钟）、25升/分钟（19.1 - 30升/分钟）和15升/分钟（13 - 17升/分钟）。传统导管、newDP导管和SP导管从基线开始的RPD变化分别为-1（-1至0）、-1（-2至-1）和-1（-2至-1）。与传统导管相比，newDP导管和SP导管从基线开始的RPD变化有显著差异（分别为p = 0.044和p = 0.01）。与基线相比，三种导管类型的生命体征和PTCco2变化相似。SP导管在显著更低的流速下提供了相当的治疗效果（传统导管与SP导管相比；p < 0.0001，newDP导管与SP导管相比；p < 0.0001）。
新型导管设计在缓解呼吸困难方面效果相当。单叉导管在显著更低的流速下提供了相当的疗效（传统导管与SP导管相比；p < 0.0001，newDP导管与SP导管相比；p < 0.0001）。HVT使用单叉导管值得进一步研究。
