High-flow nasal oxygen therapy offers benefits like precise oxygen delivery, flow-related positive end-expiratory pressure generation and improved lung function. High-flow oxygen therapy can be applied via tracheostomy as high-flow tracheal oxygen. While high-flow tracheal oxygen has been used to facilitate weaning, it has diminished physiological effects due to bypassing upper airways. To enhance its effectiveness, researchers developed a modified high-flow tracheal oxygen tube with a smaller expiratory end diameter to increase airway resistance and pressure. This is a prospective randomized crossover study that aims to compare the physiological effects of standard and modified high-flow oxygen therapy in tracheostomized patients.
High-flow nasal oxygen therapy has been shown to provide several physiological benefits, including precise control of the fraction of inspired oxygen, generation of flow-related positive end-expiratory pressure, increased end-expiratory lung volume, improved oxygenation, and enhanced carbon dioxide elimination. It has been widely utilized in managing acute hypoxemic respiratory failure and preventing hypoxemia after extubation. High-flow oxygen therapy can be applied via tracheostomy as high-flow tracheal oxygen. Previous studies have reported successful cases of using high-flow tracheal oxygen to facilitate weaning from prolonged mechanical ventilation in patients with restrictive and obstructive pulmonary disorders. However, compared to high-flow nasal oxygen, high-flow tracheal oxygen exhibits significantly diminished physiological effects due to the bypassing of the narrow nasopharynx, glottis, and upper airway, as well as a more open circuit. To address this limitation, the investigators have developed a modified high-flow tracheal oxygen tube with a reduced expiratory end tube diameter. This modification aims to create higher expiratory resistance and airway pressure, thus simulating the physiological effects of high-flow nasal cannula. This is a prospective randomized crossover physiological trial designed to compare the effects of standard and modified high-flow oxygen therapy in tracheostomized patients. Key physiological parameters will be assessed, including airway pressure, end-expiratory lung volume, vital signs, oxygenation, and respiratory workload.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
20
Modified high-flow tracheal oxygen with flow rates of 40L/min and 60L/min will be performed.
Standard high-flow tracheal oxygen with flow rates of 40 L/min and 60 L/min will be performed.
Beijing Shijitan Hospital
Beijing, Beijing Municipality, China
Mean expiratory airway pressure
Mean expiratory airway pressure will be measured during standard and modified high-flow tracheal oxygen.
Time frame: From enrollment to the end of treatment at 4 hours
Positive end-expiratory pressure
Positive end-expiratory pressure will be measured during standard and modified high-flow tracheal oxygen.
Time frame: From enrollment to the end of treatment at 4 hours
Change of end-expiatory lung volume
Change of end-expiatory lung volume will be measured during standard and modified high-flow tracheal oxygen.
Time frame: From enrollment to the end of treatment at 4 hours
Respiratory rate
Respiratory rate will be measured during standard and modified high-flow tracheal oxygen.
Time frame: From enrollment to the end of treatment at 4 hours
Tidal volume
Tidal volume will be measured during standard and modified high-flow tracheal oxygen.
Time frame: From enrollment to the end of treatment at 4 hours
End-tidal carbon dioxide
End-tidal carbon dioxide will be measured during standard and modified high-flow tracheal oxygen.
Time frame: From enrollment to the end of treatment at 4 hours
Pulse oxygen saturation
Pulse oxygen saturation will be measured during standard and modified high-flow tracheal oxygen.
Time frame: From enrollment to the end of treatment at 4 hours
Esophageal pressure-time product
Esophageal pressure-time product will be measured during standard and modified high-flow tracheal oxygen.
Time frame: From enrollment to the end of treatment at 4 hours
Tidal swing of esophageal pressure
Tidal swing of esophageal pressure will be measured during standard and modified high-flow tracheal oxygen.
Time frame: From enrollment to the end of treatment at 4 hours
Respiratory muscle pressure
Respiratory muscle pressure will be measured during standard and modified high-flow tracheal oxygen.
Time frame: From enrollment to the end of treatment at 4 hours
Dynamic transpulmonary pressure
Dynamic transpulmonary pressure will be measured during standard and modified high-flow tracheal oxygen.
Time frame: From enrollment to the end of treatment at 4 hours
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