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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Traditionally the oxygen therapy systems have been classified as low and high flow&#46; Low-flow systems do not provide all the inspiratory flow demanded by the patient&#59; do not ensure stable levels of FiO<span class="elsevierStyleInf">2</span> and it is not possible to control the temperature and moisture of inspired gas&#46; The low flow oxygen system most widely used is the nasal prongs&#46; By contrast&#44; high flow systems are able to provide the entire atmosphere breathed by the patient and do ensure a stable FiO<span class="elsevierStyleInf">2</span> and it is possible to control the temperature and moisture of the inspired gas&#46; The typical high flow oxygen system is the venturi mask&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">1</span></a> In recent years&#44; a new way of supplying patients with oxygen has appeared which in our opinion has been incorrectly called high-flow nasal cannula oxygen therapy &#40;HFNC&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">2</span></a> This therapeutic approach has a lot of physiological effects which makes it a really active treatment for patients with both acute and chronic respiratory failure&#59; it is more than a simple oxygen delivery system&#46; Several studies have shown that HFNC generates a low level of positive airway pressure&#44; improves oxygenation&#44; increases the end-expiratory lung volume&#44; reduces airway resistance&#44; increases functional residual capacity and alveolar recruitment and flushes nasopharyngeal dead space&#44; thus helping to decrease the work of breathing&#46; There is a better control of FiO<span class="elsevierStyleInf">2</span> and the gas humidification ensures better patient tolerance and comfort&#46; Due to a better mucociliary clearance&#44; pulmonary defense mechanisms are restored&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">3</span></a> Many of these effects are similar to those produced by non-invasive ventilation&#46; Several studies have shown its utility in patients with acute hypoxemic respiratory failure&#44; in the post-extubation period&#44; in palliative care&#44; in patients with acute heart failure&#44; in chronic airway diseases and its indications are still rising&#46; It is used in critical care areas&#44; in the emergency department&#44; in wards and it is being used at home in COPD patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">4&#44;5</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">As we can see&#44; oxygen plays a secondary role in this treatment&#46; The name of high-flow oxygen therapy is confusing&#46; Although the efficacy of improvement in respiratory gas exchange and effectiveness in outcomes has been demonstrated&#44; we have not fully understood the main pathophysiological principles of this therapy&#46; The role and importance of each of the mechanisms related to the high-flow therapy&#44; the end expiratory positive pressure&#44; the flushing of nasopharingeal dead space or the humidification and warming of the inspired air&#44; has not been clarified yet&#46; Up to now&#44; we have not been able to identify the functional significance of each of the three mechanisms&#44; maybe this is a question that will never be answered because in different clinical situations the relevance of these potencial mechanisms changes&#46; What is clear is that high-flow is not an oxygen therapy device&#46; Most international groups working in this field use the term &#8220;Nasal High Flow&#8221; avoiding the term &#8220;oxygen&#8221; in its definition&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">We think such an active treatment should have a name that reflects the effects of the treatment better&#44; in order to avoid confusion&#46; And that deserves some careful reflection&#46; High-flow can be applied through nasal cannula or tracheostomy&#44; so the term &#8220;nasal&#8221; should not be part of the name&#46; Perhaps the name &#8220;Active High Flow&#8221; would be more accurate so as to clearly distinguish it from the conventional or &#8220;passive&#8221; high flow like the venturi system&#46; The Venturi system is usually administered by mask and high flow by cannula&#44; which could be another distinguishing feature&#46; Taking into account the different but also relevant effects of the therapy&#44; we might ask why not include the term &#8220;humidification&#8221; or &#8220;heating&#8221; to the words &#8220;high flow&#8221;&#46; The positive expiratory pressure effect could probably be more interesting to incorporate into the name&#46; Although the pressure achieved is highly dependent on the individual patient and the interface used&#44; is low in absolute value and&#44; above all&#44; not determined by the prescribed parameters of the equipment&#44; we do have quite a lot about its relevance&#46; Certainly&#44; this therapy has demonstrated that can be useful in treating sleep apnea syndrome&#46;<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">6&#44;7</span></a> Its effect on alveolar recruitment has been clearly shown by Corley et al&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">8</span></a> Roca et al&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">9</span></a> have also indirectly demonstrated the positive intrathoracic pressure reached with the HFNC&#44; showing a reduction greater than 20&#37; in the estimated inspiratory collapse of the inferior vena cava from baseline&#46; Perhaps the provocative name of &#8220;High-flow positive pressure&#8221; would better define a treatment that gives the patient a high flow of heated and wet gas&#44; with a level of positive pressure&#44; and a controlled FiO<span class="elsevierStyleInf">2</span>&#46; Anyway&#44; the name of high-flow oxygen therapy would be restricted to the classical high flow system such as the venturi system&#46; We think that a consensus on a more precise name is required&#46;</p><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conflicts of interest</span><p id="par0035" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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Letter to the Editor
High-flow nasal oxygen is not an oxygen therapy device
S. Díaz-Lobato
Corresponding author
sdiazlobato@gmail.com

Corresponding author.
, J.M. Alonso, J.M. Carratalá, S. Mayoralas
Hospital Ramón y Cajal, Neumologia, Carretera de Colmenar Viejo, Km 9,100, 28034 Madrid, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Traditionally the oxygen therapy systems have been classified as low and high flow&#46; Low-flow systems do not provide all the inspiratory flow demanded by the patient&#59; do not ensure stable levels of FiO<span class="elsevierStyleInf">2</span> and it is not possible to control the temperature and moisture of inspired gas&#46; The low flow oxygen system most widely used is the nasal prongs&#46; By contrast&#44; high flow systems are able to provide the entire atmosphere breathed by the patient and do ensure a stable FiO<span class="elsevierStyleInf">2</span> and it is possible to control the temperature and moisture of the inspired gas&#46; The typical high flow oxygen system is the venturi mask&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">1</span></a> In recent years&#44; a new way of supplying patients with oxygen has appeared which in our opinion has been incorrectly called high-flow nasal cannula oxygen therapy &#40;HFNC&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">2</span></a> This therapeutic approach has a lot of physiological effects which makes it a really active treatment for patients with both acute and chronic respiratory failure&#59; it is more than a simple oxygen delivery system&#46; Several studies have shown that HFNC generates a low level of positive airway pressure&#44; improves oxygenation&#44; increases the end-expiratory lung volume&#44; reduces airway resistance&#44; increases functional residual capacity and alveolar recruitment and flushes nasopharyngeal dead space&#44; thus helping to decrease the work of breathing&#46; There is a better control of FiO<span class="elsevierStyleInf">2</span> and the gas humidification ensures better patient tolerance and comfort&#46; Due to a better mucociliary clearance&#44; pulmonary defense mechanisms are restored&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">3</span></a> Many of these effects are similar to those produced by non-invasive ventilation&#46; Several studies have shown its utility in patients with acute hypoxemic respiratory failure&#44; in the post-extubation period&#44; in palliative care&#44; in patients with acute heart failure&#44; in chronic airway diseases and its indications are still rising&#46; It is used in critical care areas&#44; in the emergency department&#44; in wards and it is being used at home in COPD patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">4&#44;5</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">As we can see&#44; oxygen plays a secondary role in this treatment&#46; The name of high-flow oxygen therapy is confusing&#46; Although the efficacy of improvement in respiratory gas exchange and effectiveness in outcomes has been demonstrated&#44; we have not fully understood the main pathophysiological principles of this therapy&#46; The role and importance of each of the mechanisms related to the high-flow therapy&#44; the end expiratory positive pressure&#44; the flushing of nasopharingeal dead space or the humidification and warming of the inspired air&#44; has not been clarified yet&#46; Up to now&#44; we have not been able to identify the functional significance of each of the three mechanisms&#44; maybe this is a question that will never be answered because in different clinical situations the relevance of these potencial mechanisms changes&#46; What is clear is that high-flow is not an oxygen therapy device&#46; Most international groups working in this field use the term &#8220;Nasal High Flow&#8221; avoiding the term &#8220;oxygen&#8221; in its definition&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">We think such an active treatment should have a name that reflects the effects of the treatment better&#44; in order to avoid confusion&#46; And that deserves some careful reflection&#46; High-flow can be applied through nasal cannula or tracheostomy&#44; so the term &#8220;nasal&#8221; should not be part of the name&#46; Perhaps the name &#8220;Active High Flow&#8221; would be more accurate so as to clearly distinguish it from the conventional or &#8220;passive&#8221; high flow like the venturi system&#46; The Venturi system is usually administered by mask and high flow by cannula&#44; which could be another distinguishing feature&#46; Taking into account the different but also relevant effects of the therapy&#44; we might ask why not include the term &#8220;humidification&#8221; or &#8220;heating&#8221; to the words &#8220;high flow&#8221;&#46; The positive expiratory pressure effect could probably be more interesting to incorporate into the name&#46; Although the pressure achieved is highly dependent on the individual patient and the interface used&#44; is low in absolute value and&#44; above all&#44; not determined by the prescribed parameters of the equipment&#44; we do have quite a lot about its relevance&#46; Certainly&#44; this therapy has demonstrated that can be useful in treating sleep apnea syndrome&#46;<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">6&#44;7</span></a> Its effect on alveolar recruitment has been clearly shown by Corley et al&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">8</span></a> Roca et al&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">9</span></a> have also indirectly demonstrated the positive intrathoracic pressure reached with the HFNC&#44; showing a reduction greater than 20&#37; in the estimated inspiratory collapse of the inferior vena cava from baseline&#46; Perhaps the provocative name of &#8220;High-flow positive pressure&#8221; would better define a treatment that gives the patient a high flow of heated and wet gas&#44; with a level of positive pressure&#44; and a controlled FiO<span class="elsevierStyleInf">2</span>&#46; Anyway&#44; the name of high-flow oxygen therapy would be restricted to the classical high flow system such as the venturi system&#46; We think that a consensus on a more precise name is required&#46;</p><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conflicts of interest</span><p id="par0035" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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ISSN: 21735115
Original language: English
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