Letter to the Editor
The clinical utility of domiciliary nocturnal high-flow nasal cannula in a post-gastrectomy patient with chronic lower respiratory tract infection
Satoshi Hamada
, Mitsuhiro Tsukino
Corresponding author
Department of Respiratory Medicine, Hikone Municipal Hospital, 1882 Hassakacho, Hikone 522-8539, Japan
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Vieira, O. Oliveira, M. Gomes, R. Gaio, R. Duarte" "autores" => array:5 [ 0 => array:2 [ "nombre" => "A.L." "apellidos" => "Vieira" ] 1 => array:2 [ "nombre" => "O." "apellidos" => "Oliveira" ] 2 => array:2 [ "nombre" => "M." "apellidos" => "Gomes" ] 3 => array:2 [ "nombre" => "R." "apellidos" => "Gaio" ] 4 => array:2 [ "nombre" => "R." 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At the time of diagnosis of gastric cancer, chest computed tomography (CT) revealed mild bronchial wall thickening in both lower lobes (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A). Six months after gastrectomy, follow-up chest CT showed consolidation in the right middle lobe and left lingular segment and consolidation, mucus plug, and centrilobular nodules in both lower lobes (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B). Therefore, she was referred to the Department of Respiratory Medicine in Hikone Municipal Hospital.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">She complained of productive cough without postnasal discharge. She was not on any medication, including proton pomp inhibitors. Laboratory test results revealed white blood cell counts of 5880/μL, C-reactive protein of 0.29<span class="elsevierStyleHsp" style=""></span>mg/dL, and antinuclear antibody titer of 1:40. The % predicted forced vital capacity and % predicted forced expiratory volume in 1<span class="elsevierStyleHsp" style=""></span>s were 2.07<span class="elsevierStyleHsp" style=""></span>L (81.4%) and 1.56<span class="elsevierStyleHsp" style=""></span>L (75.3%), respectively. Sinus CT revealed mild mucosal thickening and opacification of the right ethmoid and sphenoid sinuses and the bilateral maxillary sinuses; Lund–Mackay staging system score was 4. Fiber-optic bronchoscopy revealed purulent bronchial secretions from both inferior lobar bronchi, but there were no detected organisms, including bacteria and acid-fast bacilli. We administered low-dose macrolide therapy with clarithromycin 200<span class="elsevierStyleHsp" style=""></span>mg once daily. However, 1 month later, we discontinued the low-dose macrolide therapy because of hepatotoxicity. Instead, we administered mucolytic agents such as carbocysteine 500<span class="elsevierStyleHsp" style=""></span>mg three times daily.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Nineteen months after gastrectomy, follow-up chest CT showed improvement of the consolidation in the right middle lobe and left lingular segment, but there were no changes in the mucus plug and the centrilobular nodules in both lower lobes (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>C). There was also a persistent productive cough. Twenty-three months after gastrectomy, we initiated domiciliary nocturnal HFNC (myAIRVO™2, Fisher and Paykel Healthcare, Auckland, New Zealand) for humidification without oxygen at a flow rate of 30<span class="elsevierStyleHsp" style=""></span>L/min and temperature of 34<span class="elsevierStyleHsp" style=""></span>°C. Two months after the initiation of domiciliary nocturnal HFNC, the patient reported that the productive cough had reduced by half. Furthermore, repeat chest CT revealed decrease of mucus plug and centrilobular nodules (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>D). This patient did not have any of the adverse reactions induced by HFNC, such as pneumothorax, aerophagia, skin irritation, or epistaxis. During this clinical course, the patient had not undergone pulmonary rehabilitation.</p><p id="par0025" class="elsevierStylePara elsevierViewall">This chronic lower respiratory tract infection appeared after total gastrectomy. Recurrent aspiration pneumonia is frequently observed in patients who have undergone total gastrectomy because of the esophageal reflux of the intestinal contents and swallowing dysfunction.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a> Therefore, the chronic lower respiratory tract infection in this patient could have been caused by chronic aspiration.</p><p id="par0030" class="elsevierStylePara elsevierViewall">In this patient, domiciliary humidification through HFNC was able to decrease the chest CT abnormalities (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B–D) and the symptoms of productive cough. Rea et al.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">5</span></a> reported that domiciliary humidification through HFNC improved the lung function and quality of life of patients with chronic lower airway disorders, including chronic obstructive pulmonary disease and bronchiectasis. These effects of HFNC are considered to be caused by improvement in mucociliary clearance.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a> Chronic aspiration after total gastrectomy is mainly induced by nocturnal esophageal reflux.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a> This patient used HFNC only at night. Therefore, HFNC was considered to protect the patient from nocturnal aspiration, in addition to improving mucociliary clearance in this patient.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Rea et al. used HFNC at 20–25<span class="elsevierStyleHsp" style=""></span>L/min of flow rate and temperature of 37<span class="elsevierStyleHsp" style=""></span>°C at an average of 1–2<span class="elsevierStyleHsp" style=""></span>h per day, which was short, because mucociliary clearance of 3<span class="elsevierStyleHsp" style=""></span>h of daily use had been demonstrated by Hasani et al.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a> This patient used HFNC for more than 6<span class="elsevierStyleHsp" style=""></span>h per day, every night. Future studies are required to evaluate the effect of HFNC in patients with different diseases and different settings.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Patients with chronic lower respiratory tract infection are usually treated with antibiotics, including macrolides, mucolytic agents, and bronchodilators. We conclude that HFNC can be an additional treatment option for airway management in such patients.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0045" class="elsevierStylePara elsevierViewall">None of the authors have any disclosure or financial support regarding this report.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflicts of interest</span><p id="par0050" class="elsevierStylePara elsevierViewall">The authors have no conflict of interest regarding this report.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Funding" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Conflicts of interest" ] 2 => array:2 [ "identificador" => "xack370373" "titulo" => "Acknowledgements" ] 3 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1624 "Ancho" => 2166 "Tamanyo" => 375710 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Chest computed tomography images at the time of diagnosis of gastric cancer (A); at 6 months (B) and 19 months (C) after gastrectomy; and at 2 months after the initiation of HFNC.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0035" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Can high-flow nasal cannula reduce the rate of endotracheal intubation in adult patients with acute respiratory failure compared with conventional oxygen therapy and noninvasive positive pressure ventilation?: A systematic review and meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "Y.N. Ni" 1 => "J. Luo" 2 => "H. Yu" 3 => "D. Liu" 4 => "Z. Ni" 5 => "J. Cheng" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.chest.2017.01.004" "Revista" => array:6 [ "tituloSerie" => "Chest" "fecha" => "2017" "volumen" => "151" "paginaInicial" => "764" "paginaFinal" => "775" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28089816" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0040" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical evidence on high flow oxygen therapy and active humidification in adults" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "C. Gotera" 1 => "S. Díaz Lobato" 2 => "T. Pinto" 3 => "J.C. 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Zakynthinos" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1183/16000617.0028-2017" "Revista" => array:5 [ "tituloSerie" => "Eur Respir Rev" "fecha" => "2017" "volumen" => "26" "paginaInicial" => "170028" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28794144" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0050" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Postgastrectomy aspiration pneumonia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "K. Marumo" 1 => "S. Homma" 2 => "Y. Fukuchi" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Chest" "fecha" => "1995" "volumen" => "107" "paginaInicial" => "453" "paginaFinal" => "456" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7842777" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0055" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The clinical utility of long-term humidification therapy in chronic airway disease" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "H. Rea" 1 => "S. McAuley" 2 => "L. Jayaram" 3 => "J. Garrett" 4 => "H. Hockey" 5 => "L. 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Agnew" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1177/1479972307087190" "Revista" => array:6 [ "tituloSerie" => "Chron Respir Dis" "fecha" => "2008" "volumen" => "5" "paginaInicial" => "81" "paginaFinal" => "86" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18539721" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack370373" "titulo" => "Acknowledgements" "texto" => "<p id="par0055" class="elsevierStylePara elsevierViewall">We have no acknowledgements.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/25310437/0000002400000005/v1_201810040621/S2531043718301119/v1_201810040621/en/main.assets" "Apartado" => array:4 [ "identificador" => "72880" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/25310437/0000002400000005/v1_201810040621/S2531043718301119/v1_201810040621/en/main.pdf?idApp=UINPBA00004E&text.app=https://journalpulmonology.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2531043718301119?idApp=UINPBA00004E" ]
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| 2019 April | 80 | 40 | 120 |
| 2019 March | 67 | 34 | 101 |
| 2019 February | 66 | 28 | 94 |
| 2019 January | 59 | 53 | 112 |
| 2018 December | 28 | 9 | 37 |
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