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Introduction and Objectives: High flow nasal cannula (HFNC) therapy is an increasingly popular mode of non-invasive respiratory support for the treatment of patients with acute hypoxemic respiratory failure (AHRF). Previous experimental studies in healthy subjects have established that HFNC generates flow-dependent positive airway pressures, but no data is available on the levels of mean airway pressure (mP aw ) or positive end-expiratory pressure (PEEP) generated by HFNC therapy in AHRF patients. We aimed to estimate the airway pressures generated by HFNC at different flow rates in patients with AHRF, whose functional lung volume may be significantly reduced compared to healthy subjects due to alveolar consolidation and/or collapse., Materials and Methods: We developed a high-fidelity mechanistic computational model of the cardiopulmonary system during HFNC therapy using data from healthy subjects, and then measured the mP aw and PEEP levels produced when different amounts of alveolar consolidation/collapse were incorporated into the model., Results: When calibrated to represent normal lung physiology in healthy subjects, our model recapitulates the airway pressures produced by HFNC at different flow rates in healthy volunteers who were breathing normally, with their mouths closed or open. When different amounts of alveolar consolidation/collapse are implemented in the model to reflect the pathophysiology of AHRF, the mP aw and PEEP produced by HFNC at all flow rates increase as the functional lung volume decreases (up to a mP aw of 11.53 and a PEEP of 11.41 cmH 2 O at 60 L/min with the mouth closed when 50% of the model's alveolar compartments are non-aerated). When the model was matched to individual patient data from a cohort of 58 patients with AHRF receiving HFNC at 60 L/min, the mean (standard deviation) of the mP aw / PEEP produced by HFNC in the models of these patients was 8.56 (1.50) / 8.92 (1.49) cmH 2 O with mouths closed, and 1.73 (0.31) / 1.36 (0.36) cmH 2 O with mouths open., Conclusions: Our results suggest that the airway pressures produced by HFNC in patients with AHRF could be higher than is currently assumed based on experimental data from healthy subjects, particularly in patients whose mouths remain closed. Higher levels of PEEP could be beneficial if they lead to alveolar recruitment and improved lung compliance, but could cause alveolar overdistension if they do not, motivating the close monitoring of the effects of HFNC on lung mechanics. Further clinical studies are warranted to directly measure the airway pressures produced by HFNC in patients with different severities of AHRF., Competing Interests: Declarations. Ethics approval and consent to participate: Not applicable. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Background: Literature regarding the advantages of HFNC in infants for ensuring oxygen supply after non-cardiac surgery is insufficient. The purpose of our study is to compare COT vs. HFNC on postoperative outcomes in infants undergoing non-cardiac surgery. We hypothesize that prophylactic use of HFNC after non-cardiac surgery in infants would reduce the incidence of post-anesthesia hypoxemia and could also be adapted as first-line oxygen therapy after non-cardiac surgery., Methods: This is a superior, single-blind, randomized controlled study. A total of 394 infants undergoing general anesthesia will be randomly assigned to accept COT or HFNC in a 1:1 ratio. The primary outcome is the rate of desaturation post-extubation. Secondary outcomes include the rate of mild upper airway obstruction, the rate of severe respiratory depression, the rate of transfer to PICU, duration of oxygen therapy, length of PACU stay, the time to reach full enteral feeding, and postoperative adverse events, including nasal injury, agitation, vomiting, and unplanned secondary surgery related to the initial surgery., Discussion: This is the first randomized controlled trial to explore the advantages of HFNC in infants to ensure oxygen supply after non-cardiac surgery. If favorable evidence is obtained, HFNC could be adopted as first-line oxygen therapy for infants following non-cardiac surgery., Trial Registration: The trial was registered at https://www.chictr.org.cn (Registration number: ChiCTR2400081600, Date: March 6, 2024)., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2025 Zhang et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Intravenous anesthesia with high-flow nasal cannula (HFNC) has been reported to benefit oxygen reserves and enhance postoperative recovery in surgeries requiring low neuromuscular blockade. This study investigated whether HFNC improves recovery quality in elderly undergoing ureteroscopic holmium laser lithotripsy (UHLL)., Methods: We enrolled 106 elderly patients undergoing UHLL, with 96 patients (48 per group) included in the final analysis. Patients were randomly assigned (1:1, stratified by sex) to receive either HFNC (HFNC group) or laryngeal mask airway (LMA) assisted general anesthesia (LMA group). The primary outcome was the Quality of Recovery 15-questionnaire (QoR-15) scores. Secondary outcomes included PACU stay duration, time to out-of-bed mobilization, length of hospital stay, airway dryness scores, surgeons' satisfaction, and postoperative complications., Results: Compared to the LMA group, the HFNC group achieved significantly higher QoR-15 scores (125.5 [118.3-130.0] vs. 136.5 [126.3-139.0]; difference = -9, 95%CI, -11 to -5; P < 0.001) on the first postoperative day. For secondary outcomes, the HFNC group had a shorter PACU stay (difference = 11.6 min, 95% CI, 10.4-12.8 min), earlier out-of-bed mobilization (difference = 31.8 min, 95% CI, 30.6-33.1 min), lower mouth (difference = 2, 95% CI, 1-3) and throat dryness scores (difference = 2, 95% CI, 1-3) at 30 min post-operation, and lower rates of postoperative sore throat (14.6% vs. 0%; P = 0.019) and cough with sputum (odds ratio [OR] = 9.4, 95% CI, 1.1-78.4). No significant differences were observed between the groups for other measures., Conclusions: HFNC can improve recovery quality in elderly patients after UHLL compared to LMA-assisted general anesthesia., Trial Registration: This trial was registered on July 20, 2023, in the Chinese Clinical Trial Registry (ChiCTR2300073757)., Competing Interests: Declarations. Ethics approval and consent to participate: The study was performed according to the Declaration of Helsinki, and all patients provided written informed consent for participation in the research study. Ethical approval for this study (Approval No: JMSF20230720) was provided by the Medical Service of the 904th Hospital on July 1, 2023. This study was registered in the Center of Chinese Clinical Trials Registry at http://www.chictr.org.cn (ChiCTR2300073757). Our manuscript reporting adheres to CONSORT guidelines for reporting clinical trials. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Continuous positive airway pressure (CPAP) is increasingly used in infants. However, the limited number of commercially masks available for infants is challenging. The use of the Optiflow™ nasal cannula (Fisher & Paykel) with a regular CPAP device has been recently reported for chronic CPAP in children, with an objective improvement in polysomnographic events. However, this interface has not been used in young infants. We report here our experience of 4 infants aged between 3 and 8 weeks, who were treated with home CPAP with the Optiflow™ nasal cannula during a few months, before they could be successfully weaned. This pilot study reinforces the findings of the beneficial use of this nasal cannula in very young infants in whom nasal masks are scarce and not always suitably adapted. However, as this interface is not intended to be used with home CPAP, further studies are necessary to prove its clinical benefice and safety of use with home CPAP devices., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Purpose: We investigated the efficacy and safety of a high-flow nasal cannula (HFNC) at different flow rates compared to noninvasive ventilation (NIV) in patients with acute chronic obstructive pulmonary disease (COPD) exacerbations., Methods: This prospective, randomized, single-blind study assigned patients to one of three study groups. The NIV group (n = 47) received bilevel positive airway pressure. The HFNC-30 (n = 44) and HFNC-50 (n = 46) groups received HFNC therapy at flow rates of 30 and 50 L/min, respectively. Demographic and clinical characteristics and arterial blood gas parameters before and 30, 60, and 120 min after treatment were compared among the treatment groups., Results: This study included 137 consecutive patients with acute exacerbations of COPD, comprising 90 males and 47 females, with a mean age of 68.1 ± 10.5 years. A total of 21 patients (15.33 %) were intubated, and the overall mortality rate was 10.2 %. The mean PaCO 2 levels on admission were 64.69 ± 10.81, 61.51 ± 9.03, and 62.29 ± 9.87 in the NIV, HFNC-30, and HFNC-50 groups, respectively, with no significant differences observed (p = 0.372). A significant reduction in mean PaCO 2 was observed in all treatment groups at 30, 60, and 120 min (p < 0.05 for all). However, the ΔPaCO 2 at 60 min was significantly higher in the HFNC-30 group compared to the NIV group (p = 0.042). Additionally, neither intubation rates nor 28-day mortality differed among the treatment groups (p = 0.368 and p = 0.775, respectively)., Conclusion: HFNC was not inferior to NIV in improving arterial blood gas parameters, particularly PaCO 2 in patients with COPD exacerbations, especially those with hypercarbia. Moreover, HFNC at a flow rate of 30 L/min was superior to NIV for reducing PaCO 2 levels at 60 min., Trial Registry: National Library of Medicine Clinical Trial Registry; No.: NCT06495086; URL: https://clinicaltrials.gov/study/NCT06495086., Competing Interests: Declaration of competing interest All authors declare no competing interests., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objectives: To investigate heterogeneity in the cost-effectiveness of high-flow nasal cannula (HFNC) therapy compared with continuous positive airway pressure (CPAP) for acutely ill children requiring noninvasive respiratory support., Methods: Using data from the First-line Support for Assistance in Breathing in Children trial, we explore heterogeneity at the patient and subgroup levels using 2 causal forest approaches and a seemingly unrelated regression approach for comparison. First-line Support for Assistance in Breathing in Children is a noninferiority randomized controlled trial (ISRCTN60048867) involving 24 UK pediatric intensive care units. The Step-up trial focuses on acutely ill children aged 0 to 15 years, requiring noninvasive respiratory support. A total of 600 children were randomly assigned to HFNC and CPAP groups in a 1:1 allocation ratio, with 94 patients excluded because of data unavailability., Results: The primary outcome is the incremental net monetary benefit (INB) of HFNC compared with CPAP, using a willingness-to-pay threshold of £20 000 per quality-adjusted life year gain. INB is derived from total costs and quality-adjusted life years at 6 months. Subgroup analysis showed that some subgroups, such as male children, those aged less than 12 months, and those without severe respiratory distress at randomization, had more favorable INB results. Patient-level analysis revealed heterogeneity in INB estimates, particularly driven by the cost component, with greater uncertainty for those with higher INBs., Conclusions: The estimated overall INB of HFNC is significantly larger for specific patient subgroups, suggesting that the cost-effectiveness of HFNC can be heterogeneous, which highlights the importance of considering patient characteristics in evaluating the cost-effectiveness of HFNC., Competing Interests: Author Disclosures Author disclosure forms can be accessed below in the Supplemental Material section., (Copyright © 2025. Published by Elsevier Inc.)

We present the case of a 24-year-old female who was supported with ProtekDuo cannula with variations of venopulmonary (VP) extracorporeal membrane oxygenation. The patient was cannulated for acute respiratory distress syndrome and she underwent bilateral orthotopic lung transplantation. This is the first report of the ProtekDuo cannula as a drainage cannula in central (dl)VP-/AO ECMO for 5 days., (© 2024 International Center for Artificial Organ and Transplantation (ICAOT) and Wiley Periodicals LLC.)

Background: Although the Avalon Elite bi-caval dual lumen catheter for veno-venous extracorporeal membranous oxygenation (ECMO) has many advantages, it requires precise positioning and dislodgement is common. Case presentation: A 2-year-old male was placed on ECMO due to respiratory failure utilizing a 20 Fr Avalon Elite bi-caval dual lumen catheter (AEC). The AEC migrated twice with unsuccessful repositioning using the classic manual manipulations. The AEC was successfully repositioned on the two occasions using a novel method by direct access of the ECMO inflow tube using a combination of catheter and guide wire. Conclusions: A migrated AEC could be successfully repositioned with simple direct access of the inflow tube. This technique was successfully utilized twice at the bedside in an infant without needing additional venous access., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

The use of small-gauge trocar cannulas during transconjunctival sutureless pars plana vitrectomy (PPV) facilitates the smooth transition of instruments into the posterior segment and reduces trauma. However, room lighting is routinely dimmed during PPV, thereby making cannula visualization difficult and hence compromising efficient instrument exchange. We report the use of a frugal, fluorescent "glow-in-the-dark" ring placed over vitrectomy cannulas to visualize the cannula entry, thereby providing a smooth and efficient instrument exchange. We 3D-printed phosphorescent rings of optimum inner diameter to comfortably fit around the trocar cannula (The Glowport). Two such rings are fitted into the two trocar cannulas prior to surgery initiation. The cannulas are then passed via sclerostomy as performed in routine PPV. The light from the fiberoptic endo-illuminator is focused over the rings for approximately 5 seconds to activate the photoluminescence. Under mesopic conditions, the fluorescence provides visualization of the cannula entry and helps in the facilitation of smooth entry and exchange of instruments into the globe for performing vitreoretinal surgical procedures, which helps in reducing ocular touch errors as well as surgical time. The Glowport is a frugal device retrofitted onto the trocar cannulas and helps in the smooth entry and exchange of instruments under darkroom conditions, which are required in vitreoretinal surgery., (Copyright © 2024 Indian Journal of Ophthalmology.)