{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T15:59:49Z","timestamp":1753891189433,"version":"3.41.2"},"reference-count":29,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,12,2]],"date-time":"2022-12-02T00:00:00Z","timestamp":1669939200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:p>The typical approach to management of respiratory distress is focused on oxygen supplementation. However, additional oxygen alone does not improve outcomes, particularly in critically ill patients. Instead, supplemental oxygen can be associated with increased morbidities. We present the hypothesis that clinicians should focus on reducing the work of breathing early in the course of critical illness. Rather than simply supplementing oxygen, newer technologies including high flow nasal oxygen, may be utilized to increase the efficiency of gas exchange. By reducing the work of breathing, the cardiac workload can be reduced, thus relieving some excess physiologic stress and supporting the critically ill patient. To illustrate this point, we provided three clinical cases of respiratory failure from non-pulmonary origins; all cases displayed hemodynamic improvement due to reducing the work of breathing through high-velocity therapy prior to receiving definitive therapy for underlying pathologies.<\/jats:p>","DOI":"10.3389\/fmed.2022.1070517","type":"journal-article","created":{"date-parts":[[2022,12,2]],"date-time":"2022-12-02T05:52:30Z","timestamp":1669960350000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Back to basics with newer technology: Should we focus on reducing work of breathing earlier?"],"prefix":"10.3389","volume":"9","author":[{"given":"Christopher","family":"Sciarretta","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeremy","family":"Greenberg","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kara D.","family":"Wyatt","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jessica S.","family":"Whittle","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2022,12,2]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"435","DOI":"10.1164\/rccm.201111-2042ST","article-title":"An official american thoracic society statement: update on the mechanisms, assessment, and management of dyspnea","volume":"185","author":"Parshall","year":"2012","journal-title":"Am J Respir Crit Care Med"},{"key":"B2","doi-asserted-by":"publisher","first-page":"32","DOI":"10.7196\/SAMJ.2016.v106i1.10324","article-title":"Dyspnoea: pathophysiology and a clinical approach","volume":"106","author":"Coccia","year":"2015","journal-title":"South Afr Med J"},{"key":"B3","doi-asserted-by":"publisher","first-page":"657","DOI":"10.5694\/j.1326-5377.2008.tb01825.x","article-title":"Respiratory rate: the neglected vital sign","volume":"188","author":"Cretikos","year":"2008","journal-title":"Med J Aust"},{"key":"B4","doi-asserted-by":"publisher","first-page":"170","DOI":"10.1136\/thorax.57.2.170","article-title":"The pulmonary physician in critical care 2: oxygen delivery and consumption in the critically ill","volume":"57","author":"Leach","year":"2002","journal-title":"Thorax"},{"key":"B5","first-page":"481","article-title":"Respiratory muscle energetics","volume-title":"Handbook of Physiology","author":"Roussos","year":"1986"},{"key":"B6","article-title":"Chapter 36: effect of mechanical ventilation on heart-lung interactions","volume-title":"Principles and Practice of Mechanical Ventilation","author":"Gomez","year":"2012"},{"key":"B7","doi-asserted-by":"publisher","first-page":"550","DOI":"10.1097\/01.ccm.0000551892.12476.ac","article-title":"1147: development of a bedside work of breathing scale and assessment of its clinical reliability","volume":"47","author":"Gazmuri","year":"2019","journal-title":"Crit Care Med"},{"key":"B8","doi-asserted-by":"publisher","first-page":"1368","DOI":"10.1164\/rccm.201803-0589OC","article-title":"An index combining respiratory rate and oxygenation to predict outcome of nasal high-flow therapy","volume":"199","author":"Roca","year":"2019","journal-title":"Am J Respir Crit Care Med"},{"key":"B9","doi-asserted-by":"publisher","first-page":"477","DOI":"10.1186\/s13054-020-03176-y","article-title":"Development of a work of breathing scale and monitoring need of intubation in COVID-19 pneumonia","volume":"24","author":"Apigo","year":"2020","journal-title":"Crit Care"},{"key":"B10","doi-asserted-by":"publisher","first-page":"e0179641","DOI":"10.1371\/journal.pone.0179641","article-title":"DiapHRaGM: a mnemonic to describe the work of breathing in patients with respiratory failure","volume":"12","author":"Tulaimat","year":"2017","journal-title":"PLoS ONE"},{"key":"B11","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1007\/s10840-015-9983-6","article-title":"Ambulatory respiratory rate trends identify patients at higher risk of worsening heart failure in implantable cardioverter defibrillator and biventricular device recipients: a novel ambulatory parameter to optimize heart failure management","volume":"43","author":"Goetze","year":"2015","journal-title":"J Int Card Electrophysiol"},{"key":"B12","doi-asserted-by":"publisher","first-page":"e0223155","DOI":"10.1371\/journal.pone.0223155","article-title":"Accuracy and interobserver-agreement of respiratory rate measurements by healthcare professionals, and its effect on the outcomes of clinical prediction\/diagnostic rules","volume":"14","author":"Latten","year":"2019","journal-title":"PLoS ONE"},{"key":"B13","doi-asserted-by":"publisher","first-page":"569","DOI":"10.1111\/irv.12869","article-title":"Admission respiratory status predicts mortality in COVID-19","volume":"15","author":"Chatterjee","year":"2021","journal-title":"Influenza Other Respir Viruses"},{"key":"B14","doi-asserted-by":"publisher","first-page":"354","DOI":"10.1007\/BF02600071","article-title":"Respiratory rate predicts cardiopulmonary arrest for internal medicine inpatients","volume":"8","author":"Fieselmann","year":"1993"},{"key":"B15","doi-asserted-by":"publisher","first-page":"1025","DOI":"10.1056\/NEJM199510193331601","article-title":"A trial of goal-oriented hemodynamic therapy in critically ill patients","volume":"333","author":"Gattinoni","year":"1995","journal-title":"New Engl J Med"},{"key":"B16","doi-asserted-by":"publisher","first-page":"1293","DOI":"10.4187\/respcare.07044","article-title":"Oxygen use in critical illness","volume":"64","author":"O'Driscoll","year":"2019","journal-title":"Respir Care"},{"key":"B17","doi-asserted-by":"publisher","first-page":"e000102","DOI":"10.1136\/bmjresp-2015-000102","article-title":"A study of attitudes, beliefs and organisational barriers related to safe emergency oxygen therapy for patients with COPD (chronic obstructive pulmonary disease) in clinical practice and research","volume":"3","author":"O'Driscoll","year":"2016","journal-title":"BMJ Open Respir Res"},{"key":"B18","doi-asserted-by":"publisher","first-page":"1717","DOI":"10.1056\/NEJM199406163302404","article-title":"Elevation of systemic oxygen delivery in the treatment of critically ill patients","volume":"330","author":"Hayes","year":"1994","journal-title":"New Engl J Med"},{"key":"B19","doi-asserted-by":"publisher","first-page":"784","DOI":"10.1016\/S0140-6736(10)61115-4","article-title":"Effect of palliative oxygen versus room air in relief of breathlessness in patients with refractory dyspnoea: a double-blind, randomised controlled trial","volume":"376","author":"Abernethy","year":"2010","journal-title":"Lancet"},{"key":"B20","doi-asserted-by":"publisher","first-page":"242","DOI":"10.12788\/jhm.3314","article-title":"Things we do for no reason\u2122: supplemental oxygen for patients without hypoxemia","volume":"15","author":"Moss","year":"2020","journal-title":"J Hosp Med."},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-022-06884-x.","article-title":"High arterial oxygen levels and supplemental oxygen administration in traumatic brain injury: insights from CENTER-TBI and OzENTER-TBI","author":"Rezoagli","year":"2022","journal-title":"Intens Care Med."},{"key":"B22","doi-asserted-by":"publisher","first-page":"376","DOI":"10.4172\/2161-105X.1000376","article-title":"Computational fluid dynamics modeling of extrathoracic airway flush: evaluation of high flow nasal cannula design elements","volume":"6","author":"Miller","year":"2016","journal-title":"J Pulm Respir Med"},{"key":"B23","doi-asserted-by":"publisher","first-page":"1066","DOI":"10.1097\/ALN.0000000000004010","article-title":"Respiratory drive in patients with sepsis and septic shock: modulation by high-flow nasal cannula","volume":"135","author":"Mauri","year":"2021","journal-title":"Anesthesiology"},{"key":"B24","doi-asserted-by":"publisher","first-page":"243","DOI":"10.1016\/j.ccm.2019.02.012","article-title":"Why physiology is critical to the practice of medicine: a 40-year personal perspective","volume":"40","author":"Tobin","year":"2019","journal-title":"Clin Chest Med"},{"key":"B25","doi-asserted-by":"publisher","first-page":"1400","DOI":"10.1016\/j.rmed.2009.04.007","article-title":"Research in high flow therapy: mechanisms of action","volume":"103","author":"Dysart","year":"2009","journal-title":"Respir Med"},{"key":"B26","doi-asserted-by":"publisher","first-page":"145","DOI":"10.1513\/AnnalsATS.201707-548FR","article-title":"High-flow nasal cannula oxygen in adults: an evidence-based assessment","volume":"15","author":"Drake","year":"2018","journal-title":"Ann Am Thorac Soc"},{"key":"B27","doi-asserted-by":"publisher","first-page":"e3639","DOI":"10.7759\/cureus.3639","article-title":"High-flow nasal cannula: mechanisms of action and adult and pediatric indications","volume":"10","author":"Lodeserto","year":"2018","journal-title":"Cureus"},{"key":"B28","doi-asserted-by":"publisher","first-page":"1981","DOI":"10.1097\/CCM.0000000000002693","article-title":"Effects of high-flow nasal cannula on the work of breathing in patients recovering from acute respiratory failure*","volume":"45","author":"Delorme","year":"2017","journal-title":"Crit Care Med"},{"key":"B29","doi-asserted-by":"publisher","first-page":"e0337","DOI":"10.1097\/CCE.0000000000000337","article-title":"High-flow oxygen therapy application in chronic obstructive pulmonary disease patients with acute hypercapnic respiratory failure: a multicenter study","volume":"3","author":"Plotnikow","year":"2021","journal-title":"Crit Care Explor"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2022.1070517\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,12,2]],"date-time":"2022-12-02T05:52:32Z","timestamp":1669960352000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2022.1070517\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,12,2]]},"references-count":29,"alternative-id":["10.3389\/fmed.2022.1070517"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2022.1070517","relation":{},"ISSN":["2296-858X"],"issn-type":[{"type":"electronic","value":"2296-858X"}],"subject":[],"published":{"date-parts":[[2022,12,2]]},"article-number":"1070517"}}