{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T02:04:04Z","timestamp":1760148244248,"version":"build-2065373602"},"reference-count":18,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2023,4,14]],"date-time":"2023-04-14T00:00:00Z","timestamp":1681430400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>This article is a review of the physiological and technological processes underpinning high-flow nasal therapy with oxygen (HFNT or HFOT) for the treatment of hypoxemic respiratory failure. A mathematical model was carefully built to represent the relationships between the settings on the HFNT device and the resultant diffusion of oxygen into hypoxemic, arterial blood. The analysis was used to recommend a strategy for setting the flow rate at or above the patient\u2019s peak inspiratory flow when HFNT is used with a blender and equal to the patient\u2019s peak inspiratory rate when bleed-in oxygen is used. The analysis also teaches how to titrate the settings to achieve a desired fraction of inhaled oxygen, (FiO2), in the trachea using a simple ratio when bleed-in oxygen is used. The model was used to compare HFNT as a method to improve oxygen diffusion efficacy with other forms of oxygen therapy. The analysis in this article relates the efficacy of HFOT\/HFNT to that of CPAP with supplemental oxygen by computing the diffusion ratio of oxygen therapy versus breathing room air. We predicted that in non-atelectatic lungs, when considering oxygenation, HFNT can be equally effective as CPAP with supplemental oxygen therapy for treating hypoxemic respiratory failure.<\/jats:p>","DOI":"10.3390\/jcm12082878","type":"journal-article","created":{"date-parts":[[2023,4,14]],"date-time":"2023-04-14T05:29:29Z","timestamp":1681450169000},"page":"2878","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Optimizing Tracheal Oxygen Tension and Diffusion Ratio When Choosing High-Flow Oxygen Therapy or CPAP for the Treatment of Hypoxemic Respiratory Failure: Insights from Ex Vivo Physiologic Modelling"],"prefix":"10.3390","volume":"12","author":[{"given":"Bill","family":"Truschel","sequence":"first","affiliation":[{"name":"Breas Medical AB, SE-435 33 M\u00f6lnlycke, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael I.","family":"Polkey","sequence":"additional","affiliation":[{"name":"Royal Brompton Hospital, Guys & St Thomas NHS Foundation Trust, London SE1 4YB, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,4,14]]},"reference":[{"unstructured":"Powers, K.A., Phamoon, A.S., Powers, K.A., and Dhamoon, A.S. (2022, January 28). Physiology, Pulmonary Ventilation and Perfusion, Available online: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK539907\/.","key":"ref_1"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"19634","DOI":"10.1038\/s41598-022-21609-2","article-title":"Mechanical power is associated with weaning outcome in critically ill mechanically ventilated patients","volume":"12","author":"Yan","year":"2022","journal-title":"Sci. Rep."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"492","DOI":"10.1183\/09031936.95.08030492","article-title":"Reference values for residual volume, functional residual capacity, and total lung capacity. ATS Workshop on Lung Volume Measurements. Official Statement of The European Respiratory Society","volume":"8","author":"Stocks","year":"1995","journal-title":"Eur. Respir. J."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1016\/0034-5687(92)90037-W","article-title":"Estimating Alveolar Surface Area During Life","volume":"88","author":"Colbatch","year":"1992","journal-title":"Respir. Physiol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"14009","DOI":"10.1073\/pnas.95.24.14009","article-title":"Hypsographic demography: The distribution of human population by altitude","volume":"95","author":"Cohen","year":"1988","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"213","DOI":"10.6028\/jres.075A.022","article-title":"Vapor Pressure Equation for Water in the Range 0 to 100 \u00b0C","volume":"75A","author":"Wexler","year":"1971","journal-title":"J. Res. Natl. Bur. Stand. A Phys. Chem."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1977","DOI":"10.1097\/00003246-199812000-00023","article-title":"Effects of the prone position on gas exchange and hemodynamics in severe acute respiratory distress syndrome","volume":"26","author":"Jolliet","year":"1998","journal-title":"Crit. Care Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"427","DOI":"10.1152\/jappl.1956.8.4.427","article-title":"Mechanical factors in distribution of pulmonary ventilation","volume":"8","author":"Otis","year":"1956","journal-title":"J. Appl. Physiol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1525","DOI":"10.1152\/japplphysiol.00934.2014","article-title":"Nasal high flow clears anatomical dead space in upper airway models","volume":"118","author":"Moller","year":"2015","journal-title":"J. Appl. Physiol."},{"doi-asserted-by":"crossref","unstructured":"Cortegiani, A., Accurso, G., Mercadante, S., Giarratano, A., and Gregoretti, C. (2018). High flow nasal therapy in perioperative medicine: From operating room to general ward. BMC Anesthesiol., 18.","key":"ref_10","DOI":"10.1186\/s12871-018-0623-4"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1621","DOI":"10.4187\/respcare.02358","article-title":"Pressures Delivered by Nasal High Flow Oxygen during All Phases of the Respiratory Cycle","volume":"58","author":"Parke","year":"2013","journal-title":"Respir. Care"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1007\/BF03004856","article-title":"Measurement of intratracheal oxygen concentrations during face mask administration of oxygen: A modification for improved control","volume":"22","author":"Wexler","year":"1975","journal-title":"Can. Anaesth. Soc. J."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"538","DOI":"10.1111\/resp.12268","article-title":"Measurement of oxygen concentration delivered via nasal cannulae by tracheal sampling","volume":"19","author":"Kelly","year":"2014","journal-title":"Respirology"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1441","DOI":"10.1007\/s10877-021-00784-z","article-title":"High-flow nasal cannula therapy, factors affecting effective inspired oxygen fraction: An experimental adult bench model","volume":"36","author":"Duprez","year":"2022","journal-title":"J. Clin. Monit. Comput."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1186\/s13613-021-00949-8","article-title":"Optimizing high-flow nasal cannula flow settings in adult hypoxemic patients based on peak inspiratory flow during tidal breathing","volume":"11","author":"Li","year":"2021","journal-title":"Ann. Intensive Care"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"654","DOI":"10.1186\/s13054-020-03344-0","article-title":"Nasal high flow higher than 60 L\/min in patients with acute hypoxemic respiratory failure: A physiological study","volume":"24","author":"Basile","year":"2020","journal-title":"Crit. Care"},{"doi-asserted-by":"crossref","unstructured":"Suriyakul, A., Saiphoklang, N., Barjaktarevic, I., and Cooper, C.B. (2022). Correlation between Hand Grip Strength and Peak Inspiratory Flow Rate in Patients with Stable Chronic Obstructive Pulmonary Disease. Diagnostics, 12.","key":"ref_17","DOI":"10.3390\/diagnostics12123050"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1310","DOI":"10.1164\/ajrccm.154.5.8912741","article-title":"Diaphragm strength in Chronic Obstructive Pulmonary Disease","volume":"154","author":"Polkey","year":"1996","journal-title":"Am. J. Respir. Crit. Care Med."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/8\/2878\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T19:15:53Z","timestamp":1760123753000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/8\/2878"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,4,14]]},"references-count":18,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2023,4]]}},"alternative-id":["jcm12082878"],"URL":"https:\/\/doi.org\/10.3390\/jcm12082878","relation":{},"ISSN":["2077-0383"],"issn-type":[{"type":"electronic","value":"2077-0383"}],"subject":[],"published":{"date-parts":[[2023,4,14]]}}}