human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE : In a cardiothoracic and vascular intensive care unit , to compare nasal high-flow ( NHF ) oxygen therapy and st and ard high-flow face mask ( HFFM ) oxygen therapy in patients with mild to moderate hypoxemic respiratory failure . METHODS : In a prospect i ve r and omized comparative study , 60 patients with mild to moderate hypoxemic respiratory failure were r and omized to receive NHF or HFFM . We analyzed the success of allocated therapy , noninvasive ventilation rate , and oxygenation . RESULTS : Significantly more NHF patients succeeded with their allocated therapy ( P = .006 ) . The rate of noninvasive ventilation in the NHF group was 3/29 ( 10 % ) , compared with 8/27 ( 30 % ) in the HFFM group ( P = .10 ) . The NHF patients also had significantly fewer desaturations ( P = .009 ) . CONCLUSIONS : NHF oxygen therapy may be more effective than HFFM in treating mild to moderate hypoxemic respiratory failure Introduction Noninvasive ventilation ( NIV ) , as a weaning-facilitating strategy in predominantly chronic obstructive pulmonary disease ( COPD ) mechanically ventilated patients , is associated with reduced ventilator-associated pneumonia , total duration of mechanical ventilation , length of intensive care unit ( ICU ) and hospital stay , and mortality . However , this benefit after planned extubation in patients with acute respiratory failure of various etiologies remains to be eluci date d. The aim of this study was to determine the efficacy of NIV applied immediately after planned extubation in contrast to oxygen mask ( OM ) in patients with acute respiratory failure ( ARF ) . Methods A r and omized , prospect i ve , controlled , unblinded clinical study in a single center of a 24-bed adult general ICU in a university hospital was carried out in a 12-month period . Included patients met extubation criteria with at least 72 hours of mechanical ventilation due to acute respiratory failure , after following the ICU weaning protocol . Patients were r and omized immediately before elective extubation , being r and omly allocated to one of the study groups : NIV or OM . We compared both groups regarding gas exchange 15 minutes , 2 hours , and 24 hours after extubation , reintubation rate after 48 hours , duration of mechanical ventilation , ICU length of stay , and hospital mortality . Results Forty patients were r and omized to receive NIV ( 20 patients ) or OM ( 20 patients ) after the following extubation criteria were met : pressure support ( PSV ) of 7 cm H2O , positive end-expiratory pressure ( PEEP ) of 5 cm H2O , oxygen inspiratory fraction ( FiO2 ) ≤ 40 % , arterial oxygen saturation ( SaO2 ) ≥ 90 % , and ratio of respiratory rate and tidal volume in liters ( f/TV ) < 105 . Comparing the 20 patients ( NIV ) with the 18 patients ( OM ) that finished the study 48 hours after extubation , the rate of reintubation  in NIV group was 5 % and 39 % in OM group ( P = 0.016 ) . Relative risk for reintubation was 0.13 ( CI = 0.017 to 0.946 ) . Absolute risk reduction for reintubation showed a decrease of 33.9 % , and analysis of the number needed to treat was three . No difference was found in the length of ICU stay ( P = 0.681 ) . Hospital mortality was zero in NIV group and 22.2 % in OM group ( P = 0.041 ) . Conclusions In this study population , NIV prevented 48 hours reintubation if applied immediately after elective extubation in patients with more than 3 days of ARF when compared with the OM group . Trial Registration numberIS RCT N : 41524441 PURPOSE High flow nasal cannula ( HFNC ) may decrease preload being associated with beneficial hemodynamic and respiratory effects in adults with heart failure . METHODS This is a sequential intervention prospect i ve study including 10 adults with New York Heart Association ( NYHA ) class III and left ventricle ejection fraction 45 % or less .  High flow gas was administered ( fraction of inspired oxygen , 0.21 ) through nasal cannula ( Optiflow(TM ) ; Fisher & Paykel , Auckl and , New Zeal and ) . Sequential echocardiographies were performed at baseline , using HFNC with 20 lpm and 40 lpm and post-HFNC . A reduction greater than 20 % in the estimated inspiratory collapse of the inferior vena cava ( IVC ) from baseline was considered clinical ly significant . RESULTS Ten patients were included , with median age of 57 ( 44 - 65 ) years ; 6 ( 60 % ) were female , and 8 ( 80 % ) had dilated cardiomyopathy .  Median IVC inspiratory significantly ( P<.05 ) decreased from baseline ( 37 % ) to HFNC with 20 lpm ( 28 % ) and HFNC with 40 lpm ( 21 % ) , representing mean attributable reductions of 20 % ( 95 % confidence interval , 6 - 55 ) and 53 % ( 95 % confidence interval , 36 - 67 ) from baseline . Changes in the IVC inspiratory collapse were reversible after HFNC withdrawal . Respiratory rate was significantly reduced from 23 breaths per minute at baseline to 17 breaths per minute at HFNC with 20 lpm and 13 breaths per minute at HFNC with 40 lpm . In contrast , no significant changes in other echocardiographic or clinical variables were documented . CONCLUSION These findings suggest that patients with NYHA class III heart failure may benefit with HFNC supportive therapy CONTEXT Continuous positive airway pressure ( CPAP ) is widely used in the belief that it may reduce the need for intubation and mechanical ventilation in patients with acute hypoxemic respiratory insufficiency . OBJECTIVE To compare the physiologic effects and the clinical efficacy of CPAP vs st and ard oxygen therapy in patients with acute hypoxemic , nonhypercapnic respiratory insufficiency . DESIGN , SETTING , AND PATIENTS R and omized , concealed , and unblinded trial of 123 consecutive adult patients who were admitted to 6 intensive care units between September 1997 and January 1999 with a PaO(2)/FIO(2 ) ratio of 300 mm Hg or less due to bilateral pulmonary edema ( n = 102 with acute lung injury and n = 21 with cardiac disease ) . INTERVENTIONS Patients were r and omly assigned to receive oxygen therapy alone ( n = 61 ) or oxygen therapy plus CPAP ( n = 62 ) . MAIN OUTCOME MEASURES Improvement in PaO(2)/FIO(2 ) ratio , rate of endotracheal intubation at any time during the study , adverse events , length of hospital stay , mortality , and duration of ventilatory assistance , compared between the CPAP and st and ard treatment groups . RESULTS Among the CPAP vs st and ard therapy groups , respectively , causes of respiratory failure ( pneumonia , 54 % and 55 % ) , presence of cardiac disease ( 33 % and 35 % ) , severity at admission , and hypoxemia ( median [ 5th-95th percentile ] PaO(2)/FIO(2 ) ratio , 140 [ 59 - 288 ] mm Hg vs 148 [ 62 - 283 ] mm Hg ; P = .43 ) were similarly distributed . After 1 hour of treatment , subjective responses to treatment ( P<.001 ) and median ( 5th-95th percentile ) PaO(2)/FIO(2 ) ratios were greater with CPAP ( 203 [ 45 - 431 ] mm Hg vs 151 [ 73 - 482 ] mm Hg ; P = .02 ) . No further difference in respiratory indices was observed between the groups . Treatment with CPAP failed to reduce the endotracheal intubation rate ( 21 [ 34 % ] vs 24 [ 39 % ] in the st and ard therapy group ; P = .53 ) , hospital mortality ( 19 [ 31 % ] vs 18 [ 30 % ] ; P = .89 ) , or median ( 5th-95th percentile ) intensive care unit length of stay ( 6.5 [ 1 - 57 ] days vs 6.0 [ 1 - 36 ] days ; P = .43 ) . A higher number of adverse events occurred with CPAP treatment ( 18 vs 6 ; P = .01 ) . CONCLUSION In this study , despite early physiologic improvement , CPAP neither reduced the need for intubation nor improved outcomes in patients with acute hypoxemic , nonhypercapnic respiratory insufficiency primarily due to acute lung injury . JAMA . 2000;284:2352 - 2360 Importance High-flow conditioned oxygen therapy delivered through nasal cannulae and noninvasive mechanical ventilation ( NIV ) may reduce the need for reintubation . Among the advantages of high-flow oxygen therapy are comfort , availability , lower costs , and additional physiopathological mechanisms . Objective To test if high-flow conditioned oxygen therapy is noninferior to NIV for preventing postextubation respiratory failure and reintubation in patients at high risk of reintubation . Design , Setting , and Participants Multicenter r and omized clinical trial in 3 intensive care units in Spain ( September 2012-October 2014 ) including critically ill patients ready for planned extubation with at least 1 of the following high-risk factors for reintubation : older than 65 years ; Acute Physiology and Chronic Health Evaluation II score higher than 12 points on extubation day ; body mass index higher than 30 ; inadequate secretions management ; difficult or prolonged weaning ; more than 1 comorbidity ; heart failure as primary indication for mechanical ventilation ; moderate to severe chronic obstructive pulmonary disease ; airway patency problems ; or prolonged mechanical ventilation . Interventions Patients were r and omized to undergo either high-flow conditioned oxygen therapy or NIV for 24 hours after extubation . Main Outcomes and Measures Primary outcomes were reintubation and postextubation respiratory failure within 72 hours . Noninferiority margin was 10 percentage points . Secondary outcomes included respiratory infection , sepsis , and multiple organ failure , length of stay and mortality ; adverse events ; and time to reintubation . Results Of 604 patients ( mean age , 65 [ SD , 16 ] years ; 388 [ 64 % ] men ) , 314 received NIV and 290 high-flow oxygen . Sixty-six patients ( 22.8 % ) in the high-flow group vs 60 ( 19.1 % ) in the NIV group were reintubation ( absolute difference , -3.7 % ; 95 % CI , -9.1 % to ∞ ) ; 78 patients ( 26.9 % ) in the high-flow group vs 125 ( 39.8 % ) in the NIV group experienced postextubation respiratory failure ( risk difference , 12.9 % ; 95 % CI , 6.6 % to ∞ ) [ corrected ] . Median time to reintubation did not significantly differ : 26.5 hours ( IQR , 14 - 39 hours ) in the high-flow group vs 21.5 hours ( IQR , 10 - 47 hours ) in the NIV group ( absolute difference , -5 hours ; 95 % CI , -34 to 24 hours ) . Median postr and omization ICU length of stay was lower in the high-flow group , 3 days ( IQR , 2 - 7 ) vs 4 days ( IQR , 2 - 9 ; P=.048 ) . Other secondary outcomes were similar in the 2 groups . Adverse effects requiring withdrawal of the therapy were observed in none of patients in the high-flow group vs 42.9 % patients in the NIV group ( P < .001 ) . Conclusions and Relevance Among high-risk adults who have undergone extubation , high-flow conditioned oxygen therapy was not inferior to NIV for preventing reintubation and postextubation respiratory failure . High-flow conditioned oxygen therapy may offer advantages for these patients . Trial Registration clinical trials.gov Identifier : NCT01191489 PURPOSE The purpose of this study was to determine the impact of high-flow nasal cannula oxygen ( HFNC ) on patients with acute respiratory failure ( ARF ) in comparison with conventional oxygen therapy . MATERIAL S AND METHODS This was a prospect i ve observational study . Patients with persistent ARF despite oxygen with conventional facemask without indication for immediate intubation were treated with HFNC oxygen .  Clinical respiratory parameters and arterial blood gases were compared under conventional and HFNC oxygen therapy . RESULTS Twenty patients , aged 59 years ( 38 - 75 years ) and SAPS2 ( simplified acute physiology score ) 33 ( 26.5 - 38 ) , were included in the study . Etiology of ARF was mainly pneumonia ( n = 11 ) , sepsis ( n = 3 ) , and miscellaneous ( n = 6 ) . Use of H 
    Output:
    
agent
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE : In a cardiothoracic and vascular intensive care unit , to compare nasal high-flow ( NHF ) oxygen therapy and st and ard high-flow face mask ( HFFM ) oxygen therapy in patients with mild to moderate hypoxemic respiratory failure . METHODS : In a prospect i ve r and omized comparative study , 60 patients with mild to moderate hypoxemic respiratory failure were r and omized to receive NHF or HFFM . We analyzed the success of allocated therapy , noninvasive ventilation rate , and oxygenation . RESULTS : Significantly more NHF patients succeeded with their allocated therapy ( P = .006 ) . The rate of noninvasive ventilation in the NHF group was 3/29 ( 10 % ) , compared with 8/27 ( 30 % ) in the HFFM group ( P = .10 ) . The NHF patients also had significantly fewer desaturations ( P = .009 ) . CONCLUSIONS : NHF oxygen therapy may be more effective than HFFM in treating mild to moderate hypoxemic respiratory failure Introduction Noninvasive ventilation ( NIV ) , as a weaning-facilitating strategy in predominantly chronic obstructive pulmonary disease ( COPD ) mechanically ventilated patients , is associated with reduced ventilator-associated pneumonia , total duration of mechanical ventilation , length of intensive care unit ( ICU ) and hospital stay , and mortality . However , this benefit after planned extubation in patients with acute respiratory failure of various etiologies remains to be eluci date d. The aim of this study was to determine the efficacy of NIV applied immediately after planned extubation in contrast to oxygen mask ( OM ) in patients with acute respiratory failure ( ARF ) . Methods A r and omized , prospect i ve , controlled , unblinded clinical study in a single center of a 24-bed adult general ICU in a university hospital was carried out in a 12-month period . Included patients met extubation criteria with at least 72 hours of mechanical ventilation due to acute respiratory failure , after following the ICU weaning protocol . Patients were r and omized immediately before elective extubation , being r and omly allocated to one of the study groups : NIV or OM . We compared both groups regarding gas exchange 15 minutes , 2 hours , and 24 hours after extubation , reintubation rate after 48 hours , duration of mechanical ventilation , ICU length of stay , and hospital mortality . Results Forty patients were r and omized to receive NIV ( 20 patients ) or OM ( 20 patients ) after the following extubation criteria were met : pressure support ( PSV ) of 7 cm H2O , positive end-expiratory pressure ( PEEP ) of 5 cm H2O , oxygen inspiratory fraction ( FiO2 ) ≤ 40 % , arterial oxygen saturation ( SaO2 ) ≥ 90 % , and ratio of respiratory rate and tidal volume in liters ( f/TV ) < 105 . Comparing the 20 patients ( NIV ) with the 18 patients ( OM ) that finished the study 48 hours after extubation , the rate of reintubation  in NIV group was 5 % and 39 % in OM group ( P = 0.016 ) . Relative risk for reintubation was 0.13 ( CI = 0.017 to 0.946 ) . Absolute risk reduction for reintubation showed a decrease of 33.9 % , and analysis of the number needed to treat was three . No difference was found in the length of ICU stay ( P = 0.681 ) . Hospital mortality was zero in NIV group and 22.2 % in OM group ( P = 0.041 ) . Conclusions In this study population , NIV prevented 48 hours reintubation if applied immediately after elective extubation in patients with more than 3 days of ARF when compared with the OM group . Trial Registration numberIS RCT N : 41524441 PURPOSE High flow nasal cannula ( HFNC ) may decrease preload being associated with beneficial hemodynamic and respiratory effects in adults with heart failure . METHODS This is a sequential intervention prospect i ve study including 10 adults with New York Heart Association ( NYHA ) class III and left ventricle ejection fraction 45 % or less .  High flow gas was administered ( fraction of inspired oxygen , 0.21 ) through nasal cannula ( Optiflow(TM ) ; Fisher & Paykel , Auckl and , New Zeal and ) . Sequential echocardiographies were performed at baseline , using HFNC with 20 lpm and 40 lpm and post-HFNC . A reduction greater than 20 % in the estimated inspiratory collapse of the inferior vena cava ( IVC ) from baseline was considered clinical ly significant . RESULTS Ten patients were included , with median age of 57 ( 44 - 65 ) years ; 6 ( 60 % ) were female , and 8 ( 80 % ) had dilated cardiomyopathy .  Median IVC inspiratory significantly ( P<.05 ) decreased from baseline ( 37 % ) to HFNC with 20 lpm ( 28 % ) and HFNC with 40 lpm ( 21 % ) , representing mean attributable reductions of 20 % ( 95 % confidence interval , 6 - 55 ) and 53 % ( 95 % confidence interval , 36 - 67 ) from baseline . Changes in the IVC inspiratory collapse were reversible after HFNC withdrawal . Respiratory rate was significantly reduced from 23 breaths per minute at baseline to 17 breaths per minute at HFNC with 20 lpm and 13 breaths per minute at HFNC with 40 lpm . In contrast , no significant changes in other echocardiographic or clinical variables were documented . CONCLUSION These findings suggest that patients with NYHA class III heart failure may benefit with HFNC supportive therapy CONTEXT Continuous positive airway pressure ( CPAP ) is widely used in the belief that it may reduce the need for intubation and mechanical ventilation in patients with acute hypoxemic respiratory insufficiency . OBJECTIVE To compare the physiologic effects and the clinical efficacy of CPAP vs st and ard oxygen therapy in patients with acute hypoxemic , nonhypercapnic respiratory insufficiency . DESIGN , SETTING , AND PATIENTS R and omized , concealed , and unblinded trial of 123 consecutive adult patients who were admitted to 6 intensive care units between September 1997 and January 1999 with a PaO(2)/FIO(2 ) ratio of 300 mm Hg or less due to bilateral pulmonary edema ( n = 102 with acute lung injury and n = 21 with cardiac disease ) . INTERVENTIONS Patients were r and omly assigned to receive oxygen therapy alone ( n = 61 ) or oxygen therapy plus CPAP ( n = 62 ) . MAIN OUTCOME MEASURES Improvement in PaO(2)/FIO(2 ) ratio , rate of endotracheal intubation at any time during the study , adverse events , length of hospital stay , mortality , and duration of ventilatory assistance , compared between the CPAP and st and ard treatment groups . RESULTS Among the CPAP vs st and ard therapy groups , respectively , causes of respiratory failure ( pneumonia , 54 % and 55 % ) , presence of cardiac disease ( 33 % and 35 % ) , severity at admission , and hypoxemia ( median [ 5th-95th percentile ] PaO(2)/FIO(2 ) ratio , 140 [ 59 - 288 ] mm Hg vs 148 [ 62 - 283 ] mm Hg ; P = .43 ) were similarly distributed . After 1 hour of treatment , subjective responses to treatment ( P<.001 ) and median ( 5th-95th percentile ) PaO(2)/FIO(2 ) ratios were greater with CPAP ( 203 [ 45 - 431 ] mm Hg vs 151 [ 73 - 482 ] mm Hg ; P = .02 ) . No further difference in respiratory indices was observed between the groups . Treatment with CPAP failed to reduce the endotracheal intubation rate ( 21 [ 34 % ] vs 24 [ 39 % ] in the st and ard therapy group ; P = .53 ) , hospital mortality ( 19 [ 31 % ] vs 18 [ 30 % ] ; P = .89 ) , or median ( 5th-95th percentile ) intensive care unit length of stay ( 6.5 [ 1 - 57 ] days vs 6.0 [ 1 - 36 ] days ; P = .43 ) . A higher number of adverse events occurred with CPAP treatment ( 18 vs 6 ; P = .01 ) . CONCLUSION In this study , despite early physiologic improvement , CPAP neither reduced the need for intubation nor improved outcomes in patients with acute hypoxemic , nonhypercapnic respiratory insufficiency primarily due to acute lung injury . JAMA . 2000;284:2352 - 2360 Importance High-flow conditioned oxygen therapy delivered through nasal cannulae and noninvasive mechanical ventilation ( NIV ) may reduce the need for reintubation . Among the advantages of high-flow oxygen therapy are comfort , availability , lower costs , and additional physiopathological mechanisms . Objective To test if high-flow conditioned oxygen therapy is noninferior to NIV for preventing postextubation respiratory failure and reintubation in patients at high risk of reintubation . Design , Setting , and Participants Multicenter r and omized clinical trial in 3 intensive care units in Spain ( September 2012-October 2014 ) including critically ill patients ready for planned extubation with at least 1 of the following high-risk factors for reintubation : older than 65 years ; Acute Physiology and Chronic Health Evaluation II score higher than 12 points on extubation day ; body mass index higher than 30 ; inadequate secretions management ; difficult or prolonged weaning ; more than 1 comorbidity ; heart failure as primary indication for mechanical ventilation ; moderate to severe chronic obstructive pulmonary disease ; airway patency problems ; or prolonged mechanical ventilation . Interventions Patients were r and omized to undergo either high-flow conditioned oxygen therapy or NIV for 24 hours after extubation . Main Outcomes and Measures Primary outcomes were reintubation and postextubation respiratory failure within 72 hours . Noninferiority margin was 10 percentage points . Secondary outcomes included respiratory infection , sepsis , and multiple organ failure , length of stay and mortality ; adverse events ; and time to reintubation . Results Of 604 patients ( mean age , 65 [ SD , 16 ] years ; 388 [ 64 % ] men ) , 314 received NIV and 290 high-flow oxygen . Sixty-six patients ( 22.8 % ) in the high-flow group vs 60 ( 19.1 % ) in the NIV group were reintubation ( absolute difference , -3.7 % ; 95 % CI , -9.1 % to ∞ ) ; 78 patients ( 26.9 % ) in the high-flow group vs 125 ( 39.8 % ) in the NIV group experienced postextubation respiratory failure ( risk difference , 12.9 % ; 95 % CI , 6.6 % to ∞ ) [ corrected ] . Median time to reintubation did not significantly differ : 26.5 hours ( IQR , 14 - 39 hours ) in the high-flow group vs 21.5 hours ( IQR , 10 - 47 hours ) in the NIV group ( absolute difference , -5 hours ; 95 % CI , -34 to 24 hours ) . Median postr and omization ICU length of stay was lower in the high-flow group , 3 days ( IQR , 2 - 7 ) vs 4 days ( IQR , 2 - 9 ; P=.048 ) . Other secondary outcomes were similar in the 2 groups . Adverse effects requiring withdrawal of the therapy were observed in none of patients in the high-flow group vs 42.9 % patients in the NIV group ( P < .001 ) . Conclusions and Relevance Among high-risk adults who have undergone extubation , high-flow conditioned oxygen therapy was not inferior to NIV for preventing reintubation and postextubation respiratory failure . High-flow conditioned oxygen therapy may offer advantages for these patients . Trial Registration clinical trials.gov Identifier : NCT01191489 PURPOSE The purpose of this study was to determine the impact of high-flow nasal cannula oxygen ( HFNC ) on patients with acute respiratory failure ( ARF ) in comparison with conventional oxygen therapy . MATERIAL S AND METHODS This was a prospect i ve observational study . Patients with persistent ARF despite oxygen with conventional facemask without indication for immediate intubation were treated with HFNC oxygen .  Clinical respiratory parameters and arterial blood gases were compared under conventional and HFNC oxygen therapy . RESULTS Twenty patients , aged 59 years ( 38 - 75 years ) and SAPS2 ( simplified acute physiology score ) 33 ( 26.5 - 38 ) , were included in the study . Etiology of ARF was mainly pneumonia ( n = 11 ) , sepsis ( n = 3 ) , and miscellaneous ( n = 6 ) . Use of H 
    Output:
    