Category Archives: Alternative Medicine

Keeping your mouth shut isnt easy, but a viral TikTok trend is out to change your mind about that. Known as mouth taping, the idea is to literally tape your mouth closed while you sleep to improve snoring, allergies and bad breath brought on by sleeping with your mouth open. But does it work and is it safe?

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Sleep medicine specialist Cinthya Pena Orbea, MD, talks about why you should be skeptical of mouth taping and when clinicians tend to put it to good use.

Mouth taping is just what it sounds like its the act of taping your mouth closed with skin-safe tape to force you to breathe through your nose instead of your mouth. But why would a mouth breather ever be interested in changing their habits?

Breathing through your nose may have various benefits that breathing through your mouth doesnt have, including:

On the flip side, mouth breathing has various side effects, including:

Sometimes, people who are mouth breathers snore, which is a common symptom, along with restlessness and fatigue, seen in people with obstructive sleep apnea.

We usually breathe through our mouths as a backup for when we cant breathe through our nose. Blockages can be caused by a few different conditions, including congestion from allergies or sinus infections, a deviated septum, enlarged tonsils or enlarged adenoids.

The goal of mouth taping is to reduce the negative side effects and reroute your breathing through your nose. But studies done so far appear inconclusive and the jurys still out on whether or not mouth taping is beneficial.

One small study showed 30 patients snored less after mouth taping. But another study of 36 patients with asthma showed no signs of change in their condition after using mouth taping. And a 2022 study revealed that 10 patients continued to try mouth breathing even after their mouths had been taped, a phenomenon known as mouth puffing.

Most of the evidence is anecdotal. There is not strong enough evidence to support that mouth tape is beneficial, says Dr. Pena Orbea. Mouth taping is not part of our current practice to treat any sleep disorder. Nonetheless, in patients with sleep apnea, we may recommend mouth taping or to wear a chin strap to decrease an air leak while youre using a continuous positive airway pressure (CPAP) machine at night.

Rather than rely on mouth taping, Dr. Pena Orbea suggests using alternative methods to address conditions like snoring and sleep apnea directly.

Causes of snoring vary, but the main reason it happens is that your airway becomes restricted and your tissues vibrate against one another as you try to force air through. If youre having trouble snoring (or if your partner keeps you awake with their snoring), you can try a few solutions like:

Snoring is something that you should consult with your doctor about because snoring can be a sign of other conditions like sleep apnea, notes Dr. Pena Orbea.

Sleep apnea is a condition in which you stop breathing repeatedly while you sleep. This can be caused by an obstructed airway or because your brain has trouble signaling your muscles to help you breathe. One major treatment for sleep apnea is using a CPAP machine to help open your airway while you sleep.

When patients wear a CPAP at night, some patients may swallow air during the night which causes them to feel bloated or have abdominal pain the next morning, explains Dr. Pena Orbea. By closing their mouth with mouth taping or a chinstrap, we can help alleviate these problems.

Taping your mouth shut impairs your ability to breathe in full, deep breaths. Plus, you could also experience skin irritation, an allergic reaction or rash from using the wrong kind of tape. It is never advised to use duct tape or any other kind of tape on your body for any reason.

Mouth taping could cause an allergic reaction from the tape or a skin irritation or rash, warns Dr. Pena Orbea. Before starting this practice, you should talk to your doctor about this.

Mouth taping isnt recommended because theres not enough scientific evidence to support the anecdotal benefits behind this viral trend. If youre concerned about improving your snoring, bad breath, sleep apnea or any other breathing or sleep-related conditions, you should talk to a healthcare provider to figure out safer alternative treatments.

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Mouth Taping: Is It Safe? - Health Essentials

After seven decades on the throne, Queen Elizabeth II, Britains longest reigning monarch, died Thursday at Balmoral Castle. She was 96.

Elizabeth is succeeded by her eldest son, Charles. Royal officials confirmed the new monarch will be known as King Charles III.

Here are seven things you need to know about the Queens passing.

How did it happen?

Early Thursday morning, news broke that the Queen was placed under medical supervision, just two days after she appointed British Prime Minister Liz Truss the 15th prime minister to serve under her reign.

Hours later, around 1 p.m. EST, a notice was posted at the gates of Buckingham Palace notifying the public of the Queens death.

The Queen died peacefully at her estate in the Scottish Highlands, Balmoral castle, officials announced. Members of the royal family including Prince William Charles eldest son and now heir-apparent and the Queens other sons Princes Andrew and Edward were in attendance.

When is the Queens funeral?

The funeral will take place at least 10 days after the Queens passing, following a traditional period of mourning across the nation.

According to Politico, Elizabeths official send-off is expected to take place in Westminster Abbey, with members of the royal family, dignitaries and heads of state from around the world in attendance.

Elizabeth will be laid to rest at St. Georges Chapel, on the grounds of Windsor Castle. She will be buried beside her late husband Prince Philip, her father King George VI and her sister Princess Margaret.

The royal family is expected to release concrete details soon.

Whats Operation London Bridge?

Operation London Bridge is the code name for the U.K. governments secretive plans covering the immediate aftermath of the Queens death.

According to Politico, it includes a detailed schedule of the 10 days of national mourning, including a large security operation overseeing the potentially unprecedented crowds of mourners surging into London.

The plans span from the important to the seemingly mundane, from how official government websites and social media should behave to how the U.K. prime minister should.

For a full overview of the plan, click here.

Whos next in line after the Queen?

King Charles III was named king immediately after Elizabeths death. The order of succession after the 73-year-old monarch is as follows:

Prince William, eldest son of Charles and the late Princess Diana, is now the heir apparent. He is married to Catherine, Duchess of Cambridge. Their three children Prince George, Princess Charlotte and Prince Louis will succeed him in that order.

Prince Harry, younger son of Charles and Diana, follows. He will be succeeded by his children with Meghan, Archie Mountbatten-Windsor and Lilibet Mountbatten-Windsor, respectfully.

Prince Andrew, Queen Elizabeth II and Prince Philips second-eldest son, is eighth in succession. Andrew is followed by Princess Beatrice, his eldest daughter with former wife Sarah Ferguson.

With the death of Queen Elizabeth II, her son Charles becomes Britain's new king. The oldest person to ever assume the British throne, he became King Charles III on Thursday. (Sept. 8)(AP video/Mike Householder)

What do we know about King Charles III?

After a lifetime of preparation, Charles has finally ascended to the throne. His coronation marks him the oldest person ever to assume the British crown.

His wife, Camilla, Duchess of Cornwall, was named queen consort. Charles and Camilla wed in 2005 following his controversial divorce with Princess Diana in 1996. Diana later died in a car crash the following year.

Charles became the first royal heir to earn a university degree and not be educated at home. Unlike his mother, who was steadfastly apolitical, Charles delivered speeches and penned articles on topics including climate change, green energy and alternative medicine.

How will the Queens death affect Canada?

Immediately after the Queens death, King Charles III automatically became Canadas head of state. Everything else in Canadian government essentially remains the same.

The monarchs role in Canadian governance is extremely limited. Their representative, the governor general, carries out responsibilities on their behalf, most of which are largely ceremonial. One of these tasks is to formally announce the new king.

Read more here: How will Queen Elizabeth IIs death affect Canada's government?

All coins engraved with the Queen will remain legal tender and stay in circulation indefinitely. The current $20 polymer bill will continue to circulate for years to come, although Elizabeths image will eventually be replaced with her successor.

Read more here: What happens to Canadas currency, stamps, place names after the Queens death?

How are world leaders reacting?

In a news conference Thursday, newly appointed Prime Minister Liz Truss reflected on the Queens legacy and spoke on ushering in a new era. She ended her speech with God save the King.

In a speech soon after the Queens death, Canadian Prime Minister Justin Trudeau called Elizabeth one of my favourite people in the world, adding that he will miss her so.

World leaders from Ukrainian president Volodymyr Zelenskyy to the King of Jordan Abdullah bin AlHussein took to Twitter to pay their tributes. Read what they said here.

World leaders and citizens across the globe expressed their condolences and memories of Queen Elizabeth II, who died Thursday at age 96. (Sept. 9 / THE ASSOCIATED PRESS)

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Queen Elizabeth: Seven things you need to know about the Queens passing - Toronto Star

Military veteran and entrepreneur Adam Hardage aims to build an alternative medical economy in response to what he calls tyranny in the nation.

Hardage is CEO and co-founder of Remote Health Solutions (RHS), along with Dr. Jon Baugh, its chief medical officer. The two started the company five years ago, focusing on high-quality telemedicine care. After experiencing lockdowns and COVID-19 vaccine mandates, and what he calls corruption within the medical industrial complex, Hardage decided to build a medical economy 2.0.

Speaking with The Epoch Times on Aug. 12, Hardage said of the lockdowns and mandates: Its immoral, its unethical, and its unconstitutional.

Moreover, its frankly criminal, and its just punitive unnecessarily to fire health care workers that were last years heroes, and now theyre this year zeros, all for just refusing an experimental gene modification injection, Hardage added.So were going to make it our mission to hire every single one of those providers across the nation. Were going to build the medical economy 2.0.

There are no national statistics on how many health care workers have been fired nationwide for refusing the COVID-19 vaccines. In New York, a state with one of the most strict vaccination requirements, about 34,000 health care workers have quit, retired, or been fired over refusing the vaccines.

Hardage and his team pivoted the business model about a year ago. RHS now provides concierge-level health care for patients across the nation. In addition, the company, which Hardage calls the Noahs Ark for medicine, welcomes medical professionals whose careers were jeopardized because they refused COVID-19 vaccines.

Hardage said RHS can handle up to 90 percent of a patients typical needs through virtual care. The virtual medicine service can be especially helpful under certain circumstances, for instance, if a child gets sick at night or during a holiday.

We want you well. Its in our best interest financially for you to be healthy, said Hardage.If were giving out bad treatment, bad advice, bad guidance to our patients, and they get sick all the timewell, then, were going to go out of business.

Because the business charges a flat fee for unlimited care per month, seeing the doctor more frequently or getting additional treatment will not benefit RHS financially.

A hospital is completely the opposite, said Hardage.

To illustrate, Hardage used the example of COVID-19 treatment. He said hospitals are financially incentivized to perform PCR testing, use remdesivir, intubate COVID-19 patients, and put them in the ICU.

Remdesivir is a controversial drug,authorized and later approvedin 2020 by the U.S. Food and Drug Administration (FDA) to treat COVID-19 patients. Multiple studies have shown that remdesivir has no effect on hospitalized COVID-19 patients. In fact, some doctors claim that the drug has played a key role in COVID-related deaths, and the World Health Organization (WHO) recommended against the drug in November 2020. Following the publication of a clinical trial in April, the WHO now suggests using remdesivir in mild or moderate COVID-19 patients at high risk of hospitalization.

Hospitals in the nation are eligible fora 20 percent add-on payment for using some FDA-approved or authorized COVID-19 treatments, including remdesivir, according to an interim final rule issued by the Centers for Medicare and Medicaid Services (CMS), an agency under the Department of Health and Human Services (HHS).

Dr. Peter McCullough,a renowned cardiologist andepidemiologist, has called administering remdesivir as a frontline therapy intentional and injurious to the population.

As a doctor, I use lots of drugs in the hospital. Ive never had an antibiotic or antiviral where the entire hospital stay would get a 20 percent bonus, McCullough told EpochTVs Facts Matter program in early August. Americans should be asking questions.

According to CMS, the add-on payment was to mitigate potential financial disincentives for hospitals to provide new COVID-19 treatments during the public health emergency period.

The Epoch Times has contacted HHS for additional comment.

Hardage believes the United States has experienced an attempted Marxist, communist, internal coup.

Having served in the military for 20 years, I cannot believe that this is the country that I came back to, Hardage said. I dont understand what Im seeing a lot of times. But now, after the last few years, Ive really started to unpack it. And I understand very clearly whats going on. This is nothing less than Saul Alinskys playbook of, lets go after the first pillar, for example, which is health care.

Alinsky was a community organizer and left-wing social activist. His thought, reflected in the 1971 book Rules for Radicals, is believed to have influenced former President Barack Obama.

Hardage said the damage to todays medical system can be traced back to Obamas policies.

What you are seeing right now is a direct result of the Obamacare policies, Hardage said.If a hospital is going to take money from Medicare, MedicaidAffordable Care Actthen they have to follow those guidelines, those mandates, those regulations.

Hardage feels federal health agencies could have recommended early treatment options such asvitamin D, C, B, zinc, quercetin, ivermectin, or hydroxychloroquine. However, these drugs are safe but not profitable.

In reaction, what Hardage calls a parallel economy has been built, standing in direct response to oppression, to tyranny.

Stop giving your money to the institutions that are corrupt, that are literally taking everything from you, including your health, and join a patriot organization such as ours, Hardage said.

Hardage believes what he is doing is a continuation of his service to his country: Ive taken the oath of office many times, he said, citing the oath service members take to support and defend the Constitution of the United States against all enemies, foreign and domestic.

That doesnt mean Im going to pick up a gun and go run around the streets like a crazy person. But it does mean that were going to defeat them at the ballot box. Were going to defeat them in the war of ideas. Were going to defeat them on the stage. Were going to defeat them with the whole notion of reawakening America, instead of resetting America.

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Building an Alternative Medical Economy in Response to 'Tyranny': Telehealth CEO - The Epoch Times

There are two varieties of sesame oil: cold-pressed and toasted. People tend to use the cold-pressed type for cooking and the toasted variety for seasoning.

This article outlines what sesame oil is, its nutritional content, and its health benefits. We also provide some recipes incorporating sesame oil and list alternatives to this healthy oil.

Sesame oil is derived from the seeds of the plant Sesamum indicium.

Manufacturers produce sesame oil by pressing either raw or toasted sesame seeds. Pressing the raw seeds produces a cold-pressed oil that is suitable for cooking, whereas pressing the toasted seeds produces an oil with a nutty aroma and flavor that is suitable for seasoning.

According to the U.S. Department of Agriculture (USDA), 1 tablespoon (tbsp) of sesame oil contains the following:

A 2022 study notes that sesame oil also contains the following natural substances that may be beneficial to health:

Below are some of the potential health benefits of sesame oil, according to scientific research.

Atherosclerosis is the medical term for the narrowing of arteries due to a buildup of plaques along arterial walls. Plaques are an accumulation of fatty deposits and wastes that impair blood flow through the arteries.

Researchers believe that an inflammatory response contributes to the formation of arterial plaques. Without treatment, atherosclerosis can lead to cardiovascular complications, such as heart attack and stroke.

A 2017 review investigated sesame oils anti-inflammatory and antioxidant effects on atherosclerosis. According to the review, sesame oil may help by:

The authors suggest that further studies are necessary to explore the potential of sesame oil in treating atherosclerosis.

People in some parts of the world use sesame oil as a traditional medicine for joint pain. In a 2019 study, researchers compared the effectiveness of sesame oil with the nonsteroidal anti-inflammatory drug (NSAID) diclofenac gel in treating knee arthritis.

The research involved 104 people who applied either sesame oil or diclofenac gel to the knee three times per day for 4 weeks.

Analysis of the results suggested no significant difference between the two treatments in decreasing pain and increasing knee function. Thus, we can conclude that sesame oil is a good alternative to certain topical treatments.

However, more research is required to determine the effectiveness of sesame oil.

Oil pulling is a technique that involves swishing oil in the mouth for 20 minutes and then spitting it out. Proponents of oil pulling claim that it boosts oral health by sweeping away and dissolving bad bacteria inside the mouth.

A 2016 review states that traditional Indian medicine uses oil pulling to maintain oral hygiene. The research found that sesame oil reduced plaque-induced gingivitis.

A 2021 clinical trial notes that mild memory impairment may be a precursor to dementia or Alzheimers disease.

The trial investigated the safety and efficacy of sesame oil cake extract (SOCE) on memory function improvement. Sesame oil cake extract is a byproduct of the process that removes sesame oil from sesame seeds.

The 12-week trial included 70 participants with memory impairment. One group took the SOCE supplement, while the other took a placebo.

Results suggested that the SOCE significantly increased verbal memory and reduced blood plasma levels of amyloid proteins. These proteins tend to be at higher levels among people with Alzheimers.

A 2018 study investigated the effectiveness of white sesame seed oil (WSSO) against a placebo on type 2 diabetes. The study involved 46 participants.

At 90 days, researchers identified significant differences between the two groups. Compared with the placebo group, participants who took WSSO experienced a significant reduction in fasting blood glucose and HbA1c, a measure of average blood glucose. They also showed significant improvements in biomarkers of heart, liver, and kidney function.

The authors concluded that WSSO may have value in regulating blood glucose and protecting against the harmful effects of diabetes.

Below are a few recipe ideas incorporating sesame oil:

Ingredients

Instructions

Whisk ingredients together.

Ingredients

Instructions

Place all the ingredients in a food processor. Add the water last, and blend until smooth. If desired, add a little more water to thin the mixture.

Ingredients

Instructions

Below are some alternative oils to sesame oil.

Olive oil is one alternative to sesame oil. It is rich in polyphenols, which are plant compounds with antioxidant properties.

A 2019 report notes that consumption of virgin olive oil is associated with the following health benefits:

The research from this report came from in vitro and animal studies, so more human trials are needed.

Avocado oil is another alternative that compares favorably to sesame oil.

A 2019 review notes that avocado oil has anti-inflammatory properties similar to the NSAID ibuprofen. The review also cites research that found that replacing butter with avocado oil for breakfast resulted in improvements in the following:

This study was short and had a small sample size, so more research is needed in this area.

Coconut oil has a reputation as a healthy oil, but excessive consumption of coconut oil may have negative health effects.

A 2018 review notes that research supports the topical use of coconut oil for atopic dermatitis and oil pulling to prevent dental cavities. However, evidence supporting other purported benefits is either limited or nonexistent.

A separate 2018 review states that coconut oil may have a harmful effect on cardiovascular health because it increases LDL cholesterol.

Sesame oil is derived from the seeds of the Sesamum indicum plant. Toasted sesame oil is popular in Asian cuisine.

Studies suggest that sesame oil may benefit numerous health conditions, including cardiovascular disease, gingivitis, arthritis, dementia, and diabetes. However, more research is needed to determine the long-term effectiveness.

People looking for a healthy oil may wish to try alternatives, such as virgin olive oil or avocado oil. Coconut oil is another alternative, although it may increase LDL cholesterol.

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Sesame oil: Nutrition, benefits, and more - Medical News Today

Surgical methods of repair have long since been touted as the best approach to treatment and healing for patients with long-term, degenerative conditions.

While effective, factors such as high costs, long downtime, surgical complications and more can be a deterrent for patients who are considering surgery for non-life-threatening conditions.

Regenerative Medicine is an approach available for some patients who are seeking pain relief and long-term healing and would like to reduce the need for surgery.

Regenerative medicine can be defined as the process of replacing or regenerating human cells or tissues to facilitate healing and repair. The ability to encourage this repair in the human body reduces the time most patients will remain ill and offers many possibilities in the field of medicine.

In understanding the regenerative process, it is important to note that the potential for repair and the ability to repair are two separate things. We all have the potential to repair but we dont all have the ability. Increasing the ability to repair is considered one of the main benefits of regenerative medicine. This is derived from the ability of cells, particularly stem cells, to promote cell repair by reducing inflammation which promotes faster healing, better circulation and less pain in an injured area.

Stem cells can be taken from a variety of tissues in the body, and they tend to be harvested from areas that are easily accessible. With stem cell therapy, you are able to use your bodys own repair team (cells) to heal an injured area.

In fact, stem cell therapy has been proven to regenerate tissue in the human body without the need for surgery or additional medication in certain conditions. It is useful for patients who are suffering from degenerative and chronic diseases, such as chronic pain, who are in search of medical treatments without surgical interference.

Image via iStock

Regenerative Medicine and Stem Cell Therapy are useful treatment options for:

The typical patient is over 40 years perhaps starting to experience some joint pains, sexual dysfunction or lack of energy aging with an inability to keep up with their demanding lifestyles.

One patient, DG, came in for a list of concerns that are typical in a 60-year-old including knee pain, mild erectile dysfunction and high blood pressure.

One patient reported improved eyesight among other benefits after his treatment. Image via iStock

DG underwent stem cell therapy and reports to us on his experience. He reported an overwhelming relief from pain and the anxiety associated with expecting this pain. His knee, which was injured during an uphill walk, has had improvement and he is able to enjoy his daily walks without expectation of pain. He also marveled at the maintenance of life and health aspect of Stem Cell Therapy which enabled him to bank his extracted Stem Cells for future usage.

Lastly, DG mentioned the unexpected benefits that have come from the treatment such as improved eyesight without glasses, a reduction of graying hairs, a reduction in bags under the eye, a younger appearance and a reduction of Erectile Dysfunction!

BioRegeneration Integrated Medical Centre in Jamaica specialises in stem cell therapy using your own stem cells. This treatment is done locally by Dr Janice Simmonds-Fisher who has pioneered Regenerative Medicine in Jamaica for over a decade providing a life-improving treatment that enjoys over 90 per centsuccess rate in our population.

BioRegeneration is located at 15 Haining Road, Kingston. They can be contacted at 876-552-6484. For any questions, email questions@drjanicefisher.com or visit http://www.stemcelljamaica.com.

For our regional patients, Dr. Fisher offers phone or virtual consultations. To make a virtual consultation appointment, please email questions@drjanicefisher.com or whatsapp 876-565-1168.

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Regenerative Medicine: An alternative to surgery and pills | Loop Cayman Islands - Loop News Cayman

And then theres the menu of spa treatments which combines the very best from the western world of alternative medicine and traditional Chinese medicine: cupping, acupuncture, watsu, lymphatic massage, infra-red sauna, chakra re-alignment, five elements meditation and energy treatments pretty much everything you ever needed (and didnt know you needed) to feel like the very best and glowingly healthy version of yourself. When youre not busy doing a treatment, taking a class or exploring the stunning surrounding area (its a very easy walk into the village of Mystras and to the nearby Byzantine ruins; or a short drive to visit Sparta), you can while the days away sitting by the poolside; take a dip in the cold and hot pools in the spa (to reinvigorate your circulation); or relax in the steam area, which includes a cold plunge pool, ice fountain, tepidarium, Byzantine hammam, traditional steam room and Finnish sauna - all exquisitely decorated with marble, stone and mosaics.

Euphoria Retreat

At the heart of Euphorias philosophy is a specific focus on re-building strength and immunity - so that you can leave the resort better able to face daily challenges, both mentally and physically. This sets the tone for everything from bespoke programmes to group classes (dont miss yoga with Liz, or the extraordinary hikes with Elias through the unbelievably picturesque surrounding mountainside) to the food, which is fresh, nutritious and gloriously abundant. You most certainly wont be hungry: the Euphoria nutritionist works with each guest to craft a culinary programme that suits their specific needs and goals, but typically each day starts with a delectable and perfectly apportioned Greek breakfast (be it thick, creamy yogurt dressed with nuts and fruit, buckwheat pancakes, or Euphorias unforgettably good homemade granola with nut milk) and a tall, iced glass of water infused with local mountain herbs. Then, fresh smoothies and snacks are made for you and delivered to you. For lunch and dinner, some delectable variation on the theme of fresh fish, grilled or steamed, with wilted greens and Greek salads, served up in the restaurant.

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Find Euphoria: the luxury Greek spa retreat to visit now - Tatler

Employees have adapted their cheating tactics as advanced drug testing has become more commonplace in the workplace. Employers should prioritize implementing a drug testing policy that employs scientifically-validated methods, especially in industries where accidents are common. Its expected that when workers dont show up to work high or drunk, everyone is safe.

Furthermore, the accuracy of a drug test depends on the integrity of the specimen used. With greater detection of cocaine and methamphetamine, and new legislation allowing recreational or medical marijuana in numerous states, businesses are instituting tougher routines to counter the growing problem of employees submitting false positive drug tests.

People use this product to fake drug screenings since it looks and smells like human pee. Companies opt for urine tests to determine whether someone has ever taken drugs or is currently using them.

Fake urine is available for sale, modern technology has significantly improved its creation, and the close similarity to the human pee strengthens its credibility. To get clean results quickly, some individuals risk it all by utilizing synthetic urine instead of their urine to acquire clear results quickly.

It is necessary to provide some background on synthetic urine before delving into the specifics of the pee itself. Synthetic urine includes substances such as yellow coloring, creatinine, and, on occasion, uric acid to replicate the qualities of human pee.

Simply put, synthetic urine is an ordinary artificial pee created in a laboratory. This is done to simulate urine in its purest form. The required components are in synthetic urine, including creatinine, ammonia, urea, pH, uric acid, adequate sulfate concentrations, and specific gravity. If the concentrations are inaccurate, they will immediately appear in your sample. Therefore, at some point, you will need high-quality synthetic urine for your drug tests.

Historically, people used synthetic urine to evaluate the effect of urine on items such as diapers, beds, cleaning chemicals, and medical equipment.

Furthermore, they have used it to increase testing efficiency in alternative medicine, scientific investigations, and even drug testing.

With higher drug positive rates and more commonly accessible legally available substances, people often use fake pee to attempt to mislead drug tests.

Using synthetic urine is a dependable and successful method, although a risky one, to pass a drug test. You may easily pass a drug test using a fake urine kit. These items will improve your chances of passing a urine test, which is one of the most difficult drug screenings. This is one of the most effective ways to trick a urine test since it allows you to create a synthetic urine sample. This urine sample looks to be a lot more authentic and indicative of genuine pees composition, and it is straightforward to use compared to liquid urine kits. In addition, the composition of this urine sample is more accurate.

After understanding synthetic urine, the next step is to get familiar with the two variants that are accessible. You can use synthetic urine in either powder or liquid form, depending on your tastes and what you find to be the most effective for you. Both approaches have particular strengths and weaknesses but achieve the same satisfactory results. When you use it following the right directions, both varieties of synthetic urine provide good results.

The first type of synthetic urine is liquid fake urine, and it does not call for any mixing until it is diluted. There is no need to add anything further; combine the ingredients, bring them to a simmer, and then utilize them.

You need to add distilled water to be passed as genuine pee for powdered urine, and this is because powdered synthetic urine is not adequately hydrated. The sample is available in a vial, which you have to transfer to a bigger container to mix the ingredients for the fake urine together and produce the urine. In most cases, the vial contains enough ingredients to generate a whole bottle of fake urine; nonetheless, it is important to follow the manufacturers recommendations when estimating your filtered water.

People use synthetic urine to pass mandatory drug tests at many workplaces and schools. Getting a job is a major motivation for individuals to use fake urine. Most companies conduct pre-employment drug tests on all prospective hires and periodically test existing workers to ensure they remain drug-free and can do their jobs. If the firm forbids the use of drugs, a worker who fails a drug test may lose his job.

Drug tests are also a standard component of the application procedure for universities. Students who use drugs like marijuana or opioid tablets sometimes try to fool drug tests by using fake pee.

Many athletes who pass a urine drug test before participating use fake pee to fool the authorities. They may do this to cover up the usage of both illicit drugs and legal medications that boost performance.

Additionally, many utilize synthetic urine to conceal a medical issue or to trick their insurance providers.

There are some main factors developers must pay attention to when creating a synthetic urine kit. First, developers have discovered a way to replicate the same color of the human pee, giving the synthetic urine a golden yellow color.

Further, they incorporate creatinine in synthetic pee to replicate human pee characteristics. Creatinine is essential in all successful synthetic urine kits, and testers always seek to find it since it is a byproduct of the metabolism of the muscles.

Another essential factor developers have considered is the temperature of the urine. That is why they created heating stripes to bring the sample to the right degree.

Developers determine the pH level of synthetic urine after specific components have been diluted to replicate the original urine combination. Then, they examine the fake pee and improve it accordingly.

Using fake urine to pass a pee test is the most reliable method. The use of a kit, on the other hand, requires skill. Moreover, youll need to conceal it throughout the examination and swap it out before the examiner notices.

The greatest synthetic urine contains non-toxic components. Synthetic urine has a high proportion of the same elements as human urine. Firms originally developed it to test their lab equipment to confirm that it was operating before examining authentic urine samples.

Some of the most probable elements include the acid uric, urea, Sodium phosphorus, pristine water, Chloride of potassium, Creatinine, and Chloride of sodium.

The finest synthetic urines include both urea and uric acid. All effective synthetic urines need creatinine, a byproduct of protein metabolism that testers look for to guarantee theyre dealing with genuine pee. A few testers will look for urine odor, and most will look for yellow coloring to ensure that the sample is not too dilute.

There are a lot of fake urines out there, many of which are disappointments. Some can be caught on drug tests, and those that are ineffective. You must choose a reliable product and reputable manufacturer.

It might be difficult to choose the perfect synthetic urine kit since there are so many of them now available for sale. The following are some factors to consider to assist you in refining your search.

Due to the rise in demand for artificial urine kits, the number of imitation goods has expanded significantly in recent years. Hence, you must choose the most reputable brand to get your kit. In addition, look into customers comments to determine whether or not the product met other peoples needs.

Moreover, Since uric acid is present in healthy urine, most testing facilities look for it as part of their drug screening procedures. Check the ingredient list on the product to see whether it contains this key component.

Urine color varies from person to person and is influenced by several factors, including but not limited to medicine, nutrition, hydration, and other bodily substances. Urochrome is the chemical responsible for the range of colors seen in urine, from pale yellow to deeper shades of yellow and even amber.

Your synthetic urines, thus, should include either green or yellow undertones.

Temperature is an essential factor when looking for a synthetic urine kit. After a few seconds of being outside the body, the urine temperature drops. Urine outside the 9098 degrees Fahrenheit range will raise red flags, increasing the likelihood of detection. The best-selling brands of synthetic pee all come with temperature-reading strips.

The most effective solutions come with a heating pad to maintain the urine at a comfortable temperature and a unique strip indicating the actual temperature.

Finally, youll need to consider the shelf life of your product. Its not uncommon for drug tests to be very surprising. When it comes time for tests, you dont want to discover that the synthetic urine kit has expired. Be careful to select a durable kit; the leading manufacturers of synthetic urine guarantee that their products have a shelf life of at least two to three years when you store them properly.

In addition to its usage in helping people pass drug tests, synthetic urine also has the following applications:

Using synthetic urine to play pranks is by far the most amusing use of this substance for individuals with little spare time on their hands. Gardeners who are concerned about the health of their plants will use animal pesticides to keep rodents away from their plants. Synthetic urine, equally as effective as actual pee but less expensive overall, is becoming more popular among gardeners.

In the field of education, medical students practice using simulated urine. These training include urinalysis tests and clinical exercises.

When it comes to cleaning agent tests, fake urine is quite common among salespeople and marketers. They use it to demonstrate the effectiveness of various cleaning chemicals, notably for carpeting and furnishings that need urine stain cleaners and odor removers. In particular, they focus on the performance of these agents for removing pee stains.

People experimenting with drugs will frequently take considerable measures to conceal their addiction, which is why fake urine usage is becoming increasingly common. While drug users enjoy the temporary high of these substances, most cannot face the penalties of being discovered. This is evident, especially if they attempt to preserve their profession or conceal their substance use from their family.

However, utilizing fake urine is not a perfect method. Many labs and testing facilities are increasingly adept at identifying fake urine, which is no longer as easy as filling a cup. The procedures presently in use also aim to identify fake pee. This implies that if you want to use synthetic urine, your chances of getting away with it are not 100% accurate.

Furthermore, if testers find out youre using fake pee, you may face serious repercussions. You will have to pay a fine or lose your career, and people can exclude you from events and even be incarcerated for cheating on a drug test.

If you need a drug test, the easiest method is to stop using these hazardous drugs. However, we recognize that this is not a simple task.

The subject of whether synthetic urine is allowed, particularly for pre-employment testing, is likely what brought you here. So, are you breaching the law if you provide a false urine sample?

This is a nebulous area of law, and the location and kind of examination both have a role. It is not wise to rely on important choices on speculation or the ramblings of strangers on the Internet.

Do your homework and investigate relevant legal topics, or consult an attorney, for guidance. But in most places, both selling and purchasing synthetic pee is perfectly legal.

Synthetic pee is yours to do with as you choose. It is not against the law to falsify a drug test result in the United States. However, it can be against the law in the state where you are located. If caught cheating, you risk losing your job.

There is no way to pass a urine drug test by diluting your pee or increasing the amount of water you drink. Urine drug tests are very difficult and stringent. If you make even one mistake, you might throw away a good career and face negative repercussions. Therefore, getting high-quality synthetic urine kits to pass a drug test is essential.

Both powdered and liquid forms of synthetic urine kits are available today to meet your needs. If it is in powder form, you will need to create the urine solution by combining the exact quantity of water. On the other hand, in contrast to its solid counterpart, liquid synthetic urine is both pre-mixed and concentrated.

Urine from humans ranges from around 90 to 100 degrees Fahrenheit. Testers will certainly not accept anything that goes beyond this point. The temperature of the human body at rest is around 98.6 degrees Fahrenheit. We recommend maintaining the temperature of your samples at 96 degrees.

To maintain the temperature of the urine sample, most women choose a waistline pack equipped with a flexible hose that allows them to empty the pack between their legs while sitting on the toilet. On the other hand, males have a better chance of passing off their prosthetic penis than their own when it comes to passing off a sample of synthetic pee.

Certain circumstances, such as high or low temperatures, humidity, and early exposure to dust and oxygen, might shorten the shelf life of the fake pee. All of these things destroy the chemical connections that are present in urine between the various compounds. Before you use anything, make sure you check the date of manufacture.

Do not even think about attempting to produce the sample pee solution until you have finished reading and comprehending the instructions. Be very cautious about heating your sample, following the manufacturers directions. You might damage the urine sample if you raise the temperature to an excessive level.

It is smart to get some practice with the phony kits in the time leading up to the real test to improve your chances of passing the drug test.

However, there is a good chance that you wont be allowed to flush the toilet since the people in charge want to ensure that you arent trying to hide evidence of sample tampering.

You are not allowed to utilize or borrow clean urine from someone who does not use cannabis since there is a probability of being apprehended and the danger of pH, creatinine, and other chemical substances being damaged due to improper management. This act is precarious, and if you need to submit your urine sample immediately, the temperature of the sample will likely expose you.

Clearing a pee test using synthetic urine is a strategy with a high success rate. Assume that you get the kit from a reliable supplier, that you will adhere to the instructions, and that you will maintain the appropriate temperature for the urine before sending it in for testing. Under such circumstances, there is no question that you will get the desired result on the test.

It is effective for drug tests, sports testing, and even diagnostic procedures if you need to complete any of those things.

Suitable fake urine temperature should be between 32 and 38 degrees Celsius to avoid suspicion. If you have heat, your artificial pee temperature may be higher than usual, and you may fail your exam if it is too chilly or too heated. Your synthetic pee should be yellow and smell like real urine. The hand warmers you have must maintain the temperature of your urine between 2 and 6 hours. Waiting any longer than this would be considered overly lengthy for a urine test.

Any synthetic urine worth its salt will come with a hand warmer that will keep your digits toasty for several hours. Put a rubber band around it and secure it to the top of your urine container. Wait at least half an hour.

Hand warmers keep the urine temperature at the same level as the users body. This is because companies run the risk of being sued if the gadget becomes too hot and creates blisters on peoples hands.

Once mixed, the vast majority of items have a shelf life of two years. Check this on your bottle since the information may differ on different products.

The shelf life of pre-mixed synthetic urine, whether powdered or liquid. There is debate over how long synthetic urine lasts, although estimates range from a few months to almost two years.

Unopened powdered urine has a shelf life that much exceeds that. Packages of name-brand goods will always clearly state when they will go bad.

You should get rid of kits beyond the expiration date, and keep in mind that this is the date on which the packages remain unopened. Once you break the seal on a bottle of synthetic pee and mingle the contents together, the urine spoils rapidly.

Keep the package in a cold, dark area for maximum shelf life. It will spoil if left out in the sun for too long.

Sure, the brand of synthetic urine you buy does make a difference. Synthetic urine is becoming more popular as people seek legal alternatives to marijuana.

However, there are several con artists and low-quality or phony synthetic urine items available, and we will not know which ones they are until we put them to the test.

You should read up on the history of each manufacturer and choose dependable items based on your findings.

Certain synthetic urines you can freeze and then use later, while others do not need to be frozen. You can use them for up to 2 years without losing their potency. Make inquiries with your products maker.

Yes, powdered pee is effective. Regarded as unquestionable if it has every necessary component. Check to see that you have mixed it properly and is at the appropriate temperature before presenting it.

Cheating on a drug test is not unlawful under federal law, and many jurisdictions declare the procedure illegal, with penalties ranging from fines to jail. In South Carolina, for example, users and marketers of goods intended to deceive drug or alcohol tests face up to three years in jail.

In most workplaces, especially in the United States, employees take mandatory testing regularly. There are other methods for passing drug tests, such as going through detox and drinking a lot of water. However, using synthetic urine is unquestionably the most dependable and efficient method.

No assurance doing so would help you pass a drug test; at most, it will just increase your chances. Additionally, we must highlight the risks. If you are detected using synthetic urine, you will probably have your contract terminated. Moreover, depending on the state, you may even face legal action. As a result, you do so at your peril if you use synthetic urine.

While its possible to pass a drug test using synthetic urine, modern drug testing facilities have developed advanced tools to detect such fraud. The ability of modern laboratories to determine whether or not human pee is the source of the sample is a significant step forward in the fight against fake urine.

Therefore, you should get a sophisticated synthetic urine kit to be effective. Everything you want to know about synthetic pee is here in this post. Its important to know how to choose the finest brands. You should also know how to identify low-quality items, and how laboratories can distinguish between synthetic and genuine pee. Lastly, if you opt to choose this method to pass your test, you might want to practice ahead using cheap kits.

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What Is Synthetic Urine & How Does It Help To Pass A Drug Test? - The Island Now

Padmaja Ruparel, Founder, BioAngels explains Kalyani Sharma that it is not easy to invest in startups! What is important is each investors understanding of the domain/science. Some investors understand execution/tech enablement better and others understand the science behind certain healthtech spaces. However, what we have tried to do with Bioangels is to try and make it easier for all investors by bringing in domain experts to diligence AND explain the application of the science behind the proposition

Tell us about BioAngels?

BioAngels is a unique partnership between BIRAC, an enterprise of the Department of Biotechnology, and IAN, Indias single largest horizontal platform for seed and early-stage investing. It is focused on supporting biotech, medtech, healthtech, pharma, agritech & cleantech startups to raise their angel round from angel investors who bring deep domain expertise.

BioAngels brings money, mentoring, and market access, echoing IANs genetics. It aims to fuel the ecosystem through interactions with high-quality investors and industry leaders, whilst emphasising on strong operational focus, frameworks, processes, and governance. The inclusive group of ecosystem stakeholders at BioAngels comprises HNIs, angel investors, family offices, strategic investors, corporates, and VCs.

As the pandemic wanes, are VCs or investors investing less in healthcare-focused startups?

The pandemic has brought a huge focus on healthcare. It has brought focus on several aspects of healthcare:

What are the trends driving the growth for healthtech startups?

The world has not yet seen the end of the pandemic as different variants emerge regularly. In addition, the world is seeing monkeypox. This has really seen the growth of the market for vaccines and the resultant growth in business for vaccine companies. It has also meant a constant focus on R&D to evolve new vaccines.

As Dr Devi Shetty shared, 80 per cent of hospital capacities are set to move to IPD. This would imply that the market for OPD has moved home which drives the growth for smart, easy to use and non-expensive devices for the large consumer market, consultation which can be delivered over a call/video call creating a new delivery and revenue model for doctors, the growth of small doctor clinics as OPDs of large hospitals downsize, etc. Further the pandemic has also put a sharp focus on staying well which has created a much larger market for the wellness market be it preventive medicine, fitness, alternative medicine, nutrition, precision medicine, etc.

What are the key points before investing in healthtech startups?

The science/tech behind the healthtech startup must be understood well. Hence, investors may need domain experts to diligence and then explain why the proposition would work. This is a key element which is a difficult one to ensure and hence, IAN in partnership with BIRAC, has launched BioAngels which brings domain expertise to help diligence the entrepreneurial propositions. This is one of a kind and enables investors from the non healthtech/biotech /pharma space to also invest in startups from these sectors. It is important to not overlook these sectors from an investment perspective, as these have the potential to provide very high returns to investors.

The second point which is key to figure out before investing is whether the startups are going to build revenues or just focus on building a portfolio of IP. Both kinds of startups are good investment propositions but will need different kinds of diligence and gestation periods. For instance, companies building IP will not necessarily focus on revenues but as they succeed in building IP, they could become very valuable investments and the exit option for the investor would largely be enabled when the company is acquired. The founders and the team of IP-focused companies would largely be scientists or technologists. The revenue-earning startups would have shorter gestation and should have a mix of science/tech and business team members. Today we are seeing startups in precision medicine: this is very interesting as this brings in the convergence of science, data analytics, and business. Precision medicine will be widely used as it can help both preventive and curative medicine.

The third point which is important is to figure out whether the startup is focused on curative or preventive medicine. Curative medicine will be a much more need based proposition than preventive, though the latter could potentially have a much larger market but may need a change in consumer behaviour.

And finally, the most important diligence points are whether:

Is it tough or easier for you to invest in healthtech startups as compare to others sector based startups? Is healthtech profitable for you to invest?

It is not easy to invest in startups! What is important is each investors understanding of the domain/science. Some investors understand execution/tech enablement better and others understand the science behind certain healthtech spaces. However, what we have tried to do with Bioangels is to try and make it easier for all investors by bringing in domain experts to diligence AND explain the application of the science behind the proposition. It is a unique model which has been architected for investors to explore investing in high-risk but high-reward propositions.

Yes, for us, this sector has been profitable.

Name a few healthtech startups you invested in so far?

Some of the companies we have invested are: NOCCARC, Pandorum Technologies, Truemeds, Ahammune, Nayam, Consure Medical, Transcell Biologics, Mimyk, Cora Health, Yostra Labs, Vitas Pharma, Agatsa etc.

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The science behind the healthtech startup must be understood well - Express Healthcare

A critical second-line HIV treatment called darunavir/ritonavir (DRV/r) is rolling out across Nigeria and Zambia some of the earliest adopters of many countries that can now access an affordable supply of these medicines following a pricing agreement secured by CHAI and Unitaid last year. The agreement with generic manufacturer Hetero Labs has put this best-in-class treatment commonly used in high-income markets within reach of people living with HIV in low- and middle-income countries for the first time at a cost of US$17.50 per pack. A catalytic procurement is now bringing supplies to these two countries to increase demand and encourage uptake of the product across the region.

This builds on Unitaid and CHAIs long history of negotiating breakthrough pricing agreements with HIV treatment manufacturers to expand access to quality medicines in low- and middle-income countries. Most recently, pricing deals for TLD a combination single-pill HIV treatment and pediatric dolutegravir (DTG) have changed the HIV treatment landscape around the world and expanded access to the highest-quality, most effective medicines for tens of millions of people living with HIV.

As DRV/r makes its way into national treatment programs and into the hands of people living with HIV, here are four things you should know about this drug.

Darunavir was first approved by the United States Food and Drug Administration in 2006. Although a few generic versions have been approved since then, none have been formulated as a convenient fixed-dose combination or been available at a competitive price until now. This represents a 15-year equity gap in access to optimal HIV medication between people living in high-income and low- and middle-income countries. With the introduction of DRV/r (400/50 mg) into national treatment programs in low- and middle-income countries in 2022, this gap is beginning to close, but much work remains to ensure that all people needing DRV/r can access it.

Children living with HIV are a key group still without access to DRV/r, and since September 2021 Unitaid and CHAI have been working with Laurus Labs to accelerate development of pediatric DRV/r to ensure that children who are unable to take DTG have a high-quality alternative treatment option.

The World Health Organization (WHO) recommends DTG-based regimens as the preferred first- and second-line HIV treatment option given superior clinical efficacy, convenience, and low cost. However, DTG-based regimens dont work for everyone although they are very well-tolerated. People living with HIV need a high-quality alternative when DTG fails or has unwanted side effects.

Darunavir belongs to the class of drugs called protease inhibitors, which are commonly used in low- and-middle-income countries for second-line therapy. Lopinavir/ritonavir (LPV/r) and atazanavir/ritonavir (ATV/r) are the two most common protease inhibitors used in low- and middle-income countries today. However, DRV/r has numerous benefits over these medicines including being more efficacious than LPV/r and more tolerable than both LPV/r and ATV/r. DRV/r is also less expensive than LPV/r and requires a patient to take fewer daily pills.

WHO currently lists DRV/r as an alternative second-line treatment option. This is due to the historical lack of an affordable fixed-dose combination and not due to the relative efficacy of the medicine.

At the end of 2021, community advocates with AfroCAB released a position statement calling on WHO, national governments, and global procurement agencies to take several actions to expand access to DRV/r, including updating WHO and national guidelines to list DRV/r as the preferred second-line therapy and for national governments to begin introducing DRV/r into treatment programs.

We call on the WHO to immediately update its guidelines to include DRV/r as the preferred protease inhibitor for use in second-line. While DRV/r is listed as an alternative second-line regimen, its significant clinical benefits and recent availability at a dramatically reduced price mandate its use as the preferred second-line protease inhibitor.

AfroCAB Community Position Statement on DRV/r 2L Access (December 2021)

With a fixed-dose combination now available and affordable, and communities calling for access, advocates expect WHO to revise guidelines to promote DRV/r as the preferred option for people needing a protease inhibitor.

Zambia and Nigeria are some of the first countries in sub-Saharan Africa to roll out DRV/r to people experiencing treatment failure on DTG-based regimens. With funding from Unitaid, CHAI has procured catalytic amounts of DRV/r so national treatment programs and clinicians can gain experience using this product. Initial data and learnings from introduction in these countries, including healthcare worker experiences and patient satisfaction, are being collected and will be shared later in 2022.

PEPFAR has also signaled strong support for the introduction of DRV/r into treatment programs, issuing supportive language in their 2022 COP guidance. This states that, In the rare instances in which a patient cannot take TLD because of failure or intolerance, a regimen with DRVr is preferred, provided DRVr is reliably available at an affordable price.

CHAIs HIV New Product Introduction Toolkit hosts multiple resources for programs that are interested in introducing DRV/r. These include adoption-focused resources such as a product profile and clinical action memo, implementation-focused resources such as healthcare worker training slides and a prescribing algorithm, and community resources such as a frequently asked questions document.

Because of darunavirs previously high cost and high pill burden, it has historically been saved for use as a third-line HIV treatment. However, this new, affordable fixed-dose combination of DRV/r (400/50 mg) can conveniently be taken as two pills once per day and has been designed specifically for use in second-line treatment.

The ease, efficacy, and tolerability of DRV/r make it an optimal second-line treatment that could potentially reduce the number of people experiencing treatment failure. This could limit the need for third-line medicines, which are often expensive and challenging to source. Because darunavir is such a potent molecule it can often be reused in third-line treatment at a higher dose, so its use in second-line does not necessarily preclude its use in third-line. Finally, several other third-line options aside from darunavir are available, including etravirine, doravirine, dose-adjusted DTG, and other pipeline products.

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Best-in-class second-line HIV treatment rolls out in Zambia and Nigeria - Clinton Health Access Initiative

Introduction

Chronic obstructive pulmonary disease (COPD) is a common chronic disease characterized by persistent airflow limitation.1 Over the past few decades, the morbidity and mortality of COPD has increased exponentially, affecting the global About 384 million people, it is now considered the third leading cause of death globally.2 Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is defined as an acute worsening of respiratory symptoms that require additional treatment, with significant negative impact on health status, hospitalization, readmission, disease progression, and mortality. It not only seriously affects the quality of life of patients, but also imposes a heavy economic burden on families, medical systems and society.3,4

Non-invasive ventilation (NIV) is the preferred initial mode of ventilator assistance for patients with acute hypercapnic breathing failure caused by AECOPD.5,6 Compared with invasive mechanical ventilation (IMV), AECOPD patients treated with NIV has lower in-hospital mortality, shorter hospital stay and lower cost.7,8 With the development of medicine, invasive-noninvasive sequential ventilation strategy has become an effective way to wean off invasive mechanical ventilation in patients with AECOPD. And it has significantly reduced weaning-related mortality, pneumonia and ventilation time.9

High Flow Nasal Cannula (HFNC) is a new type of non-invasive breathing assistance method that can improve ventilation and oxygen by providing precise oxygen concentration heated and humidified oxygen, better tolerance and comfort than NIV.10 It may reduce the volume of dead space and increase the alveolar volume, which can result in improvement of alveolar ventilation and gas exchange.11 For COPD patients with type II respiratory failure and pH between 7.25 and 7.35, HFNC was statistically non-inferior to NIV as initial ventilatory support in decreasing PaCO2 after 2h of treatment in patients with mild-to-moderate AECOPD.12 A recent meta-analysis study showed that HFNC is more beneficial than NIV in the treatment of COPD and hypercapnic respiratory failure.13 However, in the process of weaning of AECOPD patients, the therapeutic effect of HFNC and whether it can be used as an alternative therapy for NIV is still unclear. Therefore, in this study, the method of meta-analysis was used to analyze the therapeutic effect of HFNC and NIV in patients with AECOPD after extubation, in order to provide evidence-based basis for clinical practice.

This systematic review and meta-analysis was registered at PROSPERO (http://www.crd.york.ac.uk/prospero, CRD:42022312973) and designed as per the Cochrane Handbook for Systematic Reviews of Interventions14 and reported according to the PRISMA guidelines.15

Retrieval database: PubMed, Web of science, Embase, Cochrane Library database. Retrieval database date is from establishment to March 10, 2022. Retrieval combines subject headings and free words: Pulmonary Disease, Chronic Obstructive, High-Flow Nasal Cannula OR HFNC OR High-Flow Oxygen Therapy OR High-Flow nasal oxygen OR High nasal flow OR High-Flow nasal cannula oxygen therapy OR High-Flow oxygen, Noninvasive ventilation. For detailed search strategies, see in Supplementary Data S1.

Inclusion criteria were as follows:(1) adults 18 years old,(2) Patients who meet the diagnostic criteria of COPD, have acute exacerbation and receive invasive intubation,(3) comparison of the effects of HFNC and NIV as the key study objective,(4) RCT study design,(5) at least one data outcome of interest available for extraction,(6) Chinese and English literature. Exclusion criteria are:(1) patients under the age of 18,(2) non-RCT studies,(3) data are incomplete or cannot be extracted,(4) full text is not available.

Our purpose is to evaluate the effect of HFNC and NIV on the prognosis of AECOPD patients after extubation, Therefore, the primary outcome indicator we selected is: reintubation rate. Secondary outcomes included: mortality, complication rate, and ICU length of stay, respiratory rate(RR), heart rate(HR), pH, oxygenation index (PaO2/FiO2), and partial pressure of carbon dioxide (PaCO2).

Literature screening we imported the retrieved literature into the ENDNOTE software, and two researchers independently reviewed each retrieved document, according to the inclusion and exclusion criteria, preliminary screening of the documents by reading the title and abstract, and then preliminary screening by reading the full text. Filter the file for further filtering. For trials that met the inclusion criteria, we extracted basic information from the articles, such as the first authors last name, year of publication, participant type, sample size, intervention, control and outcome. As for quality assessment, the quality of RCTs was assessed using the Cochrane risk of bias tool, including assessment of random sequence generation, allocation concealment, patient and intervention blinding, outcome measurer blinded, incomplete outcome data, selective reporting, and other potential biases. Each item was rated as low risk,high risk or unclear, and the evaluation was conducted independently by two authors. Disagreements were resolved through arbitration by discussion and consultation with a third author.

As for statistical analysis, all analyses were performed using STATA SE 15.1, binary variables were represented by risks ratio (RR), and continuous variables were represented by mean difference (MD) or standardized mean difference (SMD), and each effect size was represented by 95% confidence interval (CI). The heterogeneity among the results of the included studies was analyzed by the I2 test. P<0.05 was considered to be statistically significant. When the heterogeneity test P 0.05 and I2<50%, multiple similar studies were considered to have homogeneity. If P<0.05 and I2 50%, a random-effects model was used. If multiple time points were reported for the outcome measure, we selected the common time point included in most experiments. Mean and SD values were estimated when outcome measures were reported as interquartile range and median range (or 95% confidence interval). The Engauge Digitizer (version 4.1) graphical data extraction software was used to extract data that were only provided by images. Funnel plots and Egger tests were not used to assess potential publication bias because the number of studies performed for quantitative analysis was <10, in which case funnel plots and Egger tests could produce misleading results.16 Sensitivity analysis was performed on the necessary outcome indicators to determine the stability of the results.

We performed a subgroup analysis based on baseline PaCO2 levels. We believe that the average PaCO2 50 mmHg at the beginning of the trial or patients with type II respiratory failure were included in the study has hypercapnia, while the lower baseline PaCO2< 50 mmHg at the beginning of the trial has no hypercapnia.

A total of 710 relevant studies were initially detected, and after reading the literature titles and abstracts, they were screened according to the inclusion and exclusion criteria, and 8 qualified clinical studies were finally included,1724 a total of 612 subjects. There were 297 subjects in the HFNC group and 315 subjects in the NIV group. The screening process is shown in Figure 1, and the basic characteristics of the included studies are shown in Table 1.

Table 1 Characteristics of Included Studies

Figure 1 PRISMA (preferred reporting items for systematic reviews and meta-analysis) flow diagram.

Notes: Page MJ, Moher D, Bossuyt PM, et al. PRISMA 2020 explanation and elaboration: updated guidance and exemplars for reporting systematic reviews. BMJ. 2021;372:160. Creative Commons.15

In the 8 RCT studies included,4 were in Chinese17,18,20,23 and 4 were in English.19,21,22,24 8 studies explicitly mentioned the method of generating random sequences, among which there are 4 items that mention allocation hiding. Due to differences in oxygen therapy equipment, it was difficult to blind study patients and interventionists. No other risk of bias was found in all findings. Details are shown in Supplementary Figure S2.

All of the eight studies1724 reported the effect of HFNC on the reintubation rate of AECOPD patients after extubation, there are six studies1720,22,24 observed reintubation rate within 3 days and two studies21,23 observed within 7 days (Figure 2), the heterogeneity test result was I2=27.7%, P=0.207, using a fixed effect model, the results showed RR (1.49 [95% CI,0.95 to 2.33], P=0.082), the difference was not statistically significant. Subgroup analysis was performed according to whether the included population was accompanied by hypercapnia. In the hypercapnia group, the heterogeneity test result was I2=0.00%, P=0.602, and the results showed RR (0.69 [95% CI,0.33 to 1.44], P=0.317), the difference was not statistically significant. It shows that compared with NIV, HFNC has no statistical difference in the reintubation rate of patients with AECOPD, and the two treatment effects are equivalent. In the non-hypercapnia group, the heterogeneity test result was I2=0.00%, P=0.420, the results showed RR (2.61 [95% CI,1.41 to 4.83], P=0.002), the difference was statistically significant, indicating that the reintubation rate of the HFNC group was higher, and the treatment effect was not as good as that of the NIV group.

Figure 2 Forest plot of reintubation rates, subgroup analysis was performed according to variable of hypercapnia and non-hypercapnia.

Seven studies1721,23,24 reported the effect of HFNC on the mortality of AECOPD patients after extubation, four17,19,20,24 of them reported 28 day mortality and three18,21,23 of them reported mortality during hospitalization (Figure 3), the test result of the heterogeneity was I2=0.0%, P=0.939, using a fixed effect model, the results showed RR (0.92 [95% CI,0.56 to 1.52] P=0.752), the difference was not statistically significant. In subgroup analysis, with hypercapnia RR (1.09 [95% CI,0.55 to 2.14], P = 0.813), the difference was not statistically significant, without hypercapnia RR (0.77 [95% CI,0.37 to 1.61], P = 0.492), the difference was not statistically significant. It showed that there was no statistical difference between HFNC and NIV on the mortality of AECOPD patients regardless of whether it was accompanied by hypercapnia.

Figure 3 Forest plot of mortality, subgroup analysis was performed according to variable of hypercapnia and non-hypercapnia.

Six studies1719,21,23,24 reported the effect of HFNC and NIV on the ICU length of stay in days in patients with AECOPD after extubation (Figure 4), the heterogeneity test result was I2=87.4%, P= 0.00, using a random effects model, the results showed that MD (0.44 [95% CI,-1.01 to 0.13], P=0.132), the difference was not statistically significant. In subgroup analysis, there was no statistically significant difference in MD with hypercapnia (0.23 [95% CI,-0.51 to 0.05], P = 0.102), and without hypercapnia (0.74 [95% CI,-2.16 to 0.69], P = 0.313).

Figure 4 Forest plot of ICU length of stay, subgroup analysis was performed according to variable of hypercapnia and non-hypercapnia.

Six studies1719,2224 reported the effect of HFNC and NIV on the complication rate of AECOPD patients after extubation, Complications mainly include nasal facial skin breakdown and aspiration and flatulence during the treatment, no serious adverse events were reported (Figure 5), the heterogeneity test result was I2=1.9%, P =0.404, using a fixed effect model, the results showed RR (0.22 [95% CI,0.13 to 0.39], P=0.00), the difference was statistically significant. In subgroup analysis, with hypercapnia RR (0.24 [95% CI,0.13 to 0.43], P = 0.000)was statistically significant, and non hypercapnia RR (0.18 [95% CI,0.04 to 0.75], P = 0.018), the difference was statistically significant. Compared with NIV, it indicated that HFNC could significantly reduce the complications of post-extubation patients.

Figure 5 Forest plot of complication rates, subgroup analysis was performed according to variable of hypercapnia and non-hypercapnia.

The following data of all outcome indicators are selected from all studies with a total time of 24 hours. Seven studies1720,2224 reported the effect of HFNC and NIV on PaCO2 in patients with AECOPD after extubation. The results of heterogeneity test were I2=91.1%, P=0.00, using Random effects model, the results showed that MD (0.19 [95% CI,-0.84 to 0.45], P=0.561), the difference was not statistically significant. In subgroup analysis, there was no significant difference in MD (0.37 [95% CI,-1.21 to 0.46], P=0.378) with hypercapnia, and MD (0.28 [95% CI,-0.14 to 0.70], P=0.186) without hypercapnia. Four studies18,19,23,24 reported the effect of HFNC and NIV on the heart rate of AECOPD patients after extubation. The results of the heterogeneity test were I2=69.2%, P=0.021, using a random effect model, the results showed that MD (0.38 [95% CI,-0.85 to 0.09], P=0.115), the difference was not statistically significant. In subgroup analysis, there was no significant difference in MD (0.42 [95% CI,-1.05 to 0.21], P=0.191)with hypercapnia, without hypercapnia MD (0.24 [95% CI,-0.83 to 0.36], P=0.435), the difference was not statistically significant. Five studies18,19,2224 reported the effect of HFNC and NIV on the respiratory rate of AECOPD patients after extubation. The results of heterogeneity test were I2=20%, P=0.288, using a fixed effect model, the results showed that MD (0.51 [95% CI,-0.73 to 0.30], P=0.000), the difference was statistically significant. Subgroup analysis was performed, with hypercapnia MD (0.58 (95% CI,-0.81 to 0.35), P=0.000), the difference was statistically significant, without hypercapnia MD (0.07 [95% CI,-0.67 to 0.52], P=0.807), the difference was not statistically significant. It indicated that HFNC significantly reduced the respiratory rate in AECOPD patients with hypercapnia, but in AECOPD patients without hypercapnia, the difference was not statistically significant and the treatment effect is equivalent. Four studies18,19,23,24 reported the effect of HFNC and NIV on the acid-base balance of patients with AECOPD after extubation. The results of the heterogeneity test were I2=81.7%, P=0.001, using a random effect model, the results showed that MD (0.37 [95% CI,-0.25 to 0.98], P=0.24), the difference was not statistically significant. Subgroup analysis was performed, with hypercapnia MD (0.52 [95% CI,-0.26 to 1.30], P=0.191), the difference was not statistically significant, without hypercapnia MD (0.10 [95% CI,-0.69 to 0.49], P=0.739), the difference was not statistically significant. Five studies1719,22,24 reported the effect of HFNC and NIV on PaO2/FiO2 in patients with AECOPD after extubation. The results of heterogeneity test were I2=71.0%, P=0.008, using random effects model, the results showed MD (0.14 [95% CI,-0.27 to 0.54], P=0.514), the difference was not statistically significant. Subgroup analysis was performed, with hypercapnia MD (0.30 [95% CI,-0.05 to 0.64], P=0.093), the difference was not statistically significant, without hypercapnia MD (0.55 [95% CI,-1.15 to 0.05], P=0.070), the difference was not statistically significant. (See in Table 2, Supplementary Figure S3 for detailed forest diagrams.)

Table 2 Other Outcome Measures

We performed subgroup analyses for all outcomes, most of which showed good homogeneity, and we performed sensitivity analyses for outcomes with higher heterogeneity, sensitivity analysis was performed to exclude studies one by one, all the results remained unchanged (see in Supplementary Figure S4).

Mechanical ventilation is widely used in the treatment of respiratory failure caused by various reasons, and is of great significance in the clinical treatment of chronic obstructive pulmonary disease. The difficulty of weaning patients with acute exacerbation of chronic obstructive pulmonary disease is one of the important clinical problems, The reasons were ventilator fatigue and worsening respiratory mechanics.25 NIV can supply stable high-concentration oxygen, relaunched alveoli, improve gas exchange, and reduce intubation and mortality in patients with respiratory failure, especially those with exacerbated chronic obstructive pulmonary disease. However, NIV can lead to many complications, such as skin damage, eye irritation, claustrophobia, dryness of the oropharynx, flatulence, aspiration and expectoration difficulties, and affects eating and communication, resulting in poor tolerance and comfort, and extremely greatly limit its clinical application.26,27 HFNC can provide high-flow gas to patients, and HFNC can generate positive airway pressure, increase functional residual capacity, improve oxygenation,28 and allow patients to receive a constant oxygen concentration.29 Heated and humidified gas can promote airway secretions It can clear the airway, protect airway epithelial cells, and reduce the discomfort of patients.30

In this study, we mainly compared the reintubation rate of HFNC and NIV in the post-extubation treatment of AECOPD patients, this is different from previous systematic reviews, even the seven included studies were in the last 3 years. The results of reintubation rate showed that there was no statistical difference between them, Subgroup analysis was conducted between hypercapnia and non-hypercapnia, and the results showed that there was no significant difference in patients with hypercapnia, but in patients without hypercapnia, the reintubation rate in HFNC group was significantly higher than the NIV group, This result suggests that the effect of HFNC in AECOPD patients with hypercapnia is similar to NIV, which may be related to the reduction of respiratory muscle load and respiratory overwork by both of them, which is consistent with the results of previous studies.12,31,32 It can be used as an alternative treatment for NIV after extubation in AECOPD patients with hypercapnia, and has certain advantages, but in AECOPD patients without hypercapnia, the treatment effect of HFNC is not as good as NIV, It may be related to the lower respiratory pressure provided by HFNC than NIV. Although all included studies have given the judgment criteria for failure of HFNC or NIV treatment, mainly focusing on the patients respiratory rate, blood gas analysis, consciousness status and clinicians decision-making, the judgment criteria are different, and there are risks of delayed intubation and increased complications. In future studies, if an effective standard, such as Rox or mrox or hacor3336 can be used, the results will be more reliable.

In the analysis of complication rates, HFNC was significantly lower than NIV, and there was no change in the results of subgroup analysis, which may be related to NIV and the intolerance to the interface and poor patientventilator interaction and Synchronization.37,38 In the analysis of respiratory rate, compared with NIV, HFNC can reduce the respiratory rate of patients with AECOPD after extubation, and the subgroup analysis results suggest that HFNC has a strong effect on reducing respiratory rate in AECOPD with hypercapnia, in AECOPD patients without hypercapnia, its performance was not statistically different from NIV. The reason for the analysis may be that the long-term airflow limitation in AECOPD patients will lead to increased diaphragm load, resulting in diaphragm injury and diaphragm fatigue, which is not conducive to Patient breathing.39 HFNC can provide heated and humidified oxygen, sufficient oxygen flow and positive end-expiratory pressure, which can limit the inflammatory response and bronchial epithelial cell damage, reduce the bodys hyperresponsiveness or irritation, promote the improvement of the airway, and effectively flush the airway, promote the recovery of respiratory ciliary function, effectively remove excess carbon dioxide in the body, promote pulmonary gas exchange, improve oxygen utilization, improve patient ventilation function, and reduce respiratory power consumption, thereby helping to improve diaphragm fatigue and reduce diaphragm damage.4043 In the analysis of mortality, ICU length of stay, PaCO2, pH, HR, PaO2/FiO2, there was no statistical difference between HFNC and NIV, showing the treatment effect is equivalent.

Recent studies have shown that compared with HFNC alone, extubation Immediately applied HFNC plus NIV significantly reduced the risk of reintubation and post-extubation respiratory failure in patients at high risk of extubation failure.44 The result may provide further insight into the choice of respiratory support methods after extubation, and provide a possibility for the combined and alternate application of HFNC and NIV in the future.

In general, According to the available evidence, the application of HFNC can be used as a treatment option for AECOPD patients with hypercapnia. It has certain advantages as an alternative to NIV after extubation, but in AECOPD patients without hypercapnia, HFNC is not as effective as NIV, the result needs further evaluation.

The limitations of this study are as follows: firstly, the number of included studies is relatively small, with a total of 8 articles involving 612 subjects (297 in the HFNC group and 315 in the NIV group). secondly, the quality of the included studies is generally not high. Because of differences in oxygen therapy equipment, it is difficult to blind study patients and interventionists, which may affect the estimation of outcome measures. Thirdly, all included studies have given the judgment criteria for failure of HFNC or NIV treatment are different, may affect the results. Fourthly, a total of 8 studies included, seven of which are from China, may have regional differences and cannot be used as evidence of globalization. High-quality, multi-center RCT studies worldwide are still needed to further evaluate the effect of HFNC in patients after extubation of AECOPD. In conclusion, the results of the study should be interpreted with caution.

According to the Meta-analysis results of the existing evidence, the application of HFNC can be used as an alternative treatment for NIV after extubation in AECOPD patients with hypercapnia, and there are certain advantages, but whether HFNC can be used as an alternative treatment for NIV in AECOPD patients without hypercapnia after extubation still needs to be further studied. In the future, more high-quality, multicenter RCT studies are still needed to further verify the effect of HFNC in patients after extubation of AECOPD.

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All authors have made significant contributions to the work of the report, whether in terms of concept, research design, implementation, data acquisition, analysis and interpretation, or in all these areas; Participate in the drafting, modification or critical review of the clause; Final approval of the forthcoming edition; An agreement has been reached on the journal to submit the article; And agree to be responsible for all aspects of the work.

There is no funding to report.

The authors report no conflicts of interest in this work.

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