Effectiveness of high-flow nasal cannula oxygen therapy for acute respiratory failure with hypercapnia

Abstract

Background: Heated and humidified high-flow nasal cannula (HFNC) oxygen therapy has recently been introduced for hypoxic respiratory failure. However, it has not been well-evaluated for acute respiratory failure with hypercapnia. Methods: This retrospective study included acute respiratory failure patients with hypercapnia in the medical intensive care unit (MICU) from April 2011 to February 2013, who required HFNC oxygen therapy for hypoxemia. Respiratory parameters were recorded and arterial blood gas analyses conducted before, and at 1 and 24 h after initiation of HFNC oxygen therapy. Results: Thirty-three patients were studied [median age, 72 years; range, 17-85 years; men, 24 (72.7%)].Pneumonia (36.4%) and acute exacerbation of chronic obstructive pulmonary disease (33.4%) were the most common reasons for oxygen therapy. Most patients (60.6%) received oxygen therapy via nasal prong before HFNC application. The mean fraction of inspired oxygen (FiO 2 ) and HFNC flow rate were 0.45±0.2 and 41.1±7.1 L/min, respectively; mean duration of application was 3.6±4.1 days. The partial pressure of arterial carbon dioxide (PaCO 2 ) was 55.0±12.2 mmHg at admission, and increased by approximately 1.0±7.7 mmHg with conventional oxygen therapy. In contrast, with HFNC therapy, PaCO 2 decreased by 4.2±5.5 and 3.7±10.8 mmHg in 1 and 24 h, respectively, resulting in significant improvement in hypercapnia (P=0.006 and 0.062, respectively). Conclusions: HFNC oxygen therapy with sufficient FiO 2 to maintain a normal partial pressure of arterial oxygen (PaO 2 ) significantly reduced PaCO 2 in acute respiratory failure with hypercapnia.

Non‐invasive ventilation or high‐flow oxygen therapy: When to choose one over the other?

“…Results of this study suggest that HFOT could be an alternative option when NIV tolerance compromises continuation of treatment. A retrospective study including 33 COPD patients with hypoxaemia and hypercapnia showed that the application of HFOT after failure of standard oxygen, NIV or intolerance to NIV resulted in improvement of pCO 2 after 1 and 24 h of treatment initiation . In another observational study, Lee et al .…”

“…Indeed, previous studies showing potential benefits of HFOT in ARF did not include patients with hypercapnia. Up until now, only a few smaller studies and case reports with hypercapnic patients have been published. However, studies conducted in emergency departments comparing HFOT with standard oxygen or NIV included larger samples of patients with ARF of various causes and, especially, COPD exacerbation .…”

How to use humidified high‐flow nasal cannula in breathless adults in the emergency department

“…3,16 The utility of HHFNC in hypercapnic respiratory failure is still uncertain. 7,17 It is seen as a useful alternative in a patient who does not tolerate NIV. 3 What are the contraindications for HHFNC?…”

High Flow Nasal Therapy Use in Patients with Acute Exacerbation of COPD and Bronchiectasis: A Feasibility Study

“…Recently, some studies showed the beneficial effects of heated humidification therapy on mucociliary clearance and ventilation in patients with bronchiectasis [16,17] and COPD [18,19,20], both muco-obstructive diseases characterized by airway inflammation, mucus hypersecretion and impaired mucociliary transport [21]. Nevertheless, few data exist about the use of HFNT for the treatment of bronchiectasis and bronchiectasis-COPD exacerbations.…”