Efficacy of High-Flow Nasal Cannula Oxygen Therapy in Patients with Mild Hypercapnia

Abstract

Objectives To investigate the indications of high-flow nasal cannula (HFNC) oxygen therapy among patients with mild hypercapnia and to explore the predictors of intubation when HFNC fails. Methods This retrospective study was conducted based on the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. Adult patients with mild hypercapnia (45 < PaCO 2 ≤ 60 mmHg) received either HFNC or non-invasive ventilation (NIV) oxygen therapy. Propensity score matching (PSM) was implemented to increase between-group comparability. The Kaplan-Meier method was used to estimate overall survival and cumulative intubation rates, while 28-day mortality and 48-h and 28-day intubation rates were compared using the Chi-squared test. The predictive performances of HR/SpO 2 and the ROX index (the ratio of SpO 2 /FiO 2 to respiratory rate) at 4 h were assessed regarding HFNC failure, which was determined if intubation was given within 48 h after the initiation of oxygen therapy. The area under the receiver operating characteristic curve (AUC) for HR/SpO 2 and the ROX index were calculated and compared. Results A total of 524,520 inpatient hospitalization records were screened, 106 patients in HFNC group and 106 patients in NIV group were successfully matched. No significant difference in 48-h intubation rate between the HFNC group (the treatment group) and the NIV group (the control group) (14.2% vs. 8.5%, p = 0.278); patients receiving HFNC had higher 28-day intubation rate (26.4% vs. 14.2%, p = 0.029), higher 28-day mortality (17.9% vs. 8.5%, p = 0.043), and longer ICU length of stay (4.4 vs. 3.3 days, p = 0.019), compared to those of NIV group. The AUC of HR/SpO 2 at 4 h after the initiation of HFNC yielded around 0.660 for predicting 48-h intubation, greater than that of the ROX index with an AUC of 0.589 (p < 0.01). Conclusion Patients with impending respiratory failure had lower intubation rate, shorter ICU length of stay, and lower mortality when treated mild hypercapnia with NIV over HFNC. As opposed to the ROX index, a modest, yet improved predictive performance is demonstrated using HR/SpO 2 in predicting the failure of HFNC among these patients. Keywords High-flow nasal cannula • Hypercapnia • Non-invasive mechanical ventilation • MIMIC Abbreviations HFNC High-flow nasal cannula NIV Non-invasive ventilation MIMIC-

Cánula nasal de alto flujo en pacientes críticos: una revisión narrativa

“…En un estudio que evaluó el uso de CNAF frente a VNI para el tratamiento de la hipercapnia moderada, los autores no encontraron diferencias significativas en la tasa de IOT a las 48 h; pero al evaluarlo a los 28 días, los pacientes con CNAF presentaron valores más altos. 57 Asimismo, estos pacientes mostraron mayor mortalidad a los 28 días y mayor estancia en UCI. En un grupo similar, Nam et al 58 60 sin embargo, encontraron que la aplicación de CNAF a pacientes con EPOC reducía los valores de CO 2 transcutáneos y la FR, con un aumento en el flujo.…”

High-flow nasal cannula: Evaluation of the perceptions of various performance aspects among Chinese clinical staff and establishment of a multidimensional clinical evaluation system

“…For patients with COVID-19, it is important to consider the effect of a high flow rate on the inhaled oxygen concentration and the increased risk of aerosol transmission (26). In addition, the risk of HFNC failure should be considered and addressed in patients with different respiratory conditions (20,29,30). Notably, there remain few hospitals with RTs.…”

Utilización de cánula nasal de alto flujo en insuficiencia respiratoria aguda hipoxémica por COVID-19: estudio cuasi-experimental retrospectivo controlado

“…Recientemente, un estudio que incluyó 106 patients emparejados, evaluó el empleo de CNAF vs VNI para el tratamiento de la hypercapnia moderada (66). Los autores no encontraron diferencias significativas en la tasa de IOT a las 48h ( mientras que la atención para cuidados de la interface fue menor en estos pacientes.…”

“…Se han reportado puntos de corte de este índice y diferentes momentos de evaluación, al día de hoy no existe consenso sobre el tiempo exacto en que se deba evaluar (86,87,48) Se ha propuesto el índice FC/SpO2 para predecir el fallo de CNAF y requerimiento de IOT a las 48 h, que demostró mayor precisión que el ROX index (ROC 0.660 vs 0.589 p < .01). Es de mencionar que los pacientes evaluados en este estudio presentaban hipercapnia moderada (66). La taquipnea sostenida ha sido asociada a la fatiga de los músculos respiratorios en pacientes críticos y posterior necesidad de IMV, por sí misma es un factor asociado al fallo de la terapia con CNAF en pacientes con COVID-19 (88) En la pandemia COVID-19 surgió una propuesta clínica para determinar el riesgo de intubación en pacientes con CNAF, que evalúa clinicamente el trabajo respiratorio incluyendo la evaluaciión de los músculos inspiratorios y espiratorios junto con el aleteo nasal (89).…”