High‐flow nasal cannula oxygen therapy for acute respiratory failure in a non‐intensive geriatric setting

Fimognari, Filippo Luca; Rizzo, M.; Cuccurullo, Olga; Cristiano, Giovanna; Ricchio, Roberto; Ricci, Consalvo; Iorio, Claudio; Borrelli, Eugenio

doi:10.1111/ggi.13557

Cited by 3 publications

(2 citation statements)

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“…This study also provides an interesting insight into the issue of ARF in older patients. We observed that heart failure, sepsis and pneumonia were more frequent etiologies of ARF than acute exacerbation of COPD [1,18]. ARF may be an epiphenomenon of terminal illnesses -including degenerative cerebral diseases -and many patients had more than one underlying causes [1,18].…”

Section: Discussionmentioning

confidence: 86%

“…In conclusion, we observed that HFNC -used as escalation therapy for untreatable hypoxia during COT or NIV/CPAP -significantly increased arterial oxygenation without causing hypercapnia in ARF patients admitted to a geriatric non-intensive ward. HFNC is better tolerated than NIV, assures continuous ventilation without interruptions, does not compromise normal nutrition and oral hydration and allows patients to continue communicating with others, thereby reducing the risk of dehydration, malnutrition and delirium [3][4][5]18]. It should also be mentioned that, compared to NIV, HFNC decreased inspiratory effort in type 1 ARF, thus mitigating the risk of self-inflicted lung injury [5], and this may have contributed to the lower mortality observed during HFNC [4].…”

Section: Discussionmentioning

confidence: 99%

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Improved Arterial Oxygenation by High Flow Nasal Cannula Oxygen Therapy in Older Patients with Severe Respiratory Failure in a Non-intensive Hospital Ward

Fimognari¹,

Bambara²,

Armentaro³

et al. 2023

Preprint

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Background. There are scant data about the effectiveness of high flow nasal cannula (HFNC) oxygen therapy in patients hospitalized with severe acute respiratory failure (ARF) in non-intensive medical wards, particularly regarding the effect on arterial oxygenation compared to conventional oxygen therapy (COT) and non-invasive ventilation (NIV) or continuous positive airway pressure (CPAP). Methods. In a retrospective observational study, oxygenation parameters were measured before and immediately after HFNC initiation in 37 consecutive patients hospitalized in a geriatric ward in 2017. Results. HFNC was used as escalation therapy for untreatable hypoxia after failure of NIV/CPAP (n=18) or COT (n=19). Twenty-two patients died, 2 were transferred to the intensive care unit, while 13 were discharged alive. A “do not intubate” status was identified in 17 of the 22 deceased patients. Partial pressure of oxygen (pO2, p< 0.0001), oxygen saturation (SO2, p< 0.0001), pO2/fraction of inspired oxygen ratio (p=0.004) and peripheral SO2 measured by pulse oximetry (p< 0.0001) significantly increased soon after HFNC application. Oxygenation improvements were greater after escalation from NIV/CPAP and in patients discharged alive. Conclusion. HFNC significantly improved oxygenation in severe ARF after failure of COT or NIV/CPAP and may be particularly suitable for older patients hospitalized in non-intensive medical wards.

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