Use of High-Flow Nasal Cannula Oxygen Therapy in Subjects With ARDS: A 1-Year Observational Study

Abstract

BACKGROUND: Beneficial effects of high-flow nasal cannula (HFNC) oxygen on oxygenation and respiratory parameters have been reported in a small number of subjects with acute respiratory failure (ARF). We aimed to evaluate its effect in subjects with ARDS. METHODS: This was an observational single-center study. Prospectively obtained data were retrospectively analyzed. All patients admitted over 1 y to a university hospital medicosurgical ICU were included. Classification was according to the highest ventilatory support required. HFNC indications were reviewed, and demographics, clinical characteristics, and course of subjects with ARDS according to intubation need were compared. RESULTS: Of 607 subjects admitted, 560 required ventilatory or oxygen support, among whom 180 received noninvasive ventilatory support. HFNC was used in 87 subjects and as first-line treatment in 51 subjects (29% of first-line noninvasively treated subjects), 45 of which had ARDS (P aO 2 /F IO 2 of 137 mm Hg; 22 men, 57.9 y of age). Pneumonia accounted for 82% of ARDS causes. The intubation rate in these subjects was 40%. Higher Simplified Acute Physiology Score II (SAPS II; 46 vs 29, P ‫؍‬ .001), occurrence of additional organ failure (76% vs 26%, P ‫؍‬ .002), mainly hemodynamic (50% vs 7%, P ‫؍‬ .001) or neurological (22% vs 0, P ‫؍‬ .01), and trends toward lower P aO 2 /F IO 2 and higher breathing frequency after HFNC initiation were evidenced in subjects who failed HFNC. Higher SAPS II scores were associated with HFNC failure in multivariate analysis. CONCLUSIONS: In daily care, over one fourth of subjects requiring noninvasive ventilatory support were treated via HFNC, with a high success rate in subjects with severe ARDS. We conclude that HFNC may be considered as first-line therapy in ARF, including patients with ARDS.

High-Flow Nasal Cannula in a Mixed Adult ICU

“…16 Nevertheless, neither of these studies included HFNC, even though some literature has proposed that HFNC is equivalent or superior to standard NIV. 4,12 If HFNC performs similarly to, or even better than, standard NIV devices, HFNC therapy may have analogous benefits to medical and trauma patients who were found in the aforementioned studies using NIV.…”

“…[1][2][3][4][5][6][7][8][9][10][11][12] HFNC has been used successfully with medical ICU patients, as well as in postoperative cardiac and vascular populations. 3,6,[10][11][12][13][14][15] One study in the trauma literature supported use of early noninvasive ventilation (NIV) in blunt trauma, 16 but much work is yet to be done regarding use of HFNC in trauma populations.…”

Nasal high flow therapy: a novel treatment rather than a more expensive oxygen device

“…Moreover, therapy with NHF resulted in a significantly lower ICU and 90-day mortality, as compared with SOT or NIV, which was attributed to lower intubation rates among patients with severe hypoxaemia. Thereafter, it seems that NHF can be used in every stage of hypoxaemic ARF, even in patients with acute respiratory distress syndrome [27].…”

“…The parameters that need regular monitoring during this time frame and which have prognostic significance are the respiratory parameters listed earlier, as well as haemodynamic instability [23,27]. If the patient does not improve within 48 h, NHF treatment should be considered to have failed and we should proceed to intubation and invasive mechanical ventilation as soon as possible.…”

A Skeptical Perspective on High-Flow Nasal Cannula in the Treatment of Acute Hypoxemic Respiratory Failure

“…By employing a tight fitting mask or mask-like interface, noninvasive ventilation (NIV) overcomes these limitations and has been shown to improve outcomes in acute-on-chronic respiratory failure 1 or cardiogenic pulmonary edema (congestive heart failure), 2 albeit at the expense of comfort and patient compliance.…”