Hypoxemic respiratory failure: patients improve after high-flow nasal cannula

  • Macé J & al.
  • Am J Emerg Med
  • 5 Mar 2019

  • International Clinical Digest
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Takeaway

  • Patients with acute hypoxemic respiratory failure in the emergency department (ED) experienced more short-term symptom and respiratory improvement after high-flow nasal cannula oxygen therapy (HFNC) than after standard therapy. 
  • Randomized trial needed.

Why this matters

  • HFNC offers positive pressure in upper airway, positive end-expiratory pressure effect, and continuous washout of upper-airway dead space.
  • It is understudied in this population.

Key results

  • HFNC vs standard oxygen:
    • Improved respiratory status at hour 1: 61% (33/54 patients) vs 15% (7/48 patients; P<.001>
    • Oxygenation improvement by PaO2 of 31 (interquartile range, 0-67) mmHg vs 9 (9-36) mmHg 1 hour after treatment initiation (P=.02).
    • Dyspnea: 92% (44/48) vs 56% (20/36; P<.01>
  • PaCO2 did not change in either group.
  • Similar lengths of ED stay, ICU admissions, mortality.
  • Predictors of respiratory failure regression: HFNC, baseline respiratory rate.

Study design

  • 2-center prospective before-after study (n=102).
  • Participants presented to EDs in acute hypoxemic respiratory failure.
  • During first 6-month period, treatment was standard oxygen; in second 11-month period, it was HFNC.
  • Outcome: proportion with improved respiratory status 1 hour after treatment initiation (≤25 breaths/minute without increased effort).
  • Funding: None disclosed.

Limitations

  • Patients with cardiogenic pulmonary edema or chronic lung disease exacerbation were excluded.
  • Most patients had community-acquired pneumonia.

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