학술논문
Use of high flow nasal cannula in patients with acute respiratory failure in general wards under intensivists supervision: a single center observational study
Document Type
Original Paper
Author
Colombo, Sebastiano Maria; Scaravilli, Vittorio; Cortegiani, Andrea; Corcione, Nadia; Guzzardella, Amedeo; Baldini, Luca; Cassinotti, Elisa; Canetta, Ciro; Carugo, Stefano; Hu, Cinzia; Fracanzani, Anna Ludovica; Furlan, Ludovico; Paleari, Maria Chiara; Galazzi, Alessandro; Tagliabue, Paola; Peyvandi, Flora; Blasi, Francesco; Grasselli, Giacomo
Source
Respiratory Research. 23(1)
Subject
Language
English
ISSN
1465-993X
Abstract
Background: Few data exist on high flow nasal cannula (HFNC) use in patients with acute respiratory failure (ARF) admitted to general wards.Rationale and objectives: To retrospectively evaluate feasibility and safety of HFNC in general wards under the intensivist-supervision and after specific training.Methods: Patients with ARF (dyspnea, respiratory rate-RR > 25/min, 150 < PaO2 /FiO2 < 300 mmHg during oxygen therapy) admitted to nine wards of an academic hospital were included. Gas-exchange, RR, and comfort were assessed before HFNC and after 2 and 24 h of application.Results: 150 patients (81 male, age 74 [60–80] years, SOFA 4 [2–4]), 123 with de-novo ARF underwent HFNC with flow 60 L/min [50–60], FiO2 50% [36–50] and temperature 34 °C [31–37]. HFNC was applied a total of 1399 days, with a median duration of 7 [3–11] days. No major adverse events or deaths were reported. HFNC did not affect gas exchange but reduced RR (25–22/min at 2–24 h, p < 0.001), and improved Dyspnea Borg Scale (3–1, p < 0.001) and comfort (3–4, p < 0.001) after 24 h. HFNC failed in 20 patients (19.2%): 3 (2.9%) for intolerance, 14 (13.4%) escalated to NIV/CPAP in the ward, 3 (2.9%) transferred to ICU. Among these, one continued HFNC, while the other 2 were intubated and they both died. Predictors of HFNC failure were higher Charlson’s Comorbidity Index (OR 1.29 [1.07–1.55]; p = 0.004), higher APACHE II Score (OR 1.59 [1.09–4.17]; p = 0.003), and cardiac failure as cause of ARF (OR 5.26 [1.36–20.46]; p = 0.02).Conclusion: In patients with mild-moderate ARF admitted to general wards, the use of HFNC after an initial training and daily supervision by intensivists was feasible and seemed safe. HFNC was effective in improving comfort, dyspnea, and respiratory rate without effects on gas exchanges.Trial registration This is a single-centre, noninterventional, retrospective analysis of clinical data.
Highlights: Few data exist about feasibility and safety of HFNC outside the ICU.This study retrospectively evaluates safety, feasibility and efficacy of HFNC used in general wards under intensivist-supervision and specific training courses.150 patients with mild-moderate ARF admitted to general wards were included.HFNC demonstrated to be feasible and potentially safe (no deaths or major adverse events in the wards were reported).HFNC was effective in improving comfort, dyspnea and RR without effects on gas exchange.Failure was recorded in 20 patients (19.2%): 14 escalations to CPAP/NIV and 3 transfers to ICU.
Highlights: Few data exist about feasibility and safety of HFNC outside the ICU.This study retrospectively evaluates safety, feasibility and efficacy of HFNC used in general wards under intensivist-supervision and specific training courses.150 patients with mild-moderate ARF admitted to general wards were included.HFNC demonstrated to be feasible and potentially safe (no deaths or major adverse events in the wards were reported).HFNC was effective in improving comfort, dyspnea and RR without effects on gas exchange.Failure was recorded in 20 patients (19.2%): 14 escalations to CPAP/NIV and 3 transfers to ICU.