Impact of high-flow nasal cannula oxygen therapy on intensive care unit patients with acute respiratory failure: A prospective observational study☆,☆☆
Introduction
Oxygen supply constitutes the first-line therapy of patients with acute respiratory failure (ARF) [1]. It is generally provided via a facemask, nasal cannula, or nasals prongs. Oxygen flow through these devices is limited and generally no greater than 15 L/min. A certain degree of oxygen dilution (delivered oxygen is diluted with room air) may thus occur because of the difference between oxygen flow delivered by the device and patient's inspiratory flow [1], and for this reason, the greater the inspiratory flow, the greater the dilution. If this phenomenon may not impact too much on patients with mild hypoxemia, the situation may be different in more severe patients with more pronounced respiratory failure, bearing in mind that patient inspiratory flow rates may vary between 30 and more than 120 L/min during respiratory failure [2]. New devices now available deliver up to 60 L/min oxygen flow through wide bore nasal cannula. Given the high gas flows delivered by these devices, they are designed to heat and humidify the inspired gas; hence, the generic name of high-flow nasal cannula oxygen therapy (HFNC). If these devices are increasingly used with success in neonates [3], [4], [5], their beneficial effects in adults with respiratory failure are yet scarcely reported. A 30-minute evaluation showed an improvement in respiratory parameters in comparison with oxygen delivered via a facemask in intensive care unit (ICU) patients [6], and HFNC has been found to generate a certain level of positive pressure in healthy volunteers and in patients recovering from cardiac surgery. There are no data on a longer evaluation in the ICU. We, thus, aimed to investigate the effect of HFNC to alleviate respiratory distress and ameliorate oxygenation in adult ICU patients with ARF.
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Methods
A prospective, observational study was conducted in a university hospital 12-bed ICU to investigate the effects of HFNC of respiratory parameters of patients with ARF. The Ethics Committee of the French Society of Intensive Care Medicine (SRLF) approved the study and did not require informed consent because use of HFNC is part of our common practice in these patients. All procedures were routine. Patients and/or family were, however, informed of the study, its purpose, and objectives.
Results
Twenty patients were included in the study. Their baseline characteristics are detailed in Table 1. Ten were male, and the median age was 59 years (38-75 years). Their SAPS2 score was 33 (26.5-38), yielding a 16% risk of hospital mortality. Etiology of ARF was mainly community-acquired pneumonia (n = 11), sepsis (n = 3), and miscellaneous (n = 6). Median duration of ARF before inclusion was short, 2.25 (0.75-10) hours. Median oxygen flow was significantly greater during HFNC than during
Discussion
This study shows for the first time the beneficial effects of HFNC as first-line treatment for ICU patients with ARF. Its main results can be summarized as follows: (1) all respiratory parameters were improved after 1 hour of HFNC; (2) use of HFNC leads to a significant improvement in oxygenation; (3) HFNC was well tolerated for long periods with sustained benefits in patients who were not intubated. These results obtained in the “real life” of the management of ARF indicate that patients can
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