Yuste ME, Moreno O, Narbona S, Acosta F, Peñas L, Colmenero M. Efficacy and safety of high-flow nasal cannula oxygen therapy in moderate acute hypercapnic respiratory failure.
Rev Bras Ter Intensiva 2019;
31:156-163. [PMID:
31141082 PMCID:
PMC6649229 DOI:
10.5935/0103-507x.20190026]
[Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 02/02/2019] [Indexed: 01/26/2023] Open
Abstract
Objective
To assess the efficacy and safety of high-flow nasal cannula oxygen therapy
in treating moderate hypercapnic respiratory failure in patients who cannot
tolerate or have contraindications to noninvasive mechanical
ventilation.
Methods
A prospective observational 13-month study involving subjects admitted to an
intensive care unit with or developing moderate hypercapnic respiratory
failure. Clinical and gas exchange parameters were recorded at regular
intervals during the first 24 hours. The endpoints were a oxygen saturation
between 88 and 92% along with a reduction in breathing effort (respiratory
rate) and pH normalization (≥ 7.35). Subjects were considered
nonresponders if they required ventilatory support.
Results
Thirty subjects were treated with high-flow nasal cannula oxygen therapy.
They consisted of a mixed population with chronic obstructive pulmonary
disease exacerbation, acute cardiogenic pulmonary edema, and postoperative
and postextubation respiratory failure. A nonsignificant improvement was
observed in respiratory rate (28.0 ± 0.9 versus 24.3
± 1.5, p = 0.22), which was apparent in the first four hours of
treatment. The pH improved, although normal levels were only reached after
24 hours on high-flow nasal cannula therapy (7.28 ± 0.02
versus 7.37 ± 0.01, p = 0.02). The rate of
nonresponders was 13.3% (4 subjects), of whom one needed and accepted
noninvasive mechanical ventilation and three required intubation. Intensive
care unit mortality was 3.3% (1 subject), and a patient died after discharge
to the ward (hospital mortality of 6.6%).
Conclusion
High-flow nasal cannula oxygen therapy is effective for moderate hypercapnic
respiratory failure as it helps normalize clinical and gas exchange levels
with an acceptable rate of nonresponders who require ventilatory
support.
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