PURPOSE: Humidified High-Flow Nasal Cannula (HHFNC) oxygen therapy has gained increasing popularity in the recent years. Although HHFNC is used extensively in pediatric populations, experience in adult patients is limited. We sought to report our experience at a tertiary university hospital intensive care unit ICU.
METHODS: This is a retrospective cohort study. We included adult patients admitted to the ICU who were started on HHFNC. We excluded patients that used HHFNC outside the ICU. We collected relevant demographic,indication and gas exchange data.Primary outcome was median time to endotracheal intubation.Secondary outcomes were need for Non-Invasive ventilation and hospital and ICU mortality.
RESULTS: We reviewed charts of 10 patients (9 males and 1 female).Median age was 77.5. Median Body mass index was 28.7(range 17.1–85.2).Median PaO2 /FiO2 ratio was 144.3(range 70.2 -411.HHFNC was initiated for hypoxemia with increased work of breathing in all patients with a median flow rate of 30 L/minute. Non-Invasive ventilation was utilized in 7(70%) patients and endotracheal intubation was performed among 8(80%) patients.Median time to intubation was 14.75 hours (range 4–64). HHFNC therapy resulted in a trend toward higher oxygen saturation(93.57±4.1 versus 95.5 ±3.7;p=0.074). That was at the expense of significant increase in FIO2(0.52± 0.18 versus 0.85±0.25; p=0.008). ICU mortality was 40% and hospital mortality was 50%.
CONCLUSION: HHFNC appears to be a useful oxygen delivery device among critically ill hypoxemic patiens.Our early experience shows that HHFNC may have obviated the need for endotracheal intubation in 20% of our small cohort. This came at the expense of a significant increase in FIO2 and only marginal improvement in oxygen saturation.
CLINICAL IMPLICATIONS: HHFNC is exclusively used in pediatric critical care medicine. Usage has been gradually increasing in adult patients as we strive for tolerable and effective oxygen delivery devises.We are not certain to what extent this form of therapy can reduce mechanical ventilation rates; however our small study offers early insight into this area. Further and larger studies are necessary before HHFNC can be fully accepted in adult critical care medicine.
DISCLOSURE: Ramez Sunna, No Financial Disclosure Information; No Product/Research Disclosure Information