PURPOSE: Respiratory failure is a common complication in adult surgical ICU (SICU) patients –either as a primary problem or subsequent to ”failed“ extubation despite appropriate patient selection and assessment. Various techniques of non-invasive ventilation (NIV) have been proposed as bridges or alternatives to endotracheal intubation. Humidified high flow nasal oxygen (HFNO), which has been employed in pediatric and neonatal patients, may be useful in adults with respiratory failure.
METHODS: A retrospective review was performed of all patients managed with HFNO between November 2007 and April 2008. The SICU is a closed 18-bed unit in a 800+ bed university hospital with full-time attending intensivist coverage. HFNO was instituted in patients with tachypnea, hypoxemia, hypercapnia, or other signs of respiratory distress.
RESULTS: 20 patients were managed with HFNO. FIO2 ranged from 0.3 to 1.0 and flow rates from 20 to 40 L/min. The patients ranged in age from 25 to 89 (median = 64) years. 12 were men. Eight had recently undergone major thoracic or abdominal operations and two had sustained thoracic injuries. Seven developed respiratory distress within 48 hours of extubation and two of these were treated with BiPap before HFNO. All of these patients remained extubated. 13 developed respiratory distress without prior intubation and eight of these were managed with BiPap before HFNO. Only two of these patients required intubation. The duration of HFNO ranged from 10 hours to 8 days. Discomfort necessitated termination of BiPap in three patients, but this was not seen with HFNO. Three patients expired in the SICU, although none expired while on BiPap or HFNO.
CONCLUSION: In this unselected patient population, HFNO proved beneficial in avoiding endotracheal intubation and mechanical ventilation in 18 of 20 patients. Its value as a means of non-invasive ventilation needs to be studied in a larger, prospective, randomized trial comparing this modality to more standard therapies.
CLINICAL IMPLICATIONS: Although the physiologic basis of HFNO remains unclear, HFNO should be considered in critically ill adult patients as a means of NIV.
DISCLOSURE: Steven Blau, No Financial Disclosure Information; No Product/Research Disclosure Information