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Critical Care |

High-Flow Nasal Cannula Oxygenation in Cancer Patients: Practice Patterns and Outcomes

Dona Bugov, MD; Louis P. Voigt; Joanna Yohannes-Tomicich, NP; Qammar Abbas, MD; Yekaterina Tayban, NP; Richard Weiner, NP; Natalie Kostelecky; Jud S. Ramaker; Gleb Kirnicinii; Ashley Haynes; Stephen Pastores; Neil Halpern
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Memorial Sloan Kettering Cancer Center, New York, NY


Chest. 2015;148(4_MeetingAbstracts):301A. doi:10.1378/chest.2280327
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Abstract

SESSION TITLE: Mechanical Ventilation and Respiratory Failure Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM

PURPOSE: Data on the practice patterns and characteristics of recipients of high flow nasal cannula (HFNC) oxygenation for respiratory support in cancer patients are limited.

METHODS: Using hospital and ICU databases, we retrospectively analyzed the demographic, clinical, and outcome data of all hospitalized patients who received HFNC including those who required ICU admission during a 4-week period (February 18- March 15, 2015) at Memorial Sloan Kettering Cancer Center. Data are presented as absolute numbers, percentages, median (IQR: 1st, 3rd), and mean + SD.

RESULTS: During the study period, 36 adult patients were placed on HFNC. Mean age was 54 + 19 years and 53% were male. Nearly a quarter (22%) had a DNR order. Median duration of HFNC was 2 (IQR: 1, 4) days. The main cancer diagnoses were gastrointestinal, hematological, genitourinary, and breast malignancies. Respiratory diseases (Pneumonia, Pulmonary edema, Aspiration pneumonitis) were the main reasons for initiation of HFNC. HFNC was initiated in the ICU in 6 patients (16%) and in 30 (84%) patients outside the ICU. Of these 30 patients, 11 (36.7%) were later transferred to the ICU. 19 (53%) patients had an arterial blood gas (ABG) prior to or during HFNC with a mean pO2 of 116 (range, 63.8-248). The remaining 17 patients (47%) without an ABG had a mean SpO2 of 94.5% (range, 90-100%). Among the 36 patients, HFNC was replaced by conventional low flow nasal cannula oxygen in 19 patients (53%), endotracheal intubation in 4 (11%), face mask in 3 (8%), noninvasive positive pressure ventilation in 2 (6%), and room air in 2 patients (6%). Hospital mortality rate was 31%.

CONCLUSIONS: The use of HFNC was very modest and short-lived among hospitalized patients with cancer. HFNC was used mainly for respiratory diseases but nearly half of the patients did not have a prior ABG. Mortality rate was relatively high.

CLINICAL IMPLICATIONS: HFNC guidelines, including oxygen assessment, may assist clinicians in identifying the most suitable patients with cancer and respiratory insufficiency for HFNC respiratory support.

DISCLOSURE: The following authors have nothing to disclose: Dona Bugov, Louis P. Voigt, Joanna Yohannes-Tomicich, Qammar Abbas, Yekaterina Tayban, Richard Weiner, Natalie Kostelecky, Jud S. Ramaker, Gleb Kirnicinii, Ashley Haynes, Stephen Pastores, Neil Halpern

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