Chest Infections: Respiratory Care |

The Role of High Flow Nasal Oxygen in Hospitalized Patients With Pneumonia FREE TO VIEW

Sarun Thomas, DO; Angela Love, MD; Lina Miyakawa, MD; Jaime Deseda, MD; Boris Berlin, RRT; Paru Patrawalla, MD; Samuel Acquah, MD; David Steiger, MD
Author and Funding Information

Mount Sinai Beth Israel, New York, NY

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):156A. doi:10.1016/j.chest.2016.08.165
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SESSION TITLE: Respiratory Care

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PM

PURPOSE: High flow nasal oxygen (HFNO) is an easy-to-use supportive therapy that has been demonstrated to be safe and effective in patients with acute hypoxic respiratory failure (AHRF) predominantly caused by community-acquired pneumonia (CAP) (N Engl J Med 2015; 372:2185), compared to face mask and noninvasive ventilation. HFNO decreases dead space, reduces airways resistance, and when humidified, is well tolerated. The objective of the study was to evaluate the outcome of patients with pneumonia (PNA) who used HFNO.

METHODS: We retrospectively reviewed consecutive patients hospitalized at an urban hospital over four-months who were treated with HFNO for PNA. We compared the clinical, physiological, and radiological characteristics, treatment and outcome of patients with healthcare associated pneumonia (HCAP) and CAP.

RESULTS: Of 47 patients who received HFNO, 21 patients were treated for AHRF secondary to PNA. Of these, 15 were diagnosed with HCAP and 6 with CAP. Prior to the initiation of HFNO, the average supplemental O2 was 45.3%; 37.3% for HCAP and 67.5% for CAP, respectively. The supplemental oxygen devices used prior to HFNO differed in patients with CAP vs. HCAP: nasal cannula (16.7% vs. 53.3%), NIPPV (50% vs. 26.7%). In comparing the characteristics, the mean age was higher in CAP than HCAP, 75 and 60 years, respectively, and gender female (66% HCAP vs. 34% CAP. Comorbidities differed between patients with HCAP and CAP: malignancy (53.3%, 16.7%,) diabetes mellitus (53.3%, 50%), liver failure (13.3%, 0%), chronic renal failure (13.3%, 66.7%), HIV (13%, 0%), interstitial lung disease (16.7%, 6.7%), and non-small cell lung cancer (20%, 0%). At initiation of HFNO, 20% of HCAP patients were in shock compared to 33.3% of CAP patients. There were 2 patients that needed to be re-intubated after HFNO, 13.3% in HCAP vs. 0% in CAP. Mortality was lower in HCAP patients vs. CAP patients (33.3% vs. 83.3%). In addition, 66% of CAP patients were DNR/DNI compared to 26% of HCAP patients. All patients who died in either group were DNR/DNI and requested hospice care.

CONCLUSIONS: The use of HFNO was associated with an improved outcome in patients with HCAP compared to CAP despite higher rates of malignancy, HIV and liver failure in HCAP patients. The higher mortality in the CAP patients might be related to their more advanced age, increased prevalence of shock, chronic renal failure, and DNR/DNI status.

CLINICAL IMPLICATIONS: From our limited data, HFNO may be considered in patients with HCAP and hypoxic respiratory failure.

DISCLOSURE: The following authors have nothing to disclose: Sarun Thomas, Angela Love, Lina Miyakawa, Jaime Deseda, Boris Berlin, Paru Patrawalla, Samuel Acquah, David Steiger

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