Critical Care: Mechanical Ventilation & Respiratory Failure I |

High Flow Nasal Cannula Oxygen Therapy for Acute Hypoxemic Respiratory Failure: A Systematic Review FREE TO VIEW

Mohmmed Algamdi, MBBS; Ian Ball, MD
Author and Funding Information

Division of Critical Care Medicine, Department of Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada

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

Chest. 2016;150(4_S):306A. doi:10.1016/j.chest.2016.08.319
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SESSION TITLE: Mechanical Ventilation & Respiratory Failure I

SESSION TYPE: Original Investigation Poster

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

PURPOSE: In adults with acute hypoxemic respiratory failure (AHRF), most high flow nasal cannula (HFNC) studies evaluated patient comfort and physiologic parameters such as PaO2 and respiratory rate. Recently, several studies focusing on clinical outcomes like treatment failure and ventilator-free days have been published, hence the need for a systematic review. Our objective is to determine the role of HFNC in patients with AHRF.

METHODS: A Systematic review of MEDLINE and Embase databases. We identified prospective studies of adults aged 18 years or older, treated for AHRF, for whom HFNC was compared with other modes of oxygen therapy. We excluded patients with hypercapnia and / or chronic respiratory failure. Our outcome was treatment failure (defined as the need for intubation, a change to another mode of ventilation or premature HFNC discontinuation). Two authors abstracted study results and assessed study quality.

RESULTS: Of the 320 citations identified, 3 randomized controlled studies (RCT) met eligibility criteria. In the two larger RCTs, the use of HFNC did not result in a statistically significant difference in the rate of treatment failure compared with the other modes of oxygen therapy. One post hoc subgroup analysis of patients with a PaO2/FiO2 less than 200 mmHg demonstrated a significantly lower intubation rate in the HFNC group than the non-invasive ventilation or the standard oxygen group (P=0.01). In the smaller RCT that was mainly limited to post-cardiac surgery patients, more HFNC patients succeeded on their allocated therapy. All three RCTs were underpowered due to low event rates and / or small sample size.

CONCLUSIONS: Based on current evidence, HFNC does not lower the rate of treatment failure in patients with AHRF compared with the other modes of oxygen therapy. However, among patients with the more severe form of AHRF, a statistically significant reduction in intubation rate was demonstrated. A larger, adequately powered RCT in patients with more severe AHRF is needed.

CLINICAL IMPLICATIONS: Current evidence does not support the routine use of HFNC in patients with AHRF. However, there may be a role for HFNC in patients with the more severe form of AHRF.

DISCLOSURE: The following authors have nothing to disclose: Mohmmed Algamdi, Ian Ball

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