RT Journal Article
SR Electronic
T1 Sequential Application of Oxygen Therapy Via High-Flow Nasal Cannula and Noninvasive Ventilation in Acute Respiratory Failure: An Observational Pilot Study
JF Respiratory Care
FD American Association for Respiratory Care
SP respcare.03075
DO 10.4187/respcare.03075
A1 Jean-Pierre Frat
A1 Benjamin Brugiere
A1 Stéphanie Ragot
A1 Delphine Chatellier
A1 Anne Veinstein
A1 Véronique Goudet
A1 Rémi Coudroy
A1 Franck Petitpas
A1 René Robert
A1 Arnaud W Thille
A1 Christophe Girault
YR 2014
UL http://rc.rcjournal.com/content/early/2014/10/07/respcare.03075.abstract
AB BACKGROUND: The aim of this study was to evaluate the clinical efficacy of humidified oxygen via high-flow nasal cannula (HFNC) alternating with noninvasive ventilation (NIV) in acute hypoxemic respiratory failure (AHRF). METHODS: We performed a prospective observational study in a 12-bed ICU of a university hospital. All subjects with a PaO2/FIO2 of ≤ 300 mm Hg with standard mask oxygen and a breathing frequency of > 30 breaths/min or signs of respiratory distress were included and treated with HFNC first and then NIV. Ventilatory parameters, blood gases, and tolerance were recorded during 2 consecutive sessions of NIV and HFNC. Outcome was assessed after continuation of this noninvasive strategy. RESULTS: Twenty-eight subjects with AHRF were studied, including 23 (82%) with ARDS. Compared with standard oxygen therapy, PaO2 significantly increased from 83 (68–97) mm Hg to 108 (83–140) mm Hg using HFNC and to 125 (97–200) mm Hg using NIV (P < .01), whereas breathing frequency significantly decreased. HFNC was significantly better tolerated than NIV, with a lower score on the visual analog scale. The non-intubated subjects received HFNC for 75 (27–127) h and NIV for 23 (8–31) h. Intubation was required in 10 of 28 subjects (36%), including 8 of 23 subjects with ARDS (35%). After HFNC initiation, a breathing frequency of ≥ 30 breaths/min was an early factor associated with intubation. CONCLUSIONS: HFNC was better tolerated than NIV and allowed for significant improvement in oxygenation and tachypnea compared with standard oxygen therapy in subjects with AHRF, a large majority of whom had ARDS. Thus, HFNC may be used between NIV sessions to avoid marked impairment of oxygenation.