Safety and efficacy of high flow nasal cannula therapy in acute hypercapnic respiratory failure – a retrospective audit

Link to article at PubMed

Intern Med J. 2021 Jun 6. doi: 10.1111/imj.15400. Online ahead of print.


BACKGROUND: While the role of high flow nasal cannulae (HFNC) in the management of respiratory failure continues to expand, few studies describe its use in acute hypercapnic respiratory failure.

AIMS: In this retrospective study we assessed the safety and efficacy of HFNC for treatment of acute hypercapnic respiratory failure.

METHODS: Admissions with acute hypercapnic respiratory failure to a thoracic medicine unit at a tertiary centre between January and August 2018 were included if treated with either HFNC or non-invasive ventilation (NIV). The primary outcome was post-treatment change in arterial pCO2 . Demographics, comorbidities, length of stay, readmission rate and mortality were also collected.

RESULTS: 64 patients were identified, comprising 69 presentations grouped according to initial treatment: HFNC (n=24) or NIV (n=45). Patients in the NIV group had more severe blood gas derangement. In both groups, mean arterial pCO2 improved significantly (-10 (95% CI: -14 to -6) mmHg) from baseline with no evidence of a differential effect between groups. Six (25%) patients were transitioned from HFNC to NIV, of whom 3 had comorbid obesity and 2 had sleep disordered breathing. No significant differences in hospital length of stay, 30-day readmission rate or 90-day mortality were observed.

CONCLUSIONS: HFNC may be a reasonable initial treatment for patients with mild acute hypercapnic respiratory failure who do not have comorbid obesity or sleep disordered breathing. Prospective study may help identify clinical factors or phenotypes predictive of success with this treatment modality. This article is protected by copyright. All rights reserved.

PMID:34092008 | DOI:10.1111/imj.15400

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