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Sequential Application of Oxygen Therapy Via High-Flow Nasal Cannula and Noninvasive Ventilation in Acute Respiratory Failure: An Observational Pilot Study

2014; American Association for Respiratory Care; Volume: 60; Issue: 2 Linguagem: Inglês

10.4187/respcare.03075

1943-3654

Jean‐Pierre Frat, Benjamin Brugiere, Stéphanie Ragot, Delphine Chatellier, Anne Veinstein, Véronique Goudet, Rémi Coudroy, Franck Petitpas, René Robert, Arnaud W. Thille, Christophe Girault,

Nosocomial Infections in ICU

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 P aO 2 /F IO 2 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, P aO 2 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.