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- Title
Proactive Use of High-Flow Nasal Cannula With Critically Ill Subjects.
- Authors
Lamb, Keith D.; Spilman, Sarah K.; Oetting, Trevor W.; Jackson, Julie A.; Trump, Matthew W.; Sahr, Sheryl M.
- Abstract
INTRODUCTION: It has been suggested that use of a high-flow nasal cannula (HFNC) could be a first-line therapy for patients with acute hypoxic respiratory failure. The purpose of this study was to determine if protocolized use of HFNC decreases unplanned intubation and adverse outcomes in an ICU population. METHODS: The study was a prospective evaluation of 2 cohorts who received HFNC per protocol. Control groups were retrospective selections of subjects who received HFNC in the pre-protocol period. Cohort 1 (n = 88) received mechanical ventilation for ≥ 24 h and was extubated directly to HFNC following strict protocol criteria. Cohort 2 (n = 83) were placed on HFNC when oxygen requirements escalated (>4 L/min). RESULTS: Cohort 1 did not differ from its control group in mortality, hospital stay, or ICU days, but there were significant decreases in incidence of Gram-negative pulmonary infection (30% vs 9%, P = .001) and use of bronchodilator therapy (81% vs 61%, P = .008). Failed extubation rates were nearly identical across groups, but time to re-intubation was shorter in the protocol group (24 vs 13 h, P = .19). Cohort 2 did not differ significantly from its control group in intubation rates or mortality, but subjects managed by protocol experienced significant decreases in ICU days (4 vs 3 d, P = .03) and hospital days (12 vs 8 d, P = .007). There was a trend toward fewer hours on HFNC (33 vs 24 h, P = .10) and faster time to intubation when HFNC failed (19 vs 9 h, P = .08). CONCLUSIONS: Extubation to HFNC led to a significant decrease in pulmonary infections and bronchodilator therapy in Cohort 1 but did not reduce length of stay or rates of failed extubation. When HFNC was used early and per protocol (Cohort 2), ICU and hospital lengths of stay were reduced and HFNC was initiated more quickly when the need for respiratory support escalated.
- Subjects
IOWA; RESPIRATORY insufficiency; BRONCHODILATOR agents; ARTIFICIAL respiration; CHI-squared test; CRITICALLY ill; GRAM-negative bacterial diseases; LENGTH of stay in hospitals; INTENSIVE care units; INTUBATION; LONGITUDINAL method; LUNGS; MEDICAL protocols; OXYGEN therapy; PATIENTS; PROBABILITY theory; TIME; CONTINUING education units; RETROSPECTIVE studies; EXTUBATION; DATA analysis software; DESCRIPTIVE statistics; HOSPITAL mortality; KRUSKAL-Wallis Test; ONE-way analysis of variance; NASAL cannula; PREVENTION; THERAPEUTICS
- Publication
Respiratory Care, 2018, Vol 63, Issue 3, p259
- ISSN
0020-1324
- Publication type
Article
- DOI
10.4187/respcare.05793