Effect of post-extubation high-flow nasal cannula on reintubation in elderly patients: a retrospective propensity score-matched cohort study

Background: Studies of mechanically ventilated patients with a low risk of reintubation have suggested that the use of high-flow nasal cannula (HFNC) oxygen therapy reduces the risk of reintubation compared with conventional oxygen therapy (COT). However, the effect of HFNC following extubation in elderly patients with a high risk of reintubation remains unclear. Methods: All consecutive medical intensive care unit (ICU) patients aged >65 years who were mechanically ventilated for >24 h were prospectively registered between July 2017 and June 2018. Control was obtained from a historical database of patients attending the same ICU from January 2012 to December 2013. A total of 152 patients who underwent HFNC after planned extubation according to institutional protocols (HFNC group) were compared with a propensity-matched historical control group who underwent COT ( n = 175, COT group). The primary outcome was the proportion of reintubated patients within 48 h after planned extubation. Results: One hundred patients from the HFNC group and 129 patients from the COT group were matched by a propensity score that reflected the probability of receiving HFNC, and all variables were well matched. Post-extubation respiratory failure (41.0% versus 33.3%, p = 0.291) and reintubation rate within 48 h (16.0% versus 11.6%, p = 0.436) did not differ between the HFNC and COT groups. However, decreased levels of consciousness as a sign of post-extubation respiratory failure (27.0% versus 11.7%, p = 0.007) were significantly increased in the HFNC group compared with the COT group. Conclusion: Among elderly patients who underwent planned extubation, HFNC was not associated with a decrease in the risk of reintubation. Further prospective study evaluating the clinical benefits of post-extubation HFNC in elderly patients is needed. The reviews of this paper are available via the supplemental material section.

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A Narrative Summary of High Flow Nasal Cannula Therapy in the Adult Population

Internet Journal of Allied Health Sciences and Practice ◽

10.46743/1540-580x/2017.1626 ◽

2017 ◽

Author(s):

Joshua Gonzales ◽

Kevin Collins ◽

Christopher Russian

Keyword(s):

Respiratory Failure ◽

Acute Respiratory Failure ◽

Oxygen Therapy ◽

Work Of Breathing ◽

High Flow ◽

Nasal Cannula ◽

Positive Pressure ◽

High Flow Nasal Cannula ◽

Non Invasive ◽

Clinical Benefits

Purpose: The aim of this narrative review is to outline the mechanism of action of HFNC therapy, the clinical benefits of its use, cautions of its clinical application and limitations of previous research. Methods: A literature review was conducted using the following databases as sources: Medline, PubMed, and Google Scholar. Only publications written in English were used in this clinical review. Keywords used in the search included the following: high-flow nasal cannula, heated humidified oxygen, oxygen therapy, non-invasive ventilation, and respiratory failure. Results: The literature reveals HFNC therapy significantly decreased the use of mechanical ventilation (invasive or non-invasive) in patients experiencing respiratory failure. HFNC therapy was better tolerated by patients and decreased the patient’s work of breathing when compared to a conventional oxygen therapy (i.e., non-rebreather oxygen mask). Other clinical benefits of using HFNC when changing a patient from conventional facemask oxygen therapy to a HFNC device are significant improvements in PaO2, respiratory rate and overall comfort. Conclusions: High flow nasal cannula (HFNC) therapy serves as an alternative to conventional oxygen therapy to deliver elevated concentrations of oxygen to patients experiencing acute respiratory failure. Information detailed in this article suggests HFNC therapy is an effective therapy for improving a patient’s oxygenation status when experiencing acute respiratory failure in adults. The literature reveals, it is reasonable to initiate HFNC in adults with acute hypoxemic respiratory failure without hypercapnia, as an alternative to standard oxygen therapy or noninvasive positive pressure ventilation.

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High‐flow nasal cannula oxygen therapy for acute respiratory failure in a non‐intensive geriatric setting

Geriatrics and Gerontology International ◽

10.1111/ggi.13557 ◽

2018 ◽

Vol 18 (12) ◽

pp. 1652-1653 ◽

Cited By ~ 1

Author(s):

Filippo Luca Fimognari ◽

Massimo Rizzo ◽

Olga Cuccurullo ◽

Giovanna Cristiano ◽

Roberto Ricchio ◽

...

Keyword(s):

Respiratory Failure ◽

Acute Respiratory Failure ◽

Oxygen Therapy ◽

High Flow ◽

Nasal Cannula ◽

High Flow Nasal Cannula

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High flow nasal cannula oxygen therapy in adults with COVID-19 respiratory failure. A case report

Monaldi Archives for Chest Disease ◽

10.4081/monaldi.2020.1323 ◽

2020 ◽

Vol 90 (2) ◽

Cited By ~ 1

Author(s):

Vasileios Karamouzos ◽

Fotini Fligou ◽

Charalambos Gogos ◽

Dimitrios Velissaris

Keyword(s):

Respiratory Failure ◽

Oxygen Therapy ◽

Virus Disease ◽

High Flow ◽

Nasal Cannula ◽

High Flow Nasal Cannula ◽

Non Invasive ◽

Corona Virus ◽

Non Invasive Ventilation ◽

Hypoxic Respiratory Failure

The novel corona virus (SARS-CoV-2) continuous to spread around the globe causing high mortality, tremendous stress on healthcare systems and an unprecedented disruption of everyday life with unpredictable socioeconomic ramifications. The diseaseis typically affecting the respiratory system and some patients will develop refractory hypoxemic respiratory insufficiency requiring mechanical ventilation. The role of non-invasive ventilation (NIV), high flow nasal cannula (HFNC) or continuous positive airway pressure devices (C-PAP) in the treatment of the 2019 corona virus disease (COVID-19) is not yet clear. We hereby report a case of a 44-year-old COVID-19 positive male patient suffering from hypoxic respiratory failure that was successfully treated with high flow nasal cannula oxygen therapy in a negative pressure intensive care room. Although specific criteria for the use of high flow nasal canula devices COVID-19 are not available at this time, clinicians could use this non-invasive modality as analternative method of respiratory support in selected patients presenting with respiratory failure.

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High-flow nasal cannula oxygen therapy in acute respiratory failure at Emergency Departments: A systematic review

The American Journal of Emergency Medicine ◽

10.1016/j.ajem.2020.04.091 ◽

2020 ◽

Vol 38 (7) ◽

pp. 1508-1514

Author(s):

Nicolas Marjanovic ◽

Jérémy Guénézan ◽

Jean-Pierre Frat ◽

Olivier Mimoz ◽

Arnaud W. Thille

Keyword(s):

Systematic Review ◽

Respiratory Failure ◽

Acute Respiratory Failure ◽

Emergency Departments ◽

Oxygen Therapy ◽

High Flow ◽

Nasal Cannula ◽

High Flow Nasal Cannula

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High-Flow Nasal Cannula: A Promising Oxygen Therapy for Patients with Severe Bronchial Asthma Complicated with Respiratory Failure

Canadian Respiratory Journal ◽

10.1155/2020/2301712 ◽

2020 ◽

Vol 2020 ◽

pp. 1-7 ◽

Cited By ~ 2

Author(s):

Wanru Geng ◽

Wuliji Batu ◽

Shuhong You ◽

Zhaohui Tong ◽

Hangyong He

Keyword(s):

Respiratory Failure ◽

Bronchial Asthma ◽

Oxygen Therapy ◽

Response Rate ◽

High Flow ◽

Nasal Cannula ◽

High Flow Nasal Cannula ◽

Therapy Technique ◽

Significant Difference ◽

Life Threatening

Severe bronchial asthma complicated with respiratory failure, a common critical illness in respiratory medicine, may be life-threatening. High-flow nasal cannula (HFNC) is a novel oxygen therapy technique developed in recent years. HFNC was applied in this study for treating adult patients with severe bronchial asthma complicated with respiratory failure. Its efficacy was analyzed comparatively to conventional oxygen therapy (COT). HFNC and COT were randomly performed based on conventional treatment. The HFNC group was similar to COT-treated patients in terms of response rate, with no significant difference in efficacy between the two groups. In patients with bronchial asthma, effectively increased PO2 and reduced PCO2 were observed after treatment in both groups. However, HFNC was more efficient than COT in elevating PO2 in patients with severe bronchial asthma complicated with respiratory failure, while no statistically significant difference in PCO2 reduction was found between the two groups. Heart rate (HR) and respiratory rate (RR) between the two groups on admission (0 h) and at 2, 8, 24, and 48 h after admission were compared. Both indicators significantly decreased with time. No significant differences in HR and RR were found between the groups at 0, 2, and 8 h after admission. However, these indicators were significantly lower in the HFNC group compared with the COT group at 24 and 48 h after admission. HFNC could significantly elevate PO2 and reduce HR and RR. Thus, it is a promising option for patients with severe bronchial asthma complicated with respiratory failure.

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High-flow nasal cannula oxygen therapy as an emerging option for respiratory failure: the present and the future

Therapeutic Advances in Chronic Disease ◽

10.1177/2040622320920106 ◽

2020 ◽

Vol 11 ◽

pp. 204062232092010

Author(s):

Lucia Spicuzza ◽

Matteo Schisano

Keyword(s):

Respiratory Failure ◽

Oxygen Therapy ◽

De Novo ◽

Work Of Breathing ◽

High Flow ◽

Nasal Cannula ◽

Chronic Obstructive ◽

High Flow Nasal Cannula ◽

Obstructive Pulmonary Disease ◽

Chronic Respiratory Diseases

Conventional oxygen therapy (COT) and noninvasive ventilation (NIV) have been considered for decades as frontline treatment for acute or chronic respiratory failure. However, COT can be insufficient in severe hypoxaemia whereas NIV, although highly effective, is poorly tolerated by patients and its use requires a specific expertise. High-flow nasal cannula (HFNC) is an emerging technique, designed to provide oxygen at high flows with an optimal degree of heat and humidification, which is well tolerated and easy to use in all clinical settings. Physiologically, HFNC reduces the anatomical dead space and improves carbon dioxide wash-out, reduces the work of breathing, and generates a positive end-expiratory pressure and a constant fraction of inspired oxygen. Clinically, HFNC effectively reduces dyspnoea and improves oxygenation in respiratory failure from a variety of aetiologies, thus avoiding escalation to more invasive supports. In recent years it has been adopted to treat de novo hypoxaemic respiratory failure, exacerbation of chronic obstructive pulmonary disease (COPD), postintubation hypoxaemia and used for palliative respiratory care. While the use of HFNC in acute respiratory failure is now routine as an alternative to COT and sometimes NIV, new potential applications in patients with chronic respiratory diseases (e.g. domiciliary treatment of patients with stable COPD), are currently under evaluation and will become a topic of great interest in the coming years.

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Is high-flow nasal cannula oxygenation more effective than noninvasive ventilation or conventional oxygen therapy in treating acute hypoxemic respiratory failure in COVID-19 patients?

Acta Medica Philippina ◽

10.47895/amp.v54i0.1870 ◽

2020 ◽

Vol 54 ◽

Author(s):

Cary Amiel G. Villanueva ◽

Marie Gene D. Cruz ◽

Lia M. Palileo-Villanueva

Keyword(s):

Respiratory Failure ◽

Noninvasive Ventilation ◽

Observational Studies ◽

Oxygen Therapy ◽

High Flow ◽

Nasal Cannula ◽

Respiratory Support ◽

High Flow Nasal Cannula ◽

Hypoxemic Respiratory Failure ◽

Acute Hypoxemic Respiratory Failure

KEY FINDINGSVery low-quality evidence suggests lower mortality (based on five observational studies) but higher failurerate of respiratory support (based on two observational studies) in COVID-19 patients given high-flow nasalcannula (HFNC) oxygen compared with noninvasive ventilation (NIV) and conventional oxygenation therapy.Randomized controlled trials (RCT) are urgently needed in this area.• Respiratory failure accounts for about half of deaths in patients with COVID-19.• High-flow nasal cannula (HFNC) oxygen therapy reduces the need for escalating respiratory support and improvespatient comfort compared with conventional oxygen therapy among those with acute respiratory failure.• Mortality was consistently lower in COVID-19 patients who received HFNC rather than NIV or conventionaloxygen therapy (COT) across 5 very low-quality retrospective observational studies from China.• Several international guidelines recommend the use of HFNC oxygen therapy in COVID-19 patients whodevelop acute hypoxemic respiratory failure. However, local guidelines from the Philippine Society forMicrobiology and Infectious Diseases (PSMID) and the Philippine College of Chest Physicians (PCCP) recommendagainst HFNC due to risks of transmission and paucity of direct evidence for efficacy.• Additional infection control precautions, i.e. wearing a surgical mask over the cannula, and locating in a negativepressure room, are recommended whenever using HFNC or NIV.• There are at least two ongoing trials due to be completed by the second quarter of 2021 comparingHFNC oxygenation with NIV or COT in COVID-19 patients.

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