High-Flow Nasal Cannula

Conventionally, oxygen is given at 4 to 6 L/min through nasal cannula for supplementation of oxygen. The FiO2 achieved through this can be up to 0.4. Flows more than this can cause dryness to the nasal mucosa without much increase in the FiO2. High-flow nasal cannula (HFNC) uses flow up to 60 L/min. Positive end-expiratory pressure is created in the nasopharynx and it is also conducted to the lower airways. Studies have shown HFNC improves washout of CO2 and decreases respiratory rate. Patient compliance also improves due to the comfort of the cannula compared to the non-invasive ventilation through a mask.

High Flow Nasal Cannula Decreased Pulmonary Complications in Neurologically Critically Ill Patients

Objective: Pulmonary complications could badly affect the recovery of neurological function and neurological prognosis of neurological critically ill patients. This study evaluated the effect of high-flow nasal cannula (HFNC) therapy on decreasing pulmonary complications in neurologically critically ill patients.Patients and Methods: The patients admitted to the intensive care unit (ICU) with serious neurological disease and receiving oxygen therapy were retrospectively reviewed (Ethical No. IRB2021-YX-001). Patients were divided into the HFNC group and the conventional oxygen therapy (COT) group. We analyzed the data within these two groups, including patients’ baseline data, short-term outcomes of respiratory complications, general outcomes including hospital stay, ICU stay and mortality, and neurological functions. To analyze the relevant factors, we performed multivariable logistic regression analysis.Results: A total of 283 patients met the criteria, including 164 cases in the HFNC group and 119 cases in the COT group. The HFNC group had remarkably less mechanical ventilation requirement with lower phlegm viscosity. Even more, ICU stay and total hospital stay were significantly shortened in the HNFC group.Conclusion: HFNC decreased pulmonary complications in neurologically critically ill patients and improved recovery of neurological function and neurological prognosis.

ROX Index as a Predictor of Intubation Risk and 28-Day Mortality in COVID-19 Patients with Acute Respiratory Distress Syndrome

Background: The main concern when treating COVID-19 acute respiratory distress syndrome (ARDS) during high flow nasal cannula (HFNC) is delayed intubation, thus increasing the risk of prior mortality. This study aims to analyze the prognostic ability of the Respiratory Rate Oxygenation (ROX) index as a predictor for intubation and 28-days mortality in COVID-19 patients. Methods: A retrospective analysis of COVID-19 patients admitted to Intensive Care Unit (ICU) Dr. Soetomo General Hospital in Surabaya from July to December 2020 with ARDS. The ROX indices were recorded at the 1st hour, 2nd, 4th, 6th, 12th, 18th, 24th, and 48th hours of treatment in ICU with HFNC. Identification of ROX association with HFNC failure led to intubation and 28-days mortality was through Cox proportional hazards regression. The most specific cut-off of the ROX index for predicting intubation and 28-days mortality was assessed. Result: Among 78 patients who met the inclusion criteria, 26 (33.3%) patients required intubation. Out of 26 patients, six patients were extubated and had survived. The 28-days mortality rate is 20 (25.6%) patients. The ROX index at 12th hours (ROX-12) ≤ 4.85 (AUC 0.857; p<0.001; HR 4.7) and the ROX index at 48th hours (ROX-48) ≤ 5.68 (AUC 0.858; p<0.001; HR 5.4) can accurately predict the need for intubation. ROX-12 ≤ 4.745 is a predictor of 28-days mortality (AUC 0.85, p<0.001; HR 10.2). Conclusion: ROX index predicts the risk of intubation and 28-days mortality especially ROX-12 and ROX-48. Utilization of ROX index for rapid assessment of the respiratory deterioration in COVID-19 is recommended.

High Flow Nasal Cannula as Support in Immunocompromised Patients with Acute Respiratory Failure: A Retrospective Study

Introduction: High Flow Nasal Cannula (HFNC) is a novel technique for respiratory support that improves oxygenation. In some patients, it may reduce the work of breathing. In immunocompromised patients with Acute Respiratory Failure (ARF), Non-Invasive Ventilation (NIV) is the main support recommended strategy, since invasive mechanical ventilation could increase mortality rates. NIV used for more than 48 hours may be associated with increased in-hospital mortality and hospital length of stay. Therefore HFNC seems like a respiratory support alternative. Objective: To describe clinical outcomes of immunocompromised patients with ARF HFNC-supported. Methods: Retrospective study in patients admitted with ARF and HFNC-supported. 25 adult patients were included, 21 pharmacologically and 4 non- pharmacologically immunosuppressed. Median age of the patients was 64 [60-76] years, APACHE II 15 [11-19], and PaO2:FiO2 218 [165-248]. Demographic information, origin of immunosuppression, Respiratory Rate (RR), Heart Rate (HR), Mean Arterial Pressure (MAP), oxygen saturation (SpO2) and PaO2:FiO2 ratio were extracted from clinical records of our HFNC local protocol. Data acquisition was performed before and after the first 24 hours of connection. In addition, the need for greater ventilatory support after HFNC, orotracheal intubation, in-hospital mortality and 90 days out-patients’ mortality was recorded. Results: Mean RR before the connection was 25±22 breaths/min and 22±4 breaths/min after the first 24 hours of HFNC use (95% CI; p=0.02). HR mean before connection to HFNC was 96±22 beats/min, and after, it was 86±15 beats/min (95%CI; p=0.008). Previous mean MAP was 86±15 mmHg, and after HFNC, it was 80±12 mmHg (95%CI; p=0.09); mean SpO2 after was 93±5% and before it was 95±4% (95% CI; p=0.13); and previous PaO2:FiO2 mean was 219±66, and after it was 324±110 (95%CI; p=0.52). In-hospital mortality was 28% and 90 days out-patients’ mortality was 32%. Conclusion: HFNC in immunosuppressed ARF subjects significantly decreases HR and RR, being apparently an effective alternative to decrease work of breathing. In-hospital mortality in ARF immunosuppressed patients was high even though respiratory support was used. Better studies are needed to define the role of HFNC-support in ARF.

Impact of High Flow Nasal Cannula on Resource Utilization in Bronchiolitis

OBJECTIVES: High flow nasal cannula (HFNC) is increasingly used for children hospitalized with bronchiolitis. We aimed to validate identification of HFNC use in a national database, then compare resource utilization among children treated with and without HFNC. METHODS: In this cross-sectional, multicenter study, we obtained clinical and resource utilization data from the Pediatric Health Information System (PHIS) database for healthy children aged 1 to 24 months admitted for bronchiolitis. We assessed HFNC use based on a combination of billing codes and reviewed charts at 2 hospitals to determine their accuracy. We compared costs, length of stay, and readmissions between the HFNC and no HFNC groups at hospitals utilizing the HFNC codes. RESULTS: The PHIS codes demonstrated 90.4% sensitivity and 99.3% specificity to detect HFNC use as verified by chart review at 2 hospitals. However, only 24 of 51 PHIS hospitals used these codes for ≥1% of patients with bronchiolitis. Within those hospitals, children treated with HFNC had greater total costs ($7054 vs $4544; P &lt; .001), greater daily costs ($2922 vs $2613; P &lt; .001), and longer length of stay (57.6 vs 41.6 hours; P &lt; .001). Those treated with HFNC were less likely to be readmitted at 3 and 7 days (P &lt; .001), but by 14 days, readmissions were similar in the 2 groups. CONCLUSIONS: Billing codes for HFNC are inconsistently applied across PHIS hospitals; however, among those hospitals that routinely apply these codes, HFNC was associated with more intense resource utilization. Standardization of billing practices for HFNC would allow future study to more broadly describe the value of HFNC.