Clinical outcomes of high-flow nasal cannula oxygen therapy in acute heart failure patients with hypoxemia: A retrospective cohort study

Abstract

Acute heart failure (AHF) is life-threatening medical condition requiring hospital admission and appropriate oxygen therapy. High flow nasal cannula oxygen therapy (HFNC) has gained its popularity in treatment of AHF, however, there were less studies have demonstrated the physiological efficacy of HFNC. Purpose of this study was to evaluated the physiological responses and clinical outcomes of HFNC by comparing with noninvasive positive pressure ventilation (NPPV) therapy. A retrospective cohort investigation was conducted at emergency intensive care unit (EICU) and cardiovascular center of our hospital from June 2019 to March 2022, AHF patients with hypoxemia were reviewed. According to the received oxygen therapy model, patients were divided into HFNC and NPPV groups. Demographic data, arterial blood gas (ABG) parameter, echocardiography findings, complications and other related variables were extracted and collected from the electronic medical records (EMRs) by well-trained investigators. Physiological responses and clinical outcomes within and between 2 groups were analyzed. Finally, 156 patients with a mean age of 69.3 ± 7.1 years were reviewed, there were 82 (52.6%) male and 74 (47.4%) female patients in the sample and 70 (44.9%) and 86 (55.1%) patients classified III and IV score were included in this study, 80 patients received HFNC and 76 underwent NPPV oxygen therapy. There were no significant differences of baseline characteristics for the 2 groups patients. Changes of left ventricular function parameters, ABG and clinical outcomes were all improved satisfactorily after 24 h medical interventions in both group, what's more, patients underwent HFNC therapy could acquire a better amelioration when compared with NPPV groups (P < .05). HFNC may be an ideal model for patients with AHF, particularly those with hypoxemia. HFNC therapy could significantly improve several objective parameters of physiological responses and clinical outcomes. Abbreviations: ABG = arterial blood gas, AHF = acute heart failure, APACHE II = physiology and chronic health evaluation-II, FiO 2 = inspired oxygen concentration, HF = heart failure, HFNC = high flow nasal cannula, HR = heart rate, LVEDV = left ventricular end diastolic volume, LVEF = left ventricular ejection fraction, LVESD = left ventricular and systolic diameter, LVESV = left ventricular end systolic volume, NPPV = noninvasive positive pressure ventilation, NT-proBNP = N-terminal pro-B-type natriuretic peptide, PaO 2 = arterial partial pressure of oxygen, RR = respiratory rate, SpO 2 = blood oxygen saturation.