Factors Associated With Failure of High-Flow Nasal Cannula

Abstract

BACKGROUND: The use of high-flow nasal cannula (HFNC) is rapidly increasing without clear indications, creating the potential for overuse or misuse and the accompanying risk of adverse events. The purpose of this study was to determine the factors associated with HFNC failure by examining the current clinical practice of HFNC. METHODS: From July 1, 2017, to June 30, 2018, in 5 university-affiliated hospitals in the Republic of Korea, a total of 1,161 admitted adult subjects who had HFNC administered were retrospectively enrolled and their medical records were reviewed. RESULTS: Pulmonary diseases including pneumonia (n 5 757, 65.2%) were the most common reason for use of HFNC. Subjects with do-not-resuscitate (DNR) or do-not-intubate (DNI) orders comprised 33.8% of the study population (n 5 392); 563 subjects (48.5%) were escalated directly to HFNC from low-flow devices without applying reservoir or other high-flow devices. In the non-DNR/DNI subjects, arterial blood gas was not monitored in 15.2% and 14.8% of subjects before and after HFNC application, respectively, and it was not monitored in 28.0% just before HFNC weaning. The HFNC failure rate was 27.0% in non-DNR/DNI subjects, and the HFNC failure was significantly associated with the decision by residents to apply HFNC (odds ratio [OR] 2.03, 95% CI 1.29-3.18, P 5 .002), high breathing frequency (OR 1.07, 95% CI 1.04-1.10, P < .001) 6 h before HFNC application, low S aO 2 (OR 0.92, 95% CI 0.89-0.95, P < .001)^6 h before HFNC application, low S pO 2 (OR 0.95, 95% CI 0.93-0.98, P < .001)^6 h before HFNC application, and the ratio of S pO 2 /F IO 2 to breathing frequency (ROX index)^6 h after HFNC application (OR 0.88, 95% CI 0.84-0.92, P < .001). CONCLUSIONS: HFNC was practiced without applying reservoir or other high-flow devices before application and without appropriate arterial blood gas monitoring during HFNC therapy. HFNC failure was significantly associated with the decision by the resident to use HFNC, breathing frequency, S aO 2 , and S pO 2^6 h before HFNC application, and with the ROX index^6 h after HFNC application.

The effectiveness of high-flow nasal cannula during sedated digestive endoscopy: a systematic review and meta-analysis

“…Four other studies enrolled subjects were of relatively low risk for developing hypoxemia, such as with more people BMI < 30, or were ASA physical status 1 or 2. It seems acceptable to explain the heterogeneity from the perspective of hypoxemia risk during digestive endoscopic sedation, because populations with different hypoxemia risks may respond differently to HFNC [ 23 , 41 , 42 ]. Besides, we also note that hypoxemia in these studies was inconsistently defined.…”

Application of high-flow nasal cannula in hypoxemic patients with COVID-19: a retrospective cohort study

“…Some indicators have been shown to be useful in monitoring oxygenation status in patients with HFNC and in predicting the outcome of HFNC. Oxygen saturation index (SpO 2 /FiO 2 ) and respiratory rate-oxygenation index (ROX index: SpO 2 /FiO 2 *RR) have been reported to be an effective monitoring indicator in the application of HFNC [13][14][15]. However, it is not known whether these indicators are still applicable in COVID-19 patients.…”

Application of high-flow nasal cannula in hypoxemic patients with COVID-19: a retrospective cohort study

“…Some indicators have been shown to be useful in monitoring oxygenation status in patients with HFNC and in predicting the success of HFNC. Oxygen saturation index (SpO 2 /FiO 2 ) and Respiratory rateoxygenation index (ROX index: SpO 2 /FiO 2 *RR) have been reported to be an effective monitoring indicator in the application of HFNC (13)(14)(15) . However, it is not known whether these indicators are still applicable in In this study, we retrospectively analyzed patients with severe COVID-19 using HFNC to evaluate the value of HFNC in COVID-19 and the predictive value of SpO 2 /FiO 2 and ROX index in HFNC use.…”