High-Flow Nasal Cannula Oxygen Therapy Can Be Effective for Patients in Acute Hypoxemic Respiratory Failure with Hypercapnia: a Retrospective, Propensity Score-Matched Cohort Study

Abstract

Background: Usually, high-flow nasal cannula (HFNC) therapy is indicated for de novo acute hypoxemic respiratory failure (AHRF). Although only a few researches have examined the effectiveness of HFNC therapy for respiratory failure with hypercapnia, this therapy is often performed under such conditions for various reasons. We investigated the effectiveness of HFNC therapy for AHRF patients with hypercapnia compared to those without hypercapnia. Methods: All consecutive patients receiving HFNC therapy between January 2012 and June 2018 at a university hospital were enrolled and classified into nonhypercapnic and hypercapnic groups. We compared the outcomes of both groups and adjusted the outcomes with propensity score matching. Results: A total of 862 patients were enrolled, of which 202 were included in the hypercapnic group. HFNC weaning success rates were higher, and intensive care unit (ICU) and hospital mortality was lower in the hypercapnic group than in the nonhypercapnic group (all P < 0.05). However, no statistical differences in HFNC weaning success (adjusted P = 0.623, matched P = 0.593), ICU mortality (adjusted P = 0.463, matched P = 0.195), and hospital mortality (adjusted P = 0.602, matched P = 0.579) were noted from the propensityadjusted and propensity-matched analyses. Additionally, in the propensity score-matched subgroup analysis (according to chronic lung diseases and causes of HFNC application), there was also no significant difference in outcomes between the two groups. Conclusion: In AHRF with underlying conditions, HFNC therapy might be helpful for patients with hypercapnia. Large prospective and randomized controlled trials are required for firm conclusions.

Failure of High-Flow Nasal Cannula Therapy in Pneumonia and Non-Pneumonia Sepsis Patients: A Prospective Cohort Study

“…Post-hoc analysis also showed that HFNC therapy seemed to be better than non-invasive ventilation or standard oxygenation for immunocompromised patients [4]. However, although beneficial effects have been reported for patients with various medical conditions [23][24][25][26][27], HFNC therapy for sepsis patients at risk of hemodynamic instability has not been sufficiently evaluated. Hence, our study is clinically relevant.…”

“…In patients who undergo noninvasive therapy for AHRF, the respiratory rate and oxygenation level are important predictors of respiratory failure and the need for intubation [9,27,33,39]. Tracking dynamic changes in these parameters during HFNC therapy is important [9,39].…”

Comparison of High-Flow Oxygen Treatment and Standard Oxygen Treatment in Hypertensive Pulmonary Edema Patients

“…According to the literature, HFOT is generally explored for patients with acute respiratory distress and supportive results have been suggested ( 19 ). In an animal model experiment comparing HFOT and CPAP, a significant decrement in CO 2 levels with HFOT was observed, and HFOT was suggested as an alternative for CPAP ( 20 ).…”

Cánula nasal de alto flujo en pacientes críticos: una revisión narrativa

“…Utilizaron caudales no superiores a 50 L/min y FiO 2 <0,5 y, al compararlo con SO, observaron una reducción en la concentración de CO 2 . Finalmente, Bae et al 64 evaluaron la eficacia de la CNAF en comparación con pacientes que solo tenían IRA y observaron que la mortalidad hospitalaria y en la UCI sin ajustar era menor en los pacientes con CNAF. Al ajustar estos datos no se encontraron diferencias significativas.…”