Prognostic impact of high flow nasal cannula compared to noninvasive positive-pressure ventilation in the treatment of acute pulmonary edema

Abstract

Funding Acknowledgements Type of funding sources: None. Background The high flow nasal cannula oxygen (HFNC) may offer an alternative to invasive and noninvasive positive pressure ventilation (NIPPV) in patients with acute pulmonary edema (APE) with theoretical advantages related with patient adaptation, comfort and lower need of staff training to achieve optimal therapy. However, clinical efficacy and safety of HFNC is not well established. We aimed to compare the in-hospital clinical outcomes between NIPPV and HFNC in patients without hypercapnia as initial treatment of acute pulmonary edema (APE). Methods In a prospective, observational study, 47 patients treated with HFNC or NIPPV as initial treatment of no-hypercapnic APE were included. Primary endpoint was the composite of death or need for orotracheal intubation within 30 days after admission. Results 47 patients (mean [±SD] age 68.8± 13.1 years, 83% man) were included. 28 (59.6%) patients received HFNC and 19 (40.4%) NIPPV- CPAP as initial treatment to APE. De novo acute heart failure was the initial presentation in 76,6% and 61,7% was secondary to acute coronary syndrome. There was no significant difference in 30-days mortality rates or composite objective of death/intubation in HFNC vs NIPPV (21.5 vs 15.8 p = 0.72) and (37.0 vs 21.1% p= 0.24). However the failure of therapy defined as the combined objective of intubation or change of therapy due to respiratory worsening was more frequent (40.7 vs 15.8 p = 0.07) in HFNC group. Conclusion The HFNC was not associated with increased 30-day mortality in patients with no-hypercapnic EAP, but was associated with no-significant increase of treatment failure secondary to respiratory worsening, despite comparable disease severity and initial treatment. Randomized studies are needed Ends points comparing NIPPV and HFNCVariableOverall (n = 47)CPAP/NIPPVN = 19HFNCn = 28P valueDeath at 30 days (%)19.115.821.50.72Respiratory infection after 48 hours of admission (%)15.226.37.40.107Intubation at 30 days (%)23.915.829.60.32Death or intubation 30 days (%)30.421.137.00.24Intubation or change therapy for worsening RD (%)30.440.715.80.07Length hospital stay (days)11.8 ± 10.912.06 ± 9.611.7 ± 11.80.65Length critical care unit stay(days)5.87 ± 6.86.9 ± 7.25.1 ± 6.50.24RD Respiratory distress