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High Flow Nasal Cannula (HFNC) in acute respiratory hypoxemia
- HFNC has been used for a variety of patients with respiratory distress (See previous pearl: https://umem.org/educational_pearls/2411/)
- The benefits include:
- Low levels of positive pressure in the upper airways
- High flow rates, titratable oxygen levels, humidied air, more comfort than NIV
- Decreases physiological dead space by flushing out CO2 therefore improving oxygenation
- A recent trial published in NEJM looked at using HFNC in patients with respiratory failure
The Trial:
- Patients without hypercapnia and with acute hypoxemic respiratory failure (PaO2/FiO2 <300 or less) were randomized to HFNC, standard oxygen therapy via face mask, or non-invasive positive pressure ventilation (NIV).
- Primary outcome was proportion of patients intubated at day 28
- 310 patients in European ICUs
Results:
- Intubation rate (p=0.18): 38% in the HFNC; 47% in the standard group; 50% in the NIV
- Number of ventilator free days at day 28 was significantly higher in the HFNC
- Higher mortality at 90 days with NIV
- No difference in intubation rates but there were more ventilator free dates as well as a lower 90 day mortality
Bottom line:
Consider using HFNC prior to or while deciding on intubation in patients with hypoxemic respiratory failure usually due to pneumonia
References