Use of high flow nasal cannula in patients with acute respiratory failure in general wards under intensivists supervision: a single center observational study

被引：13

作者：

Colombo, Sebastiano Maria ^{[1
,2
]}

Scaravilli, Vittorio ^{[1
,3
]}

Cortegiani, Andrea ^{[4
,5
]}

Corcione, Nadia ^{[6
,7
,8
]}

Guzzardella, Amedeo ^{[2
]}

Baldini, Luca ^{[9
,10
]}

Cassinotti, Elisa ^{[11
]}

Canetta, Ciro ^{[9
]}

Carugo, Stefano ^{[9
,12
]}

Hu, Cinzia ^{[9
]}

Fracanzani, Anna Ludovica ^{[2
,13
]}

Furlan, Ludovico ^{[9
,12
]}

Paleari, Maria Chiara ^{[1
,2
]}

Galazzi, Alessandro ^{[14
]}

Tagliabue, Paola ^{[1
]}

Peyvandi, Flora ^{[2
,9
]}

Blasi, Francesco ^{[2
,15
,16
]}

Grasselli, Giacomo ^{[1
,2
]}

机构：

[1] Fdn IRCCS Ca Granda Osped Maggiore Policlin, Dept Anaesthesia & Intens Care Med, Via Sforza 35, I-20122 Milan, Lombardia, Italy

[2] Univ Milan, Dept Pathophysiol & Transplantat, Milan, Lombardia, Italy

[3] Univ Milan, Dept Biomed Surg & Dent Sci, Milan, Lombardia, Italy

[4] Univ Palermo, Dept Surg Oncol & Oral Sci DiChirOnS, Palermo, Sicilia, Italy

[5] Policlin Paolo Giaccone, Dept Anesthesia Intens Care & Emergency, Palermo, Sicilia, Italy

[6] Fdn IRCCS Ca Granda Osped Maggiore Policlin, Resp Unit, Milan, Lombardia, Italy

[7] Fdn IRCCS Ca Granda Osped Maggiore Policlin, Cyst Fibrosis Adult Ctr, Milan, Lombardia, Italy

[8] Azienda Osped Antonio Caldarelli, Intervent Pulmunol, Naples, Campania, Italy

[9] Fdn IRCCS Ca Granda Osped Maggiore Policlin, Dept Internal Med, Milan, Lombardia, Italy

[10] Univ Milan, Dept Oncol & Hematooncol, Milan, Lombardia, Italy

[11] Fdn IRCCS Ca Granda Osped Maggiore Policlin, Dept Surg, Milan, Lombardia, Italy

[12] Univ Milan, Dept Clin Sci & Community Hlth, Milan, Lombardia, Italy

[13] Fdn IRCCS Ca Granda Osped Maggiore Policlin, Unit Internal Med & Metab Dis, Milan, Lombardia, Italy

[14] Fdn IRCCS Ca Granda Osped Maggiore Policlin, Healthcare Profess Dept, Milan, Lombardia, Italy

[15] Fdn IRCCS Ca Granda Osped Maggiore Policlin, Internal Med Dept, Milan, Lombardia, Italy

[16] Fdn IRCCS Ca Granda Osped Maggiore Policlin, Resp Med Unit, Milan, Lombardia, Italy

来源：

RESPIRATORY RESEARCH | 2022年 / 23卷 / 01期

关键词：

HFNC; ARF; AHRF; ICU-supervision; General-wards; Safety; OXYGEN-THERAPY;

D O I：

10.1186/s12931-022-02090-x

中图分类号：

R56 [呼吸系及胸部疾病];

学科分类号：

摘要：

Background Few data exist on high flow nasal cannula (HFNC) use in patients with acute respiratory failure (ARF) admitted to general wards. Rationale and objectives To retrospectively evaluate feasibility and safety of HFNC in general wards under the intensivist-supervision and after specific training. Methods Patients with ARF (dyspnea, respiratory rate-RR > 25/min, 150 < PaO2/FiO(2) < 300 mmHg during oxygen therapy) admitted to nine wards of an academic hospital were included. Gas-exchange, RR, and comfort were assessed before HFNC and after 2 and 24 h of application. Results 150 patients (81 male, age 74 [60-80] years, SOFA 4 [2-4]), 123 with de-novo ARF underwent HFNC with flow 60 L/min [50-60], FiO(2) 50% [36-50] and temperature 34 degrees C [31-37]. HFNC was applied a total of 1399 days, with a median duration of 7 [3-11] days. No major adverse events or deaths were reported. HFNC did not affect gas exchange but reduced RR (25-22/min at 2-24 h, p < 0.001), and improved Dyspnea Borg Scale (3-1, p < 0.001) and comfort (3-4, p < 0.001) after 24 h. HFNC failed in 20 patients (19.2%): 3 (2.9%) for intolerance, 14 (13.4%) escalated to NIV/CPAP in the ward, 3 (2.9%) transferred to ICU. Among these, one continued HFNC, while the other 2 were intubated and they both died. Predictors of HFNC failure were higher Charlson's Comorbidity Index (OR 1.29 [1.07-1.55]; p = 0.004), higher APACHE II Score (OR 1.59 [1.09-4.17]; p = 0.003), and cardiac failure as cause of ARF (OR 5.26 [1.36-20.46]; p = 0.02). Conclusion In patients with mild-moderate ARF admitted to general wards, the use of HFNC after an initial training and daily supervision by intensivists was feasible and seemed safe. HFNC was effective in improving comfort, dyspnea, and respiratory rate without effects on gas exchanges. Trial registration This is a single-centre, noninterventional, retrospective analysis of clinical data.

引用

页数：11

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