Proactive Use of High-Flow Nasal Cannula With Critically Ill Subjects
| Autor: | Matthew W Trump, Sheryl M Sahr, Keith D Lamb, Julie A Jackson, Sarah K. Spilman, Trevor W Oetting |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
Pulmonary and Respiratory Medicine
Lung Diseases Male medicine.medical_treatment Critical Illness Population Airway Extubation Critical Care and Intensive Care Medicine medicine.disease_cause 03 medical and health sciences 0302 clinical medicine Clinical Protocols medicine Intubation Intratracheal Intubation Cannula Humans Prospective Studies education Prospective cohort study Hypoxia Aged Mechanical ventilation education.field_of_study business.industry Oxygen Inhalation Therapy 030208 emergency & critical care medicine General Medicine Length of Stay Middle Aged Oxygen Survival Rate Intensive Care Units 030228 respiratory system Respiratory failure Anesthesia Cohort Female business Gram-Negative Bacterial Infections Respiratory Insufficiency Nasal cannula |
| Zdroj: | Respiratory care. 63(3) |
| ISSN: | 1943-3654 |
| Popis: | INTRODUCTION: It has been suggested that use of a high-flow nasal cannula (HFNC) could be a first-line therapy for patients with acute hypoxic respiratory failure. The purpose of this study was to determine if protocolized use of HFNC decreases unplanned intubation and adverse outcomes in an ICU population. METHODS: The study was a prospective evaluation of 2 cohorts who received HFNC per protocol. Control groups were retrospective selections of subjects who received HFNC in the pre-protocol period. Cohort 1 ( n = 88) received mechanical ventilation for ≥ 24 h and was extubated directly to HFNC following strict protocol criteria. Cohort 2 ( n = 83) were placed on HFNC when oxygen requirements escalated (>4 L/min). RESULTS: Cohort 1 did not differ from its control group in mortality, hospital stay, or ICU days, but there were significant decreases in incidence of Gram-negative pulmonary infection (30% vs 9%, P = .001) and use of bronchodilator therapy (81% vs 61%, P = .008). Failed extubation rates were nearly identical across groups, but time to re-intubation was shorter in the protocol group (24 vs 13 h, P = .19). Cohort 2 did not differ significantly from its control group in intubation rates or mortality, but subjects managed by protocol experienced significant decreases in ICU days (4 vs 3 d, P = .03) and hospital days (12 vs 8 d, P = .007). There was a trend toward fewer hours on HFNC (33 vs 24 h, P = .10) and faster time to intubation when HFNC failed (19 vs 9 h, P = .08). CONCLUSIONS: Extubation to HFNC led to a significant decrease in pulmonary infections and bronchodilator therapy in Cohort 1 but did not reduce length of stay or rates of failed extubation. When HFNC was used early and per protocol (Cohort 2), ICU and hospital lengths of stay were reduced and HFNC was initiated more quickly when the need for respiratory support escalated. |
| Databáze: | OpenAIRE |
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