From: High-flow nasal cannula support therapy: new insights and improving performance
Condition | Author [ref] | Design | Patients | Main results |
---|---|---|---|---|
Acute respiratory failure (ARF) | Roca et al. [19] | Retrospective cohort | 37 lung transplant recipients readmitted to ICU due to ARF (40 episodes) | The absolute risk reduction for MV with HFNC was 29.8%, and the NNT to prevent one intubation with HFNC was 3. Multivariate analysis showed that HFNC therapy was the only variable at ICU admission associated with a decreased risk of MV (OR 0.11 [95% CI 0.02–0.69]; p = 0.02) |
Frat et al. [20] | Randomized controlled trial | 313 ARF patients randomly assigned to HFNC, conventional oxygen therapy or NIV | The hazard ratio for death at 90 days was 2.01 (95% CI 1.01 to 3.99) with conventional oxygen therapy vs HFNC (p = 0.046) and 2.50 (95% CI, 1.31 to 4.78) with NIV vs HFNC (p = 0.006). In the subgroup of patients with a PaO2/FiO2 ≤ 200 mmHg, the intubation rate was significantly lower in the HFNC group | |
Rello et al. [31] | Retrospective cohort | 35 patients with ARF due to H1N1 viral pneumonia | After 6 h of HFNC, non‐responders had a lower PaO2/FiO2. All 8 patients on vasopressors required intubation | |
Lemiale et al. [29] | Randomized controlled trial | 100 immunocompromised patients with ARF randomized to a 2 h of HFNC vs conventional oxygen | No differences in NIV or invasive MV during the 2 h period were observed. No differences in secondary outcomes (RR, HR, comfort, dyspnea and thirst) were observed | |
Mokart et al. [42] | Retrospective propensity‐score analysis | 178 cancer patients admitted to the ICU due to severe ARF | HFNC‐NIV was associated with more VFD and less septic shock occurrence. Mortality of patients treated with HFNC 35 vs 57% for patients never treated with HFNC, p = 0.008 | |
Kang et al. [30] | Retrospective cohort | 175 patients who failed on HFNC and required intubation | In propensity‐adjusted and ‐matched analysis, early intubation (<48 h) was associated with better overall ICU mortality [adjusted OR = 0.317, p = 0.005; matched OR = 0.369, p = 0.046] | |
Frat et al. [23] | Post‐hoc analysis of a randomized controlled trial | 82 immunocompromised patients of the FLORALI study | NIV was associated with higher risk of intubation and mortality | |
Roca et al. [32] | Prospective cohort | 157 patients with severe pneumonia | ROX index, defined as ratio of SpO2/FiO2 to respiratory rate, ≥ 4.88 measured after 12 h of HFNC was significantly associated with lower risk for MV (HR 0.273 [95% CI 0.121–0.618]) | |
Coudroy et al. [25] | Retrospective cohort | 115 immunocompromised patients | The rates of intubation and 28‐day mortality were significantly higher in patients treated with NIV than with HFNC | |
Cardiac surgery | Parke et al. [18] | Randomized | 60 patients with non‐severe hypoxemic ARF were randomized to receive HFNC or oxygen therapy | HFNC patients tended to need NIV less frequently (10 vs 30%; p = 0.10) and had significantly fewer desaturations (p = 0.009) |
Parke et al. [38] | Randomized controlled trial | 340 patients after cardiac surgery randomized to HFNC vs conventional oxygen therapy for 48 h | No differences in oxygenation on Day 3 after surgery were observed, but HFNC did reduce the requirement for escalation of respiratory support (OR 0.47, 95% CI 0.29–0.7, p = 0.001) | |
Corley et al. [39] | Randomized controlled trial | 155 extubated patients with BMI ≥ 30 kg/m2 received conventional oxygen therapy or HFNC | No difference was seen between groups in atelectasis. There was no difference in mean PaO2/FiO2 ratio or RR. Five patients failed allocated treatment in the control group compared with three in the treatment group (OR 0.53; 95% CI 0.11, 2.24, p = 0.40) | |
Stephan et al. [28] | Randomized noninferiority trial | 830 cardiothoracic surgical patients who developed ARF or were deemed at risk for respiratory failure after extubation. HFNC vs BiPAP | The treatment failed in 87 (21.0%) of 414 patients with HFNC and 91 (21.9%) of 416 patients with BiPAP (p = 0.003). No significant differences were found for ICU mortality (23 patients with BiPAP [5.5%] and 28 with HFNC [6.8%]; p = 0.66) | |
Pre‐intubation | Vourc’h et al. [43] | Randomized controlled trial | 124 patients with PaO2/FIO2 ratio < 300 mmHg, RR ≥ 30 bpm and FIO2 ≥ 0.5. Randomized to HFNC or facial mask | No differences in the lowest saturation was observed (HFNC 91.5% vs high flow facial mask 89.5%; p = 0.44). There was no difference in difficult intubation, VFD, intubation‐related adverse events including desaturation < 80% or mortality |
Post‐extubation | Maggiore et al. [37] | Randomized controlled trial | 105 patients with PaO2/FiO2 ≤ 300 before extubation who were randomized to 48 h of conventional oxygen therapy or HFNC | HFNV improved the PaO2/FiO2 ratio, comfort, airway dryness, episodes of interface displacements, oxygen desaturations, reintubation rate, or any form of ventilator support |
Rittayamai et al. [44] | Randomized crossover study | 17 patients were randomized after extubation to sequential HFNC and conventional oxygen therapy for 30 min periods | At the end of the study, patients with HFNC reported less dyspnea and lower RR and HR. Most of the subjects (88.2%) preferred HFNC to conventional oxygen therapy | |
Tiruvoipati et al. [36] | Randomized crossover study | 50 patients were randomized to sequential HFNC and facial mask after extubation | There was no significant difference in gas exchange, RR or hemodynamics. HFNC was better tolerated (p = 0.01) and tended to be more comfortable (p = 0.09) | |
Hernandez et al. [1] | Randomized controlled trial | 527 extubated patients without any high‐risk factor for reintubation were randomized to either HFNC or conventional oxygen therapy for 24 h | Reintubation within 72 h was less common in the high‐flow group, 4.9 vs 12.2% in the conventional group (p = 0.004). Postextubation respiratory failure was less common in the high‐flow group 8.3 vs 14.4% in the conventional group (p = 0.03) | |
Hernandez et al. [5] | Randomized non‐inferiority trial | 604 extubated patients with at least one high‐risk factor for reintubation were randomized to either HFNC or NIV for 24 h | Reintubation within 72 h was noninferior in the HFNC group compared to the NIV group (22.8 vs 19.1%, absolute difference, −3.7%; 95% CI −9.1% to ∞); postextubation respiratory failure was lower in the HFNC group (26.9 vs 39.8%, risk difference, 12.9%; 95% CI 6.6% to ∞) | |
Invasive procedures | Lucangelo et al. [45] | Randomized controlled trial | 45 patients were randomly assigned to 3 groups: Venturi mask, nasal cannula, and HFNC during bronchoscopy | At the end of bronchoscopy, HFNC‐treated patients had higher PaO2/FiO2, and SpO2 |
Simon et al. [46] | Randomized controlled trial | 40 patients with hypoxemic ARF received NIV or HFNC during bronchoscopy | NIV group had better oxygenation. Two patients with HFNC were unable to proceed to bronchoscopy due to progressive hypoxemia | |
Heart failure | Roca et al. [9] | Prospective cohort | 10 adult patients with NYHA class III and left ventriclar ejection fraction 45% or less | Median inspiratory IVC collapse significantly (p < 0.05) decreased from baseline (37%) to HFNC with 20 l/min (28%) and HFNC with 40 l/min (21%). Changes in IVC inspiratory collapse were reversible |
Emergency department | Rittayamai et al. [15] | Randomized comparative study | 40 hypoxemic patients were randomized to receive HFNC or conventional oxygen for 1 h | HFNC improved dyspnea and comfort. No serious adverse events related to HFNC were observed |
Jones et al. [47] | Randomized controlled trial | 303 hypoxemic and tachypneic patients admitted to the lemergency department | 5.5% of HFNC patients vs 11.6% of conventional oxygen therapy patients required MV within 24 h of admission (p = 0.053) |