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Use of High-Flow Nasal Cannula Oxygen Therapy in Subjects With ARDS: A 1-Year Observational Study.
Respir Care. 2015 Feb; 60(2):162-9.RC

Abstract

BACKGROUND

Beneficial effects of high-flow nasal cannula (HFNC) oxygen on oxygenation and respiratory parameters have been reported in a small number of subjects with acute respiratory failure (ARF). We aimed to evaluate its effect in subjects with ARDS.

METHODS

This was an observational single-center study. Prospectively obtained data were retrospectively analyzed. All patients admitted over 1 y to a university hospital medicosurgical ICU were included. Classification was according to the highest ventilatory support required. HFNC indications were reviewed, and demographics, clinical characteristics, and course of subjects with ARDS according to intubation need were compared.

RESULTS

Of 607 subjects admitted, 560 required ventilatory or oxygen support, among whom 180 received noninvasive ventilatory support. HFNC was used in 87 subjects and as first-line treatment in 51 subjects (29% of first-line noninvasively treated subjects), 45 of which had ARDS (PaO2 /FIO2 of 137 mm Hg; 22 men, 57.9 y of age). Pneumonia accounted for 82% of ARDS causes. The intubation rate in these subjects was 40%. Higher Simplified Acute Physiology Score II (SAPS II; 46 vs 29, P=.001), occurrence of additional organ failure (76% vs 26%, P=.002), mainly hemodynamic (50% vs 7%, P=.001) or neurological (22% vs 0, P=.01), and trends toward lower PaO2 /FIO2 and higher breathing frequency after HFNC initiation were evidenced in subjects who failed HFNC. Higher SAPS II scores were associated with HFNC failure in multivariate analysis.

CONCLUSIONS

In daily care, over one fourth of subjects requiring noninvasive ventilatory support were treated via HFNC, with a high success rate in subjects with severe ARDS. We conclude that HFNC may be considered as first-line therapy in ARF, including patients with ARDS.

Authors+Show Affiliations

Assistance Publique-Hôpitaux de Paris, Hôpital Louis Mourier, Service de Réanimation Médico-Chirurgicale, Colombes, France. Institut National de la Santé et de la Recherche Médicale, Infection, Antimicrobiens, Modélisation, Evolution, Unité Mixte de Recherche 1137, Paris, France and with Université Paris Diderot, Infection, Antimicrobiens, Modélisation, Evolution, Unité Mixte de Recherche 1137, Sorbonne Paris Cité, Paris, France.Assistance Publique-Hôpitaux de Paris, Hôpital Louis Mourier, Service de Réanimation Médico-Chirurgicale, Colombes, France.Assistance Publique-Hôpitaux de Paris, Hôpital Louis Mourier, Service de Réanimation Médico-Chirurgicale, Colombes, France. Institut National de la Santé et de la Recherche Médicale, Infection, Antimicrobiens, Modélisation, Evolution, Unité Mixte de Recherche 1137, Paris, France and with Université Paris Diderot, Infection, Antimicrobiens, Modélisation, Evolution, Unité Mixte de Recherche 1137, Sorbonne Paris Cité, Paris, France.Assistance Publique-Hôpitaux de Paris, Hôpital Louis Mourier, Service de Réanimation Médico-Chirurgicale, Colombes, France.Assistance Publique-Hôpitaux de Paris, Hôpital Louis Mourier, Service de Réanimation Médico-Chirurgicale, Colombes, France.Assistance Publique-Hôpitaux de Paris, Hôpital Antoine Béclère, Service de Réanimation Médico-Chirurgicale, Clamart, France.Assistance Publique-Hôpitaux de Paris, Hôpital Louis Mourier, Service de Réanimation Médico-Chirurgicale, Colombes, France. Institut National de la Santé et de la Recherche Médicale, Infection, Antimicrobiens, Modélisation, Evolution, Unité Mixte de Recherche 1137, Paris, France and with Université Paris Diderot, Infection, Antimicrobiens, Modélisation, Evolution, Unité Mixte de Recherche 1137, Sorbonne Paris Cité, Paris, France.Assistance Publique-Hôpitaux de Paris, Hôpital Louis Mourier, Service de Réanimation Médico-Chirurgicale, Colombes, France. Institut National de la Santé et de la Recherche Médicale, Infection, Antimicrobiens, Modélisation, Evolution, Unité Mixte de Recherche 1137, Paris, France and with Université Paris Diderot, Infection, Antimicrobiens, Modélisation, Evolution, Unité Mixte de Recherche 1137, Sorbonne Paris Cité, Paris, France. jean-damien.ricard@lmr.aphp.fr.

Pub Type(s)

Journal Article
Observational Study

Language

eng

PubMed ID

25371400

Citation

Messika, Jonathan, et al. "Use of High-Flow Nasal Cannula Oxygen Therapy in Subjects With ARDS: a 1-Year Observational Study." Respiratory Care, vol. 60, no. 2, 2015, pp. 162-9.
Messika J, Ben Ahmed K, Gaudry S, et al. Use of High-Flow Nasal Cannula Oxygen Therapy in Subjects With ARDS: A 1-Year Observational Study. Respir Care. 2015;60(2):162-9.
Messika, J., Ben Ahmed, K., Gaudry, S., Miguel-Montanes, R., Rafat, C., Sztrymf, B., Dreyfuss, D., & Ricard, J. D. (2015). Use of High-Flow Nasal Cannula Oxygen Therapy in Subjects With ARDS: A 1-Year Observational Study. Respiratory Care, 60(2), 162-9. https://doi.org/10.4187/respcare.03423
Messika J, et al. Use of High-Flow Nasal Cannula Oxygen Therapy in Subjects With ARDS: a 1-Year Observational Study. Respir Care. 2015;60(2):162-9. PubMed PMID: 25371400.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Use of High-Flow Nasal Cannula Oxygen Therapy in Subjects With ARDS: A 1-Year Observational Study. AU - Messika,Jonathan, AU - Ben Ahmed,Karim, AU - Gaudry,Stéphane, AU - Miguel-Montanes,Romain, AU - Rafat,Cédric, AU - Sztrymf,Benjamin, AU - Dreyfuss,Didier, AU - Ricard,Jean-Damien, Y1 - 2014/11/04/ PY - 2014/11/6/entrez PY - 2014/11/6/pubmed PY - 2016/5/10/medline KW - acute respiratory failure KW - high flow KW - noninvasive ventilation KW - outcome KW - oxygen therapy SP - 162 EP - 9 JF - Respiratory care JO - Respir Care VL - 60 IS - 2 N2 - BACKGROUND: Beneficial effects of high-flow nasal cannula (HFNC) oxygen on oxygenation and respiratory parameters have been reported in a small number of subjects with acute respiratory failure (ARF). We aimed to evaluate its effect in subjects with ARDS. METHODS: This was an observational single-center study. Prospectively obtained data were retrospectively analyzed. All patients admitted over 1 y to a university hospital medicosurgical ICU were included. Classification was according to the highest ventilatory support required. HFNC indications were reviewed, and demographics, clinical characteristics, and course of subjects with ARDS according to intubation need were compared. RESULTS: Of 607 subjects admitted, 560 required ventilatory or oxygen support, among whom 180 received noninvasive ventilatory support. HFNC was used in 87 subjects and as first-line treatment in 51 subjects (29% of first-line noninvasively treated subjects), 45 of which had ARDS (PaO2 /FIO2 of 137 mm Hg; 22 men, 57.9 y of age). Pneumonia accounted for 82% of ARDS causes. The intubation rate in these subjects was 40%. Higher Simplified Acute Physiology Score II (SAPS II; 46 vs 29, P=.001), occurrence of additional organ failure (76% vs 26%, P=.002), mainly hemodynamic (50% vs 7%, P=.001) or neurological (22% vs 0, P=.01), and trends toward lower PaO2 /FIO2 and higher breathing frequency after HFNC initiation were evidenced in subjects who failed HFNC. Higher SAPS II scores were associated with HFNC failure in multivariate analysis. CONCLUSIONS: In daily care, over one fourth of subjects requiring noninvasive ventilatory support were treated via HFNC, with a high success rate in subjects with severe ARDS. We conclude that HFNC may be considered as first-line therapy in ARF, including patients with ARDS. SN - 1943-3654 UR - https://www.unboundmedicine.com/medline/citation/25371400/Use_of_High_Flow_Nasal_Cannula_Oxygen_Therapy_in_Subjects_With_ARDS:_A_1_Year_Observational_Study_ L2 - http://rc.rcjournal.com/cgi/pmidlookup?view=short&pmid=25371400 DB - PRIME DP - Unbound Medicine ER -