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High-Flow Nasal Cannula in Early Emergency Department Management of Acute Hypercapnic Respiratory Failure Due to Cardiogenic Pulmonary Edema.
Respir Care. 2020 Sep; 65(9):1241-1249.RC

Abstract

BACKGROUND

Noninvasive ventilation (NIV) is the recommended ventilatory support for acute cardiogenic pulmonary edema (CPE) associated with acute respiratory failure or hypercapnia. High-flow nasal cannula (HFNC) has emerged as an alternative to NIV in acute hypoxemic respiratory failure. We aimed to assess the efficacy of HFNC on early changes in [Formula: see text] and respiratory parameters in patients in the emergency department with acute hypercapnic CPE and to compare it to NIV.

METHODS

We conducted a prospective observational study in consecutive emergency department patients with acute hypercapnic CPE. Subjects received either HFNC or NIV, according to the attending emergency physician's expertise in HFNC. The primary outcome was change in [Formula: see text] after treatment for 1 h. Secondary outcomes were change in pH, breathing frequency, signs of work of breathing, and comparisons to NIV.

RESULTS

Twenty-seven subjects with a discharge diagnosis of hypercapnic CPE were analyzed. Subjects had a median age of 87 y (interquartile range [IQR] 78-93); 37% were male. Twelve (44%) received HFNC, and 15 (56%) received NIV. Median of changes in [Formula: see text] from baseline to after 1 h of treatment were 7 mm Hg (IQR 4-11, P = .002) for HFNC and 3 mm Hg (IQR 1-8, P = .02) for NIV, with no between-group difference. pH, breathing frequency and signs of work of breathing also improved after both HFNC and NIV.

CONCLUSIONS

This preliminary study suggests that HFNC treatment for 1 h improves [Formula: see text] and respiratory parameters in subjects with hypercapnic acute CPE in a manner that is comparable to NIV. Further studies are needed to assess HFNC as a possible alternative to NIV in early management of acute hypercapnic respiratory failure of cardiogenic origin. (ClinicalTrials.gov registration NCT03883555.).

Authors+Show Affiliations

Department of Emergency Medicine and Prehospital Care, Montpellier University Hospital, Montpellier, France.Department of Emergency Medicine and Prehospital Care, Montpellier University Hospital, Montpellier, France.Department of Emergency Medicine and Prehospital Care, Montpellier University Hospital, Montpellier, France.Department of Emergency Medicine and Prehospital Care, Montpellier University Hospital, Montpellier, France.Department of Emergency Medicine and Prehospital Care, Montpellier University Hospital, Montpellier, France.Department of Emergency Medicine and Prehospital Care, Montpellier University Hospital, Montpellier, France.Department of Emergency Medicine and Prehospital Care, Montpellier University Hospital, Montpellier, France.Department of Emergency Medicine and Prehospital Care, Montpellier University Hospital, Montpellier, France.Department of Emergency Medicine and Prehospital Care, Montpellier University Hospital, Montpellier, France. m-sebbane@chu-montpellier.fr.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32291308

Citation

Marjanovic, Nicolas, et al. "High-Flow Nasal Cannula in Early Emergency Department Management of Acute Hypercapnic Respiratory Failure Due to Cardiogenic Pulmonary Edema." Respiratory Care, vol. 65, no. 9, 2020, pp. 1241-1249.
Marjanovic N, Flacher A, Drouet L, et al. High-Flow Nasal Cannula in Early Emergency Department Management of Acute Hypercapnic Respiratory Failure Due to Cardiogenic Pulmonary Edema. Respir Care. 2020;65(9):1241-1249.
Marjanovic, N., Flacher, A., Drouet, L., Gouhinec, A. L., Said, H., Vigneau, J. F., Chollet, B., Lefebvre, S., & Sebbane, M. (2020). High-Flow Nasal Cannula in Early Emergency Department Management of Acute Hypercapnic Respiratory Failure Due to Cardiogenic Pulmonary Edema. Respiratory Care, 65(9), 1241-1249. https://doi.org/10.4187/respcare.07278
Marjanovic N, et al. High-Flow Nasal Cannula in Early Emergency Department Management of Acute Hypercapnic Respiratory Failure Due to Cardiogenic Pulmonary Edema. Respir Care. 2020;65(9):1241-1249. PubMed PMID: 32291308.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - High-Flow Nasal Cannula in Early Emergency Department Management of Acute Hypercapnic Respiratory Failure Due to Cardiogenic Pulmonary Edema. AU - Marjanovic,Nicolas, AU - Flacher,Alexandre, AU - Drouet,Loïc, AU - Gouhinec,Aude Le, AU - Said,Hakim, AU - Vigneau,Jean-François, AU - Chollet,Barbara, AU - Lefebvre,Sophie, AU - Sebbane,Mustapha, Y1 - 2020/04/14/ PY - 2020/4/16/pubmed PY - 2021/2/23/medline PY - 2020/4/16/entrez KW - cardiogenic pulmonary edema/heart failure KW - emergency medicine KW - high-flow nasal cannula KW - noninvasive ventilation KW - respiratory insufficiency SP - 1241 EP - 1249 JF - Respiratory care JO - Respir Care VL - 65 IS - 9 N2 - BACKGROUND: Noninvasive ventilation (NIV) is the recommended ventilatory support for acute cardiogenic pulmonary edema (CPE) associated with acute respiratory failure or hypercapnia. High-flow nasal cannula (HFNC) has emerged as an alternative to NIV in acute hypoxemic respiratory failure. We aimed to assess the efficacy of HFNC on early changes in [Formula: see text] and respiratory parameters in patients in the emergency department with acute hypercapnic CPE and to compare it to NIV. METHODS: We conducted a prospective observational study in consecutive emergency department patients with acute hypercapnic CPE. Subjects received either HFNC or NIV, according to the attending emergency physician's expertise in HFNC. The primary outcome was change in [Formula: see text] after treatment for 1 h. Secondary outcomes were change in pH, breathing frequency, signs of work of breathing, and comparisons to NIV. RESULTS: Twenty-seven subjects with a discharge diagnosis of hypercapnic CPE were analyzed. Subjects had a median age of 87 y (interquartile range [IQR] 78-93); 37% were male. Twelve (44%) received HFNC, and 15 (56%) received NIV. Median of changes in [Formula: see text] from baseline to after 1 h of treatment were 7 mm Hg (IQR 4-11, P = .002) for HFNC and 3 mm Hg (IQR 1-8, P = .02) for NIV, with no between-group difference. pH, breathing frequency and signs of work of breathing also improved after both HFNC and NIV. CONCLUSIONS: This preliminary study suggests that HFNC treatment for 1 h improves [Formula: see text] and respiratory parameters in subjects with hypercapnic acute CPE in a manner that is comparable to NIV. Further studies are needed to assess HFNC as a possible alternative to NIV in early management of acute hypercapnic respiratory failure of cardiogenic origin. (ClinicalTrials.gov registration NCT03883555.). SN - 1943-3654 UR - https://www.unboundmedicine.com/medline/citation/32291308/High_Flow_Nasal_Cannula_in_Early_Emergency_Department_Management_of_Acute_Hypercapnic_Respiratory_Failure_Due_to_Cardiogenic_Pulmonary_Edema_ L2 - http://rc.rcjournal.com/cgi/pmidlookup?view=short&pmid=32291308 DB - PRIME DP - Unbound Medicine ER -