2011 OPEN FORUM Abstracts
NASAL HIGH FLOW (NHF) THERAPY IN DO-NOT-INTUBATE (DNI) PATIENTS WITH RESPIRATORY DISTRESS.
Steven Holets, Peter Gay, Steve Peters; Mayo Clinic, Rochester, MN
Background: Patients with DNI status, especially those with congestive heart failure (CHF) and chronic obstructive pulmonary disease (COPD), may benefit from non-invasive ventilation (NIV). NHF supplies heated and humidified high flow mixed gas through a nasal cannula which may provide effective support with greater ease of use and patient comfort. We proposed a pilot study to investigate the efficacy and feasibility of NHF administered to DNI patients transferred to the ICU for respiratory distress. Methods: With IRB approval we prospectively evaluated the use of NHF in DNI patients with primarily hypoxemic respiratory distress. We analyzed 50 consecutive patients admitted to a medical ICU and who received NHF. We excluded patients with PaCO2 < 60 mmHg or pH < 7.28. The primary endpoint was the need for escalation to NIV as determined by the primary care physician. Patients served as their own controls and mean changes were compared for statistical significance (p < 0.05 threshold). Results: Patients included 25 men and 25 women, mean age 73 yrs. (range, 27-96). Underlying diagnoses (allowing multiple conditions) included pulmonary fibrosis (23), pneumonia (22), COPD (21), cancer (12), hematologic malignancy (6), CHF (3) and pulmonary embolism (2). Hospital mortality was 56% (28/50). NHF was initiated at FiO2 mean 0.67 (range, 0.30-1.0) and flow rate 42.6 L/min (range, 30-60). Mean O2 saturations went from 89.1% to 94.7% on NHF (p < .0001), and respiratory rate 30.6 per minute to 24.7 (p < .0001). In 8/50 patients (16%), we escalated to NIV, while 84% were maintained on NHF or eventually went to lower flow O2. The mean duration of NHF was 41.9 hours (range, 2-144 hours) Subjectively, NHF was well tolerated. Conclusion: NHF can provide adequate oxygenation for many patients with hypoxemic respiratory distress and may be an alternative to NIV for DNI patients. More widespread NHF use in the hospital ward area might help avoid ICU admissions. Direct comparison in a randomized controlled trial appears warranted. Disclosure: This study was supported in part by Fisher & Paykel.
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