Proactive Use of High-Flow Nasal Cannula With Critically Ill Subjects.
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 pop...
| Publicado en: | Respiratory Care Vol. 63; no. 3; pp. 259 - 267 |
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| Autores principales: | , , , , , |
| Formato: | CEU research tables/charts Journal Article |
| Publicado: |
Mary Ann Liebert, Inc.
Mar2018
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=128238627&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 128238627 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 00201324 4GG jtl: Respiratory Care issn: 00201324 maglogo: N pubinfo: dt: Mar2018 vid: 63 iid: 3 pid: 1365 pub: Mary Ann Liebert, Inc. place: New Rochelle, New York artinfo: ui: 128238627 128238627 128238627 10.4187/respcare.05793 128238627 ppf: 259 ppct: 8 formats: fmt: @attributes: type: P tig: atl: Proactive Use of High-Flow Nasal Cannula With Critically Ill Subjects. aug: au: Lamb, Keith D. Spilman, Sarah K. Oetting, Trevor W. Jackson, Julie A. Trump, Matthew W. Sahr, Sheryl M. affil: Department of Respiratory Therapy, UnityPoint Health, Des Moines, Iowa sug: subj: Nasal Cannula Utilization Critically Ill Patients Oxygen Therapy Respiratory Failure Prevention and Control Education, Continuing (Credit) Human Descriptive Statistics Protocols Intubation Intensive Care Units Prospective Studies Retrospective Design Hospital Mortality Length of Stay P-Value Gram-Negative Bacterial Infections Lung Extubation Time Factors Bronchodilator Agents Therapeutic Use Iowa Respiration, Artificial Data Analysis Software Kruskal-Wallis Test One-Way Analysis of Variance Chi Square Test Middle Age Aged Male Female Middle Aged: 45-64 years Aged: 65+ years Male Female ab: 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. pubtype: Academic Journal doctype: CEU research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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