Changes in arterial blood gases after use of high-flow nasal cannula therapy in the ED

• Published in: The American journal of emergency medicine 2015-10, Vol.33 (10), p.1344-1349
• Main Authors: Jeong, Jin Hee, MD, Kim, Dong Hoon, MD, PhD, Kim, Seong Chun, MD, Kang, Changwoo, MD, Lee, Soo Hoon, MD, Kang, Tae-Sin, MD, Lee, Sang Bong, MD, Jung, Sang Min, MD, Kim, Dong Seob, MD
• Format: Article
• Language: English
• Subjects: Aged; Blood; Blood Gas Analysis - instrumentation; Blood Gas Analysis - methods; Catheters - adverse effects; Catheters - statistics & numerical data; Comorbidity; Disease Progression; Electronic Health Records; Emergency; Emergency medical care; Emergency Service, Hospital - statistics & numerical data; Gases; Hospital Mortality; Humans; Hypercapnia - diagnosis; Hypercapnia - etiology; Hypercapnia - therapy; Lung Diseases - complications; Male; Mortality; Oximetry; Oxygen Inhalation Therapy - instrumentation; Oxygen Inhalation Therapy - methods; Respiration, Artificial - methods; Respiration, Artificial - mortality; Respiratory distress syndrome; Respiratory Insufficiency - etiology; Respiratory Insufficiency - mortality; Respiratory Insufficiency - therapy; Respiratory therapy; Retrospective Studies; Ventilation
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2015.07.060

Abstract Introduction A high-flow nasal cannula (HFNC) has been used to treat patients with dyspnea. We identified changes in arterial blood gas (ABG) of patients visiting the emergency department (ED) with hypercapnic and nonhypercapnic respiratory failure after use of an HFNC. Methods This study was a retrospective chart review of patients with respiratory failure who visited the hospital and used an HFNC in the ED. The study period was July 1, 2011, to December 31, 2013. Patients with Pa co2 greater than 45 mm Hg before the HFNC ABG analyses were included in the hypercapnia group; others comprised the nonhypercapnia group. Primary outcomes were the changes in ABG before and after use of an HFNC in the hypercapnia and nonhypercapnia groups. Progression to noninvasive or invasive ventilation and mortality rates were also assessed. Results A total of 173 patients were included after exclusion of 92 according to exclusion criteria. Eighty-one patients (hypercapnia group, 46, and nonhypercapnia group, 35) were included. Pa co2 significantly decreased among all patients after use of HFNC (from 54.7 ± 26.4 mm Hg to 51.3 ± 25.8 mm Hg; P = .02), but the reduction was significant only in the hypercapnia group (from 73.2 ± 20.0 to 67.2 ± 23.4; P = .02). Progression to noninvasive or invasive ventilation and mortality rates were similar between the groups. Conclusions Use of an HFNC in patients with hypercapnia could show a significant trend of decrease in Pa co2 . Progression to noninvasive or invasive ventilation and mortality rates were similar in patients with and without hypercapnia.