Title: High Flow Nasal Cannula for Hypoxemia<br/>Author: Feras Khan<br/><a href='http://umem.org/profiles/faculty/1145/'>[Click to email author]</a><hr/><p>
<strong>High Flow Nasal Cannula (HFNC) in acute respiratory hypoxemia</strong></p>
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HFNC has been used for a variety of patients with respiratory distress (See previous pearl: https://umem.org/educational_pearls/2411/)</li>
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The benefits include:</li>
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Low levels of positive pressure in the upper airways</li>
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High flow rates, titratable oxygen levels, humidied air, more comfort than NIV</li>
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Decreases physiological dead space by flushing out CO2 therefore improving oxygenation </li>
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A recent trial published in NEJM looked at using HFNC in patients with respiratory failure</li>
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<strong>The Trial:</strong></p>
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Patients <em>without</em> hypercapnia and with acute hypoxemic respiratory failure (PaO2/FiO2 <300 or less) were randomized to HFNC, standard oxygen therapy via face mask, or non-invasive positive pressure ventilation (NIV).</li>
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Primary outcome was proportion of patients intubated at day 28</li>
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310 patients in European ICUs</li>
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<strong>Results:</strong></p>
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Intubation rate (p=0.18): 38% in the HFNC; 47% in the standard group; 50% in the NIV</li>
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Number of ventilator free days at day 28 was significantly higher in the HFNC</li>
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Higher mortality at 90 days with NIV</li>
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No difference in intubation rates but there were more ventilator free dates as well as a lower 90 day mortality</li>
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<strong>Bottom line:</strong></p>
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Consider using HFNC prior to or while deciding on intubation in patients with hypoxemic respiratory failure usually due to pneumonia </p>
<fieldset><legend>References</legend>
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<span role="menubar"><a abstractlink="yes" alsec="jour" alterm="N Engl J Med." aria-expanded="false" aria-haspopup="true" href="http://www.ncbi.nlm.nih.gov/pubmed/25981908#" role="menuitem" style="color: rgb(102, 0, 102); border-bottom-width: 0px;" title="The New England journal of medicine.">N Engl J Med.</a></span> 2015 May 17. [Epub ahead of print]</div>
<h1 style="font-size: 1.231em; margin: 0.375em 0px; line-height: 1.125em; font-family: arial, helvetica, clean, sans-serif;">
High-Flow Oxygen through Nasal Cannula in Acute Hypoxemic Respiratory Failure.</h1>
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<a href="http://www.ncbi.nlm.nih.gov/pubmed/?term=Frat%20JP%5BAuthor%5D&cauthor=true&cauthor_uid=25981908" style="font-size: 0.923em; color: rgb(102, 0, 102); border-bottom-width: 0px;">Frat JP</a><font size="1"><span style="line-height: 15.3344278335571px;"> et al. </span></font><span style="font-size: 0.923em;"> </span><a href="http://www.ncbi.nlm.nih.gov/pubmed/?term=FLORALI%20Study%20Group%20and%20the%20REVA%20Network%5BCorporate%20Author%5D" style="font-size: 0.923em; color: rgb(102, 0, 102); border-bottom-width: 0px;">FLORALI Study Group and the REVA Network</a><span style="font-size: 0.923em;">.</span></div>
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