J Korean Soc Emerg Med.  2016 Dec;27(6):580-585. 10.0000/jksem.2016.27.6.580.

Factors about Failure after High Flow Oxygen through Nasal Cannula Therapy in Hypoxic Respiratory Failure Patients at Emergency Department Presentation

• Kim HJ
• Lee DW
• Lee JW
• Moon HJ
• Choi JH
• Joeng DK
• Song JH

• KMID: 2369046
• DOI: http://doi.org/10.0000/jksem.2016.27.6.580

Abstract

PURPOSE
High-flow oxygen through a nasal cannula may offer an alternative therapy to patients with respiratory failure. However, a recent study has shown that the success rate of high-flow oxygen through a nasal cannula was only 62%, and the mortality rate for patients who require intubation after failure of high-flow oxygen through a nasal cannula was as high as 32.5%. The aim of this study is to determine the parameters, specifically for emergency department presentation, associated with high-flow oxygen through a nasal cannula failure.
METHODS
A retrospective cohort study was performed in respiratory patients who were admitted between June 2015 and January 2016 at a single university hospital. All patients who were treated with high-flow oxygen through a nasal cannula were included. The exclusion criteria for high-flow oxygen via nasal cannulation were as follows: Hemodynamic instability, hypercapnic coma, inefficient clearance of secretions, and cardiac arrest. Univariable regression analysis was used and, if the p-value was less than 0.10, analyses were entered into a multivariable logistic regression analysis model.
RESULTS
Sixty-two patients were enrolled in our study. High-flow oxygen through a nasal cannula was successful in 33 patients, and 29 required intubation. Older age (over 65 years), Glasgow Coma Scale Score of less than 15, and respiratory rate of more than 30/min were significantly associated with the failure of high-flow oxygen through a nasal cannula according to multivariable analysis (p-value<0.05).
CONCLUSION
Older age, low Glasgow Coma Scale Score, and respiratory rate of more than 30/min are factors associated with the failure of high-flow oxygen through a nasal cannula.

Keyword

Glasgow Coma Scale; Intubation; Respiratory insufficiency

MeSH Terms

Catheterization
Catheters*
Cohort Studies
Coma
Emergencies*
Emergency Service, Hospital*
Glasgow Coma Scale
Heart Arrest
Hemodynamics
Humans
Intubation
Logistic Models
Mortality
Oxygen*
Respiratory Insufficiency*
Respiratory Rate
Retrospective Studies
Oxygen