J Korean Med Sci.  2020 Mar;35(10):e67. 10.3346/jkms.2020.35.e67.

High-Flow Nasal Cannula Oxygen Therapy Can Be Effective for Patients in Acute Hypoxemic Respiratory Failure with Hypercapnia: a Retrospective, Propensity Score-Matched Cohort Study

• Bae S
• Han M
• Kim C
• Lee H
• Ahn JJ
• Kim JH
• Kang BJ

• KMID: 2471800
• DOI: http://doi.org/10.3346/jkms.2020.35.e67

Abstract

BACKGROUND
Usually, high-flow nasal cannula (HFNC) therapy is indicated for de novo acute hypoxemic respiratory failure (AHRF). Although only a few researches have examined the effectiveness of HFNC therapy for respiratory failure with hypercapnia, this therapy is often performed under such conditions for various reasons. We investigated the effectiveness of HFNC therapy for AHRF patients with hypercapnia compared to those without hypercapnia.
METHODS
All consecutive patients receiving HFNC therapy between January 2012 and June 2018 at a university hospital were enrolled and classified into nonhypercapnic and hypercapnic groups. We compared the outcomes of both groups and adjusted the outcomes with propensity score matching.
RESULTS
A total of 862 patients were enrolled, of which 202 were included in the hypercapnic group. HFNC weaning success rates were higher, and intensive care unit (ICU) and hospital mortality was lower in the hypercapnic group than in the nonhypercapnic group (all P < 0.05). However, no statistical differences in HFNC weaning success (adjusted P = 0.623, matched P = 0.593), ICU mortality (adjusted P = 0.463, matched P = 0.195), and hospital mortality (adjusted P = 0.602, matched P = 0.579) were noted from the propensity-adjusted and propensity-matched analyses. Additionally, in the propensity score-matched subgroup analysis (according to chronic lung diseases and causes of HFNC application), there was also no significant difference in outcomes between the two groups.
CONCLUSION
In AHRF with underlying conditions, HFNC therapy might be helpful for patients with hypercapnia. Large prospective and randomized controlled trials are required for firm conclusions.

Keyword

Oxygen Inhalation Therapy; Respiratory Insufficiency; Noninvasive Ventilation; Hypercapnia; Propensity Score

MeSH Terms

Catheters*
Cohort Studies*
Hospital Mortality
Humans
Hypercapnia*
Intensive Care Units
Lung Diseases
Mortality
Noninvasive Ventilation
Oxygen Inhalation Therapy
Oxygen*
Propensity Score
Prospective Studies
Respiratory Insufficiency*
Retrospective Studies*
Weaning
Oxygen