High-Flow Oxygen Cuts Need for Intubation in Acute Respiratory Failure

Fran Lowry

January 25, 2011

January 25, 2011 (San Diego, California) — Humidified high-flow oxygen therapy (HFT) reduces the need for intubation in older children and adults with acute respiratory failure, researchers reported here at the Society of Critical Care Medicine 40th Critical Care Congress.

The technique provides humidification and warmth and can deliver oxygen (up to 40 L/min) with a nasal cannula. It provides inspiratory assistance and expiratory resistance and has been widely used and described in neonates, but little has been published on its use in older children and adults, said Steven B. Johnson, MD, professor of surgery and chief of the Division of Surgical Critical Care at the University of Maryland School of Medicine in Baltimore, in a poster presentation.

It can also provide a more comfortable and effective alternative to bilevel positive airway pressure (BiPAP), he added.

Dr. Johnson and his team retrospectively reviewed prospectively collected data from 211 adults and 120 older children who were admitted to surgical, medical, and pediatric intensive care units at the R. Adams Cowley Shock Trauma Center in Baltimore, and who had received HFT.

Of the 331 patients, 221 (64%) were successfully weaned to low-flow oxygen (4 L/min) with a nasal cannula.

The most common indication for HFT was hypoxia (59.7% of patients), followed by increased work of breathing or shortness of breath (23.6%), and hypoventilation with hypercarbia in (13.1%).

After the start of HFT, 67% of patients with hypoxia were weaned and 25% were intubated; 75% of patients with increased work of breathing or shortness of breath were weaned and 21% were intubated; and 56% of patients with hypoventilation and hypercarbia were weaned and 28% were intubated.

If HFT had not been used, intubation would have occurred in 63 patients (19%). Dr. Johnson noted.

Intubation was avoided in 37 patients, and they were successfully weaned from HFT, he said.

The researchers also found that 188 patients (56.8%) would have been placed on a BiPAP mask. Of these, 120 (64%) were successfully weaned from HFT and only 41 (22%) needed to be intubated.

Only a small proportion (23 of 331 patients; 7%) of HFT patients subsequently required BiPAP. Of the 37 patients on BiPAP prior to HFT, 24 were weaned successfully on HFT and only 5 were returned to BiPAP, Dr. Johnson said.

Just 4 patients (1.2%) were unable to tolerate HFT, he added.

"High-flow therapy via nasal cannula is a significant improvement in noninvasive ventilation for patients with acute respiratory failure," Dr. Johnson told Medscape Medical News after his poster presentation.

"It provides assistance for these patients by allowing them to become more comfortable with improved patient interface, as well as supporting them in their respiratory distress and preventing the need for intubation and for more invasive types of ventilator support," he said.

Alexandre Rotta, MD, director of cardiac critical care at Riley Hospital for Children in Indianapolis, Indiana, who moderated the poster session, told Medscape Medical News that he welcomes these data.

"This is an intriguing study that looks at a technology that has been widely used in pediatric intensive care units. It provides some data in an area that is data-starved," he said. "We are using this technology without having precise studies indicating the effectiveness of the technology. This study certainly advances our knowledge of the field."

Dr. Johnson and Dr. Rotta have disclosed no relevant financial relationships.

Society of Critical Care Medicine (SCCM) 40th Critical Care Congress: Abstract 381. Presented January 18, 2011.


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