High-flow nasal cannula therapy: clinical practice in intensive care units

Annals of Intensive Care

for the BoReal study group¹  Emmanuel Besnier²  Julien Maizel³  Damien Du Cheyron⁴  Saad NSeir⁵  Benoit Misset⁶  Christophe Girault⁶  Sinad Hobeika⁶  Fabienne Tamion⁷  Jack Richecoeur⁸  Bertrand Sauneuf⁹  Guillaume Schnell^1,10  Fabien Lambiotte^1,11 

[1] ;Department of Anaesthesiology and Critical Care, Rouen University Hospital;Department of Medical Intensive Care, Amiens University Hospital;Department of Medical Intensive Care, Caen University Hospital;Department of Medical Intensive Care, Lille University Hospital;Department of Medical Intensive Care, Rouen University Hospital;Inserm U1096 EnVi, Normandie Univ, Unirouen;Intensive Care Unit, Beauvais Hospital;Intensive Care Unit, Cherbourg-En-Cotentin Hospital;Intensive Care Unit, Le Havre Hospital;Intensive Care Unit, Valenciennes Hospital;

关键词: Oxygen therapy;    High-flow nasal cannula;    Acute respiratory failure;    Intensive care unit;    Clinical practices;   

DOI  :  10.1186/s13613-019-0569-9

来源: DOAJ

【 摘 要 】

Abstract Background Despite the extensive use of high-flow nasal cannula (HFNC) therapy in intensive care units (ICU) for acute respiratory failure (ARF), its daily clinical practice has not been assessed. We designed a regional survey in ICUs in North-west France to evaluate ICU physicians’ clinical practice with HFNC. Materials and methods We sent an observational survey to ICU physicians from 34 French ICUs over a 6-month period in 2016–2017. The survey included questions regarding the indications and expected efficiency of HFNC, practical aspects of use (initiation, weaning) and satisfaction. Comparisons between junior and senior ICU physicians were performed using a Fischer exact test. Results Among the 235 ICU physicians contacted, 137 responded (58.3%) all of whom regularly used HFNC. Hypoxemic ARF was considered a good indication for HFNC by all 137, but only 30% expected HFNC success (i.e., avoiding intubation in at least 60% of cases). Among hypoxemic indications, 30% of juniors considered acute pulmonary edema a good indication versus 74% of seniors (p < 0.0001). Hypercapnic ARF was considered a good indication by 33% with only 2% expecting HFNC success. A need for conventional oxygen therapy ≥ 6 L/min justified HFNC therapy for 40% and ≥ 9 L/min for 39% of responders. 58% of ICU physicians started HFNC therapy with a FiO2 ≥ 50% and 28% with a gas flow ≥ 50 L/min. Practices for HFNC weaning were heterogeneous: 48% considered a FiO2 ≤ 30%; whereas, 30% considered a FiO2 ≤ 30% with a high flow ≤ 20 L/min. Criteria for HFNC failure (i.e., need for intubation) were ventilatory pauses or arrest (97%), persistent hypoxemia (95%), respiratory acidosis (81%), worsening of breathing (95%, 100% of seniors and 86% of juniors, p = 0.003), bronchial congestion (75%) and circulatory failure (61%, 72% of seniors and 44% of juniors, p = 0.007). Conclusion HFNC is used by ICU physicians in many situations of ARF, despite their relatively low expectations of success, especially in cases of hypercapnia. Clinical practices appear somewhat heterogeneous. Despite the physiological benefit of HFNC, further prospective observational studies are still required on HFNC outcomes and daily practices.

【 授权许可】

Unknown