Changes in arterial blood gases after use of high-flow nasal cannula therapy in the ED - 27/08/15

Doi : 10.1016/j.ajem.2015.07.060

Jin Hee Jeong, MD, Dong Hoon Kim, MD, PhD ^{^⁎} , Seong Chun Kim, MD, Changwoo Kang, MD, Soo Hoon Lee, MD, Tae-Sin Kang, MD, Sang Bong Lee, MD, Sang Min Jung, MD, Dong Seob Kim, MD
Department of Emergency Medicine, Gyeongsang National University School of Medicine, Jinju-si, Gyeongsangnam-do, Republic of Korea

^⁎Corresponding author at: Department of Emergency Medicine, Gyeongsang National University School of Medicine, Chiram-dong, Jinju-si, Gyeongsangnam-do, 660-702, Republic of Korea. Tel.: +82 55 750 8281; fax: +82 55 757 0514.

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Thursday 27 August 2015

Abstract

Introduction

A high-flow nasal cannula (HFNC) has been used to treat patients with dyspnea. We identified changes in arterial blood gas (ABG) of patients visiting the emergency department (ED) with hypercapnic and nonhypercapnic respiratory failure after use of an HFNC.

Methods

This study was a retrospective chart review of patients with respiratory failure who visited the hospital and used an HFNC in the ED. The study period was July 1, 2011, to December 31, 2013. Patients with Paco₂ greater than 45 mm Hg before the HFNC ABG analyses were included in the hypercapnia group; others comprised the nonhypercapnia group. Primary outcomes were the changes in ABG before and after use of an HFNC in the hypercapnia and nonhypercapnia groups. Progression to noninvasive or invasive ventilation and mortality rates were also assessed.

Results

A total of 173 patients were included after exclusion of 92 according to exclusion criteria. Eighty-one patients (hypercapnia group, 46, and nonhypercapnia group, 35) were included. Paco₂ significantly decreased among all patients after use of HFNC (from 54.7 ± 26.4 mm Hg to 51.3 ± 25.8 mm Hg; P = .02), but the reduction was significant only in the hypercapnia group (from 73.2 ± 20.0 to 67.2 ± 23.4; P = .02). Progression to noninvasive or invasive ventilation and mortality rates were similar between the groups.

Conclusions

Use of an HFNC in patients with hypercapnia could show a significant trend of decrease in Paco₂. Progression to noninvasive or invasive ventilation and mortality rates were similar in patients with and without hypercapnia.

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Plan

Introduction

Patients and methods

Study design and setting

Participants

Data collection and setting

Outcomes

Data analysis

Results

Changes in ABG results and respiratory rates

Progression to noninvasive or invasive ventilation and mortality rate

Discussion

Conclusion

☆	Funding source: The authors have no financial relationships relevant to this article to disclose.
☆☆	Financial disclosure: The authors have nothing to disclose.
★	Conflict of interest: The authors have no conflicts of interest to disclose.