Advertisement

Intensive Care Medicine

, Volume 41, Issue 4, pp 623–632 | Cite as

Failure of high-flow nasal cannula therapy may delay intubation and increase mortality

  • Byung Ju Kang
  • Younsuck Koh
  • Chae-Man Lim
  • Jin Won Huh
  • Seunghee Baek
  • Myongja Han
  • Hyun-Suk Seo
  • Hee Jung Suh
  • Ga Jin Seo
  • Eun Young Kim
  • Sang-Bum Hong
Original

Abstract

Purpose

Intubation in patients with respiratory failure can be avoided by high-flow nasal cannula (HFNC) use. However, it is unclear whether waiting until HFNC fails, which would delay intubation, has adverse effects. The present retrospective observational study assessed overall ICU mortality and other hospital outcomes of patients who received HFNC therapy that failed.

Methods

All consecutive patients in one tertiary hospital who received HFNC therapy that failed and who then required intubation between January 2013 and March 2014 were enrolled and classified according to whether intubation started early (within 48 h) or late (at least 48 h) after commencing HFNC.

Results

Of the 175 enrolled patients, 130 (74.3 %) and 45 (25.7 %) were intubated before and after 48 h of HFNC, respectively. The groups were similar in terms of most baseline characteristics. The early intubated patients had better overall ICU mortality (39.2 vs. 66.7 %; P = 0.001) than late intubated patients. A similar pattern was seen with extubation success (37.7 vs. 15.6 %; P = 0.006), ventilator weaning (55.4 vs. 28.9 %; P = 0.002), and ventilator-free days (8.6 ± 10.1 vs. 3.6 ± 7.5; P = 0.011). In propensity-adjusted and -matched analysis, early intubation was also associated with better overall ICU mortality [adjusted odds ratio (OR) = 0.317, P = 0.005; matched OR = 0.369, P = 0.046].

Conclusions

Failure of HFNC might cause delayed intubation and worse clinical outcomes in patients with respiratory failure. Large prospective and randomized controlled studies on HFNC failure are needed to draw a definitive conclusion.

Keywords

Oxygen inhalation therapy Intubation Noninvasive ventilation Oxygen Respiratory insufficiency 

Notes

Conflicts of interest

The authors have no conflicts of interest to declare.

Supplementary material

134_2015_3693_MOESM1_ESM.doc (81 kb)
Supplementary material 1 (DOC 81 kb)

References

  1. 1.
    L’Her E, Deye N, Lellouche F, Taille S, Demoule A, Fraticelli A, Mancebo J, Brochard L (2005) Physiologic effects of noninvasive ventilation during acute lung injury. Am J Respir Crit Care Med 172:1112–1118. doi: 10.1164/rccm.200402-226OC CrossRefPubMedGoogle Scholar
  2. 2.
    Roca O, Riera J, Torres F, Masclans JR (2010) High-flow oxygen therapy in acute respiratory failure. Respir Care 55:408–413PubMedGoogle Scholar
  3. 3.
    Sztrymf B, Messika J, Bertrand F, Hurel D, Leon R, Dreyfuss D, Ricard JD (2011) Beneficial effects of humidified high flow nasal oxygen in critical care patients: a prospective pilot study. Intensive Care Med 37:1780–1786. doi: 10.1007/s00134-011-2354-6 CrossRefPubMedGoogle Scholar
  4. 4.
    Lenglet H, Sztrymf B, Leroy C, Brun P, Dreyfuss D, Ricard JD (2012) Humidified high flow nasal oxygen during respiratory failure in the emergency department: feasibility and efficacy. Respir Care 57:1873–1878. doi: 10.4187/respcare.01575 CrossRefPubMedGoogle Scholar
  5. 5.
    Carratala Perales JM, Llorens P, Brouzet B, Jimenez ARA, Fernandez-Canadas JM, Dalmau JC, Beloqui EN, Forner SR (2011) High-flow therapy via nasal cannula in acute heart failure. Rev Esp Cardiol (Engl Ed) 64:723–725. doi: 10.1016/j.rec.2010.10.035 CrossRefGoogle Scholar
  6. 6.
    Rittayamai N, Tscheikuna J, Rujiwit P (2014) High-flow nasal cannula versus conventional oxygen therapy after endotracheal extubation: a randomized crossover physiologic study. Respir Care 59:485–490. doi: 10.4187/respcare.02397 CrossRefPubMedGoogle Scholar
  7. 7.
    Frat J (2014) Clinical effect of the association of noninvasive ventilation and high flow nasal oxygen therapy in resuscitation of patients with acute lung injury. A randomised study (FLORALI Study). http://clinicaltrials.gov/show/NCT01320384. Accessed 08 01 2015
  8. 8.
    Antonelli M, Bonten M, Chastre J, Citerio G, Conti G, Curtis JR, De Backer D, Hedenstierna G, Joannidis M, Macrae D, Mancebo J, Maggiore SM, Mebazaa A, Preiser JC, Rocco P, Timsit JF, Wernerman J, Zhang H (2012) Year in review in Intensive Care Medicine 2011: III. ARDS and ECMO, weaning, mechanical ventilation, noninvasive ventilation, pediatrics and miscellanea. Intensive Care Med 38:542–556. doi: 10.1007/s00134-012-2508-1 CrossRefPubMedCentralPubMedGoogle Scholar
  9. 9.
    Moretti M, Cilione C, Tampieri A, Fracchia C, Marchioni A, Nava S (2000) Incidence and causes of non-invasive mechanical ventilation failure after initial success. Thorax 55:819–825CrossRefPubMedCentralPubMedGoogle Scholar
  10. 10.
    Kang BJ, Koh Y, Lim CM, Huh JW, Han M, Seo HS, Hong SB (2014) The failure of high flow nasal cannula therapy may cause delayed intubation and mortality. Respirology 19:131Google Scholar
  11. 11.
    Jaderling G, Calzavacca P, Bell M, Martling CR, Jones D, Bellomo R, Konrad D (2011) The deteriorating ward patient: a Swedish-Australian comparison. Intensive Care Med 37:1000–1005. doi: 10.1007/s00134-011-2156-x CrossRefPubMedGoogle Scholar
  12. 12.
    Antonelli M, Bonten M, Chastre J, Citerio G, Conti G, Curtis JR, De Backer D, Hedenstierna G, Joannidis M, Macrae D, Mancebo J, Maggiore SM, Mebazaa A, Preiser JC, Rocco P, Timsit JF, Wernerman J, Zhang H (2012) Year in review in Intensive Care Medicine 2011. II. Cardiovascular, infections, pneumonia and sepsis, critical care organization and outcome, education, ultrasonography, metabolism and coagulation. Intensive Care Med 38:345–358. doi: 10.1007/s00134-012-2467-6 CrossRefPubMedCentralPubMedGoogle Scholar
  13. 13.
    Huh JW, Lim CM, Koh Y, Lee J, Jung YK, Seo HS, Hong SB (2014) Activation of a medical emergency team using an electronic medical recording-based screening system*. Crit Care Med 42:801–808. doi: 10.1097/CCM.0000000000000031 CrossRefPubMedGoogle Scholar
  14. 14.
    Maggiore SM, Idone FA, Vaschetto R, Festa R, Cataldo A, Antonicelli F, Montini L, De Gaetano A, Navalesi P, Antonelli M (2014) Nasal high-flow versus venturi mask oxygen therapy after extubation. Effects on oxygenation, comfort, and clinical outcome. Am J Respir Crit Care Med 190:282–288. doi: 10.1164/rccm.201402-0364OC CrossRefPubMedGoogle Scholar
  15. 15.
    Lind R, Lorem GF, Nortvedt P, Hevroy O (2011) Family members’ experiences of “wait and see” as a communication strategy in end-of-life decisions. Intensive Care Med 37:1143–1150. doi: 10.1007/s00134-011-2253-x CrossRefPubMedCentralPubMedGoogle Scholar
  16. 16.
    Antonelli M, Bonten M, Chastre J, Citerio G, Conti G, Curtis JR, De Backer D, Hedenstierna G, Joannidis M, Macrae D, Mancebo J, Maggiore SM, Mebazaa A, Preiser JC, Rocco P, Timsit JF, Wernerman J, Zhang H (2012) Year in review in intensive care medicine 2011: I. Nephrology, epidemiology, nutrition and therapeutics, neurology, ethical and legal issues, experimentals. Intensive Care Med 38:192–209. doi: 10.1007/s00134-011-2447-2 CrossRefPubMedCentralPubMedGoogle Scholar
  17. 17.
    Reynolds SF, Heffner J (2005) Airway management of the critically ill patient: rapid-sequence intubation. Chest 127:1397–1412. doi: 10.1378/chest.127.4.1397 CrossRefPubMedGoogle Scholar
  18. 18.
    Barr J, Fraser GL, Puntillo K, Ely EW, Gelinas C, Dasta JF, Davidson JE, Devlin JW, Kress JP, Joffe AM, Coursin DB, Herr DL, Tung A, Robinson BR, Fontaine DK, Ramsay MA, Riker RR, Sessler CN, Pun B, Skrobik Y, Jaeschke R, American College of Critical Care M (2013) Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Crit Care Med 41:263–306. doi: 10.1097/CCM.0b013e3182783b72 CrossRefPubMedGoogle Scholar
  19. 19.
    Hilbert G, Gruson D, Vargas F, Valentino R, Gbikpi-Benissan G, Dupon M, Reiffers J, Cardinaud JP (2001) Noninvasive ventilation in immunosuppressed patients with pulmonary infiltrates, fever, and acute respiratory failure. N Engl J Med 344:481–487. doi: 10.1056/NEJM200102153440703 CrossRefPubMedGoogle Scholar
  20. 20.
    Longo DL (2012) Harrison’s principles of internal medicine, 18th edn. McGraw-Hill, New YorkGoogle Scholar
  21. 21.
    Demoule A, Girou E, Richard JC, Taille S, Brochard L (2006) Increased use of noninvasive ventilation in French intensive care units. Intensive Care Med 32:1747–1755. doi: 10.1007/s00134-006-0229-z CrossRefPubMedGoogle Scholar
  22. 22.
    Rosenbaum PR, Rubin DB (1983) The central role of the propensity score in observational studies for causal effects. Biometrika 70:41–55CrossRefGoogle Scholar
  23. 23.
    Gum PA, Thamilarasan M, Watanabe J, Blackstone EH, Lauer MS (2001) Aspirin use and all-cause mortality among patients being evaluated for known or suspected coronary artery disease: a propensity analysis. JAMA 286:1187–1194CrossRefPubMedGoogle Scholar
  24. 24.
    Seung KB, Park DW, Kim YH, Lee SW, Lee CW, Hong MK, Park SW, Yun SC, Gwon HC, Jeong MH, Jang Y, Kim HS, Kim PJ, Seong IW, Park HS, Ahn T, Chae IH, Tahk SJ, Chung WS, Park SJ (2008) Stents versus coronary-artery bypass grafting for left main coronary artery disease. N Engl J Med 358:1781–1792. doi: 10.1056/NEJMoa0801441 CrossRefPubMedGoogle Scholar
  25. 25.
    Ozyilmaz E, Ugurlu AO, Nava S (2014) Timing of noninvasive ventilation failure: causes, risk factors, and potential remedies. BMC Pulm Med 14:19. doi: 10.1186/1471-2466-14-19 CrossRefPubMedCentralPubMedGoogle Scholar
  26. 26.
    Dysart K, Miller TL, Wolfson MR, Shaffer TH (2009) Research in high flow therapy: mechanisms of action. Respir Med 103:1400–1405. doi: 10.1016/j.rmed.2009.04.007 CrossRefPubMedGoogle Scholar
  27. 27.
    Parke R, McGuinness S, Eccleston M (2009) Nasal high-flow therapy delivers low level positive airway pressure. Br J Anaesth 103:886–890. doi: 10.1093/bja/aep280 CrossRefPubMedCentralPubMedGoogle Scholar
  28. 28.
    Ricard JD (2012) High flow nasal oxygen in acute respiratory failure. Minerva Anestesiol 78:836–841PubMedGoogle Scholar
  29. 29.
    O’Driscoll BR, Howard LS, Davison AG, British Thoracic S (2008) BTS guideline for emergency oxygen use in adult patients. Thorax 63 Suppl 6:vi1-68. doi: 10.1136/thx.2008.102947
  30. 30.
    Tiruvoipati R, Lewis D, Haji K, Botha J (2010) High-flow nasal oxygen vs high-flow face mask: a randomized crossover trial in extubated patients. J Crit Care 25:463–468. doi: 10.1016/j.jcrc.2009.06.050 CrossRefPubMedGoogle Scholar
  31. 31.
    Rello J, Perez M, Roca O, Poulakou G, Souto J, Laborda C, Balcells J, Serra J, Masclans JR, Investigators C (2012) High-flow nasal therapy in adults with severe acute respiratory infection: a cohort study in patients with 2009 influenza A/H1N1v. J Crit Care 27:434–439. doi: 10.1016/j.jcrc.2012.04.006 CrossRefPubMedGoogle Scholar
  32. 32.
    Sztrymf B, Messika J, Mayot T, Lenglet H, Dreyfuss D, Ricard JD (2012) Impact of high-flow nasal cannula oxygen therapy on intensive care unit patients with acute respiratory failure: a prospective observational study. J Crit Care 27(324):e313–e329. doi: 10.1016/j.jcrc.2011.07.075 Google Scholar
  33. 33.
    Gristina GR, Antonelli M, Conti G, Ciarlone A, Rogante S, Rossi C, Bertolini G, GiViTI (2011) Noninvasive versus invasive ventilation for acute respiratory failure in patients with hematologic malignancies: a 5-year multicenter observational survey. Crit Care Med 39:2232–2239. doi: 10.1097/CCM.0b013e3182227a27 CrossRefPubMedGoogle Scholar
  34. 34.
    Sousa D, Justo I, Dominguez A, Manzur A, Izquierdo C, Ruiz L, Nebot M, Bayas JM, Celorrio JM, Varona W, Llinares P, Miguez E, Sanchez E, Carratala J (2013) Community-acquired pneumonia in immunocompromised older patients: incidence, causative organisms and outcome. Clin Microbiol Infect 19:187–192. doi: 10.1111/j.1469-0691.2012.03765.x CrossRefPubMedGoogle Scholar
  35. 35.
    Ferra C, Marcos P, Misis M, Morgades M, Bordeje ML, Oriol A, Lloveras N, Sancho JM, Xicoy B, Batlle M, Klamburg J, Feliu E, Ribera JM (2007) Outcome and prognostic factors in patients with hematologic malignancies admitted to the intensive care unit: a single-center experience. Int J Hematol 85:195–202. doi: 10.1532/IJH97.E0625 CrossRefPubMedGoogle Scholar
  36. 36.
    Staudinger T, Stoiser B, Mullner M, Locker GJ, Laczika K, Knapp S, Burgmann H, Wilfing A, Kofler J, Thalhammer F, Frass M (2000) Outcome and prognostic factors in critically ill cancer patients admitted to the intensive care unit. Crit Care Med 28:1322–1328CrossRefPubMedGoogle Scholar
  37. 37.
    Parke RL, McGuinness SP, Eccleston ML (2011) A preliminary randomized controlled trial to assess effectiveness of nasal high-flow oxygen in intensive care patients. Respir Care 56:265–270. doi: 10.4187/respcare.00801 CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2015

Authors and Affiliations

  • Byung Ju Kang
    • 1
  • Younsuck Koh
    • 2
  • Chae-Man Lim
    • 2
  • Jin Won Huh
    • 2
  • Seunghee Baek
    • 3
  • Myongja Han
    • 4
  • Hyun-Suk Seo
    • 4
  • Hee Jung Suh
    • 5
  • Ga Jin Seo
    • 5
  • Eun Young Kim
    • 5
  • Sang-Bum Hong
    • 2
  1. 1.Division of Pulmonary and Critical Care Medicine, Department of Internal MedicineUniversity of Ulsan College of Medicine, Ulsan University HospitalUlsanSouth Korea
  2. 2.Department of Pulmonary and Critical Care MedicineUniversity of Ulsan College of Medicine, Asan Medical CenterSeoulSouth Korea
  3. 3.Department of Clinical Epidemiology and BiostatisticsUniversity of Ulsan College of Medicine, Asan Medical CenterSeoulSouth Korea
  4. 4.Medical Emergency TeamUniversity of Ulsan College of Medicine, Asan Medical CenterSeoulSouth Korea
  5. 5.Intensive Care Nursing Team Respiratory Care UnitUniversity of Ulsan College of Medicine, Asan Medical CenterSeoulSouth Korea

Personalised recommendations