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 HongEmail author



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.


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.


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].


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.


Oxygen inhalation therapy Intubation Noninvasive ventilation Oxygen Respiratory insufficiency 


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)


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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
    Email author
  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

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