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1800: NASAL HIGH-FLOW THERAPY IMPROVES OUTCOMES FOR RIB FRACTURE PATIENTS

Introduction/Hypothesis: Nasal high flow (NHF) therapy is an effective therapeutic option for patients with hypoxic respiratory failure that reduces work of breathing and improves oxygenation. There is a paucity of data evaluating NHF in patients with acute hypoxic respiratory failure due to chest trauma, and no prior work has explored protocolized use of NHF outside the Intensive Care Unit (ICU). The purpose of this study is to describe use of NHF for patients with significant chest trauma and to evaluate patient outcomes when the therapy was available on all hospital floors. Methods: In 2018, the study hospital expanded use of NHF (AIRVO-Fisher Paykel, Auckland, NZ) outside the ICU and made it available in the Emergency Department (ED) and on general inpatient floors. Patients were identified and monitored by the respiratory therapy and critical care teams throughout their hospital stay. This study is an ongoing retrospective review of all adult patients with significant chest trauma (defined as 3+ rib fractures, pneumothorax, hemothorax) who received NHF during the study period (Phase 2: January 2018-May 2019). The study group was compared to a historical control group when NHF was available only in the ICU (Phase 1: March 2012-August 2015). Patients were excluded from the study if they received invasive mechanical ventilation (MV) prior to NHF. Primary outcome were MV rates, length of hospitalization, and mortality. Results: To date, 44 patients received NHF during the study period, with one-third of patients starting therapy in the ED. In addition, 18% of patients started therapy in the ICU and transitioned to the floor, while 21% received the duration of therapy on a general inpatient floor. When compared to the control group (N=86), patients in the study group had fewer hospital days (9 vs. 10), fewer ICU days (2 vs. 3), a lower intubation rate (7% vs. 16%), and lower mortality (0% vs. 8%). Conclusions: Study results suggest that NHF therapy can be safely initiated and managed on all hospital floors for patients with significant chest trauma. Preliminary findings suggest that making the therapy available outside the ICU reduces healthcare resource utilization and improves outcomes for this patient population.