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Respiratory management of acute exacerbation of interstitial pneumonia using high-flow nasal cannula oxygen therapy: a single center cohort study.

Background
The role of high-flow nasal cannula oxygen therapy (HFNC) in respiratory management of acute exacerbation of interstitial pneumonia (AE-IP) is unknown.


Methods
We retrospectively reviewed patients with AE-IP who were admitted to our hospital from June 2009 - May 2015 and compared mortality, complications, sedatives and analgesia use, and oral intake between cohorts before (pre-HFNC: June 2009 - May 2012) and after (post-HFNC: June 2012 - May 2015) the introduction of HFNC. In the pre-HFNC cohort, standard oxygen therapy, noninvasive ventilation (NIV), and invasive mechanical ventilation (IMV) were used for respiratory management of AE-IP. In the post-HFNC cohort, HFNC was also used as an alternative to NIV in patients (I) who had refused NIV; (II) unable to cooperate, (III) intolerant to NIV, or (IV) who improved in respiratory parameters after NIV treatment for weaning.


Results
Fifty-three pre-HFNC patients and 43 post-HFNC patients were enrolled. Neither the baseline characteristics at admission nor the major pharmacotherapy for AE-IP differed between the two cohorts. Twenty-eight (52.8%) patients and 19 (44.2%) patients required any respiratory support, in pre- and post-HFNC cohort, respectively (P=0.40). After introduction of HFNC, it was used in 40% of the patients who required respiratory support and NIV use was significantly reduced from 49.1% to 16.3% (P<0.001). The post-HFNC cohort had significantly lower in-hospital mortality than the pre-HFNC cohort (27.9% vs. 49.1%, P=0.04). The incidence of complications was not significantly different between the two cohorts. The use of sedoanalgesia during respiratory support and the number of patients who discontinued oral intake for >24 hours were decreased after the introduction of HFNC (78.6% vs. 31.6%, P<0.001; 52.8% vs. 23.3%, P=0.003).


Conclusions
HFNC might be a feasible option in respiratory management of AE-IP.