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High-flow oxygen by nasal cannula: experience of an intensive care unit

Introduction: High-flow oxygen through nasal cannula (HFNC) is an increasingly used therapy that allows high flows and fractions of inspired oxygen (FiO2) at a more physiological level of temperature and humidity. Objectives: To analyze the experience with HFNC in acute respiratory failure in a respiratory intensive care unit (ICU). Methods: Retrospective analysis of patients who underwent HFNC in the ICU of the Central Hospital of Lisbon over 52 months. Results: A total of 43 patients were identified, 70% of whom were men, with a mean age of 60.8±19.7 years. The main cause of admission to the ICU was pneumonia (58.1%) followed by pulmonary hypertension (16.3%). The main comorbidities were interstitial lung disease, chronic heart failure and emphysema (32.6%, 23.3% and 20.9%, respectively). The mean use of HFNC was 7.6±5.9 days, with maximum flow and FiO2 averaging 45L/min and 99%, respectively. In 25 patients (58.1%), HFNC was alternated with non-invasive ventilation (NIV). Mean paO2/FiO2 values were higher at the end of treatment (100.9mmHg vs 120.7mmHg), although the difference was not statistically significant (p = 0.128); there was a significant increase in paCO2 at the end of treatment (40.7mmHg vs. 47.3mmHg, p = 0.011). Three patients (7.0%) stopped treatment due to discomfort associated with it. The success of HFNC was achieved in 68% of the pneumonias (n=17). The failure of HFNC, defined as intubation and/or death, occurred in 21 patients (48.8%), 19 of whom died (44.2%). There were no differences in the TISS28, SOFA and APACHE scores between the successful groups and failure of the HFNC. Conclusions: In this study, HFNC was globally well tolerated both continuously and alternately with NIV. Its efficacy was higher in pneumonias, and intubation was avoided in most cases.