Peters, S.G., Holets, S.R., & Gay, P.C. (2013). High-flow nasal cannula therapy in do-not-intubate patients with hypoxemic respiratory distress. Respiratory Care, 58, 597–600.
To document the characteristics of do-not-intubate (DNI) patients on high-flow nasal cannula (HFNC)—Optiflow™—including underlying disease, HFNC FiO2/flows, breathing frequency, oxygen saturation (pre and post HFNC), escalation to noninvasive ventilation (NIV), and hospital mortality for participants
Based on chart review, HFNC therapy was usually started at previous FiO2 and at a flow of 35 L per minute, with flow titrated as tolerated to 45–50 L per minute. FiO2 was ultimately titrated to maintain SaO2 greater than 90%, or according to specific clinical orders. Average changes in oxygen saturation and breathing frequency before and after HFNC were compared. Arterial blood gases were available for all participants at baseline but with variable availability after HFNC. Data were analyzed using closest values prior to HFNC and about one hour after starting HFNC (participants served as their own control).
HFNC reduced hypoxemic respiratory failure in patients with DNI, as well as the need for NIV. HFNC is, therefore, an effective, tolerable, and safe alternative to noninvasive intubation for patients with DNI with hypoxemic respiratory failure.
HFNC has the ability to generate a low level of positive airway pressure with the mouth closed and sufficiently provides oxygenation for patients with hypoxemic respiratory failure.