Beong Ki Kim1, Sua Kim2, Chi Young Kim1, Jaehyung Cha3, Young Seok Lee4, Yousang Ko5, Won Gun Kwack6, So Young Park7, Je Hyeong Kim8,2. 1. Division of Pulmonology, Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea. 2. Department of Critical Care Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea. 3. Medical Science Research Center, Korea University Ansan Hospital, Ansan, Republic of Korea. 4. Division of Respiratory and Critical Care Medicine, Department of Internal Medicine, Korea University Guro Hospital, Seoul, Republic of Korea. 5. Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Kangdong Sacred Heart Hospital, Seoul, Republic of Korea. 6. Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea. 7. Department of Pulmonary and Critical Care Medicine, Chung Nam National University Medical Center, Daejeon, Republic of Korea. 8. Division of Pulmonology, Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea. chepraxis@korea.ac.kr.
Abstract
BACKGROUND: The use of high-flow nasal cannula (HFNC) is rapidly increasing without clear indications, creating the potential for overuse or misuse and the accompanying risk of adverse events. The purpose of this study was to determine the factors associated with HFNC failure by examining the current clinical practice of HFNC. METHODS: From July 1, 2017, to June 30, 2018, in 5 university-affiliated hospitals in the Republic of Korea, a total of 1,161 admitted adult subjects who had HFNC administered were retrospectively enrolled and their medical records were reviewed. RESULTS: Pulmonary diseases including pneumonia (n = 757, 65.2%) were the most common reason for use of HFNC. Subjects with do-not-resuscitate (DNR) or do-not-intubate (DNI) orders comprised 33.8% of the study population (n = 392); 563 subjects (48.5%) were escalated directly to HFNC from low-flow devices without applying reservoir or other high-flow devices. In the non-DNR/DNI subjects, arterial blood gas was not monitored in 15.2% and 14.8% of subjects before and after HFNC application, respectively, and it was not monitored in 28.0% just before HFNC weaning. The HFNC failure rate was 27.0% in non-DNR/DNI subjects, and the HFNC failure was significantly associated with the decision by residents to apply HFNC (odds ratio [OR] 2.03, 95% CI 1.29-3.18, P = .002), high breathing frequency (OR 1.07, 95% CI 1.04-1.10, P < .001) ≤ 6 h before HFNC application, low [Formula: see text] (OR 0.92, 95% CI 0.89-0.95, P < .001) ≤ 6 h before HFNC application, low [Formula: see text] (OR 0.95, 95% CI 0.93-0.98, P < .001) ≤ 6 h before HFNC application, and the ratio of [Formula: see text]/[Formula: see text] to breathing frequency (ROX index) ≤ 6 h after HFNC application (OR 0.88, 95% CI 0.84-0.92, P < .001). CONCLUSIONS: HFNC was practiced without applying reservoir or other high-flow devices before application and without appropriate arterial blood gas monitoring during HFNC therapy. HFNC failure was significantly associated with the decision by the resident to use HFNC, breathing frequency, [Formula: see text], and [Formula: see text] ≤ 6 h before HFNC application, and with the ROX index ≤ 6 h after HFNC application.
BACKGROUND: The use of high-flow nasal cannula (HFNC) is rapidly increasing without clear indications, creating the potential for overuse or misuse and the accompanying risk of adverse events. The purpose of this study was to determine the factors associated with HFNC failure by examining the current clinical practice of HFNC. METHODS: From July 1, 2017, to June 30, 2018, in 5 university-affiliated hospitals in the Republic of Korea, a total of 1,161 admitted adult subjects who had HFNC administered were retrospectively enrolled and their medical records were reviewed. RESULTS:Pulmonary diseases including pneumonia (n = 757, 65.2%) were the most common reason for use of HFNC. Subjects with do-not-resuscitate (DNR) or do-not-intubate (DNI) orders comprised 33.8% of the study population (n = 392); 563 subjects (48.5%) were escalated directly to HFNC from low-flow devices without applying reservoir or other high-flow devices. In the non-DNR/DNI subjects, arterial blood gas was not monitored in 15.2% and 14.8% of subjects before and after HFNC application, respectively, and it was not monitored in 28.0% just before HFNC weaning. The HFNC failure rate was 27.0% in non-DNR/DNI subjects, and the HFNC failure was significantly associated with the decision by residents to apply HFNC (odds ratio [OR] 2.03, 95% CI 1.29-3.18, P = .002), high breathing frequency (OR 1.07, 95% CI 1.04-1.10, P < .001) ≤ 6 h before HFNC application, low [Formula: see text] (OR 0.92, 95% CI 0.89-0.95, P < .001) ≤ 6 h before HFNC application, low [Formula: see text] (OR 0.95, 95% CI 0.93-0.98, P < .001) ≤ 6 h before HFNC application, and the ratio of [Formula: see text]/[Formula: see text] to breathing frequency (ROX index) ≤ 6 h after HFNC application (OR 0.88, 95% CI 0.84-0.92, P < .001). CONCLUSIONS:HFNC was practiced without applying reservoir or other high-flow devices before application and without appropriate arterial blood gas monitoring during HFNC therapy. HFNC failure was significantly associated with the decision by the resident to use HFNC, breathing frequency, [Formula: see text], and [Formula: see text] ≤ 6 h before HFNC application, and with the ROX index ≤ 6 h after HFNC application.
Authors: Amit Kansal; Wei Jun Dan Ong; Shekhar Dhanvijay; Arbe Tisha Pepito Siosana; Loraine Mae Padillo; Chee Keat Tan; Monika Gulati Kansal; Faheem Ahmed Khan Journal: BMC Pulm Med Date: 2022-09-16 Impact factor: 3.320