Abstract
Introduction: The use of the high-flow nasal cannula (HFNC) has been poorly evaluated in the Emergency Department (ED) in adults.
Objetives: To describe the change in respiratory rate (RR), heart rate (HR) and dyspnea before and after the use of HFNC. Methods: Retrospective observational study in adult patients presenting to the ED with clinical signs of acute respiratory failure (ARF) and were treated with HFNC. The study period was July 1, 2015, to January 31, 2016. We use a nasal cannula (Optiflow®), a high flow generator (Whisper Flow®), and a one line heated with an active humidification system (Fisher & Paykel®). We measured RR and HR using a multiparameter monitor (Philips®)and evaluated dyspnea using the modified Borg scale, before and after 2 hours using HFNC. Progression to noinvasive or invasive ventilarion and mortality were also assessed. For statistical analysis, the Wilcoxon test for paired samples was used. The results are presented as median and interquartile range.
Results: A total of 19 patients, 10 men and 9 women, with a median of aged 64(55-74) were included. Four of them had a history of COPD and six pulmonary fibrosis. Pneumonia was the first cause of ARF. The initial settings were: gas flow rate of 65(44-70) liters per minute and FiO2 of 0.40(0.31-0.55). We observed a significant reduction of RR [from 29 (23-35) to 19 (17-27) breaths per minute,P=.0002]; HR [from 97(84-107) to 92(83-98) beats per minute,P=.0058] and dyspnea [from 5(3-8) to 3(0-4),P=.0039]. Only one patient required endotracheal intubation and 2 patients non-invasive ventilation. Over a 28-day follow-up, 4 patients died after the limitation of treatment.
Conclusion: we observed that using HFNC in the ED reduced RR, HR and dyspnea.
- Copyright ©the authors 2016