Abstract
Heart failure patients with pulmonary edema presenting to the emergency department (ED) require an effective approach to deliver sufficient oxygen and reduce the rate of intubation and mechanical ventilation in the ED; conventional oxygen therapy has proven ineffective in delivering enough oxygen to the tissues. We aimed to identify whether high-flow nasal cannula (HFNC) therapy over time improved the respiratory rate (RR), lactate clearance, and certain arterial blood gas (ABG) parameters, in comparison with conventional oxygen therapy, in patients with cardiogenic pulmonary edema. This prospective, multi-institutional, and interventional study (clinical trial, reference KCT0004578) conducted between 2016 and 2019 included adult patients diagnosed with heart failure within the previous year and pulmonary edema confirmed at admission. Patients were randomly assigned to the conventional or HFNC group and treated with the goal of maintaining oxygen saturation (SpO2) ≥ 93. We obtained RR, SpO2, lactate levels, and ABG parameters at baseline and 30 and 60 min after randomization. All parameters showed greater improvement with HFNC therapy than with conventional therapy. Significant changes in ABG parameters were achieved within 30 min. HFNC therapy could therefore be considered as initial oxygen therapy. Physicians may consider advanced ventilation if there is no significant improvement in ABG parameters within 30 min of HFNC therapy.
Highlights
Heart failure (HF) is a serious condition associated with high morbidity and mortality [1,2,3]
The inclusion criteria were: age over 19 years with a diagnosis of HF according to the New York Heart Association (NYHA) classification I–IV and the American Heart Association/European Society of Cardiology (AHA/ESC) guidelines within one year of admission; and acute pulmonary edema confirmed by a chest radiograph at admission
We observed that several objective parameters including respiratory rate (RR), lactate levels, SpO2, and arterial blood gas (ABG) parameters (PaCO2, pH, PaO2, pH, HCO3, and SpO2) in the high-flow nasal cannula (HFNC)-treated group clinically improved over time compared with the conventional oxygen therapy group in patients with cardiogenic pulmonary edema
Summary
Heart failure (HF) is a serious condition associated with high morbidity and mortality [1,2,3]. The European Society of Cardiology guidelines for the diagnosis and treatment of acute and chronic heart failure propose the application of noninvasive mechanical ventilation, such as CPAP or NIPPV, to reduce hypercapnia and acidosis and improve the breathing difficulty in dyspneic patients with a respiratory rate of more than 20 breaths/min and acute cardiogenic pulmonary edema (Class IIa recommendation) [1,11] These abovementioned factors have significantly reduced the need for tracheal intubation and mechanical ventilation [3,12,13]. Bilevel NIPPV provides additional inspiratory positive airway pressure and positive end expiratory pressure [14] These devices are more invasive than conventional oxygen therapy using a nasal cannula or face mask, and can pose limitations for use in ED settings for patients with poor compliance, excessive mucus excretion, altered consciousness, or facial anatomical abnormalities (due to surgery or injury) [5,12,15]. CPAP and BiPAP may cause discomfort, leading to failure of treatment and a reduction in cardiac index and venous return in patients with low filling pressure and good ventricular performance [16,17,18]
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