Abstract
ObjectivesTo investigate the indications of high-flow nasal cannula (HFNC) oxygen therapy among patients with mild hypercapnia and to explore the predictors of intubation when HFNC fails.MethodsThis retrospective study was conducted based on the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. Adult patients with mild hypercapnia (45 < PaCO2 ≤ 60 mmHg) received either HFNC or non-invasive ventilation (NIV) oxygen therapy. Propensity score matching (PSM) was implemented to increase between-group comparability. The Kaplan–Meier method was used to estimate overall survival and cumulative intubation rates, while 28-day mortality and 48-h and 28-day intubation rates were compared using the Chi-squared test. The predictive performances of HR/SpO2 and the ROX index (the ratio of SpO2/FiO2 to respiratory rate) at 4 h were assessed regarding HFNC failure, which was determined if intubation was given within 48 h after the initiation of oxygen therapy. The area under the receiver operating characteristic curve (AUC) for HR/SpO2 and the ROX index were calculated and compared.ResultsA total of 524,520 inpatient hospitalization records were screened, 106 patients in HFNC group and 106 patients in NIV group were successfully matched. No significant difference in 48-h intubation rate between the HFNC group (the treatment group) and the NIV group (the control group) (14.2% vs. 8.5%, p = 0.278); patients receiving HFNC had higher 28-day intubation rate (26.4% vs. 14.2%, p = 0.029), higher 28-day mortality (17.9% vs. 8.5%, p = 0.043), and longer ICU length of stay (4.4 vs. 3.3 days, p = 0.019), compared to those of NIV group. The AUC of HR/SpO2 at 4 h after the initiation of HFNC yielded around 0.660 for predicting 48-h intubation, greater than that of the ROX index with an AUC of 0.589 (p < 0.01).ConclusionPatients with impending respiratory failure had lower intubation rate, shorter ICU length of stay, and lower mortality when treated mild hypercapnia with NIV over HFNC. As opposed to the ROX index, a modest, yet improved predictive performance is demonstrated using HR/SpO2 in predicting the failure of HFNC among these patients.
Highlights
High-flow nasal cannula (HFNC) oxygen therapy has been widely applied, delivering a heated and humidified high-flow air-oxygen mixture, which has been shown to outperform conventional oxygen therapy [1,2,3]
This study retrospectively analyzed patients derived from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database to investigate the indications of HFNC for patients with mild hypercapnia
Source of Data and Ethics Approval. This retrospective study was conducted based on the MIMIC-IV database [9], consisting of comprehensive and high-quality data of patients admitted to the intensive care unit (ICU) at the Beth Israel Deaconess Medical Center between 2008 and 2019 with pre-existing institutional review board approval
Summary
High-flow nasal cannula (HFNC) oxygen therapy has been widely applied, delivering a heated and humidified high-flow air-oxygen mixture, which has been shown to outperform conventional oxygen therapy [1,2,3]. Several clinical trials have suggested that the effect of HFNC in patients with hypoxemia is not inferior to that of non-invasive ventilation (NIV) [4,5,6]. Only a few studies have reported that HFNC can achieve the same therapeutic effect as NIV among patients with mild hypercapnia [7, 8]. Whether HFNC can replace NIV in treating mild hypercapnia is still unclear, while predictors at an early stage for the outcome of oxygen therapy remain to be explored. This study retrospectively analyzed patients derived from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database to investigate the indications of HFNC for patients with mild hypercapnia. The predictive performance of physiological parameters for the outcome of high-flow therapy was evaluated
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