Abstract
Background: High-flow nasal cannula (HFNC) oxygen is becoming an integral part of respiratory failure management. Effects of HFNC on arterial blood gas (ABG) parameters especially partial carbon dioxide (PaCO2) require further investigation to provide insight into the efficacy and safety of the treatment.Methods: Acute respiratory failure patients with sequential ABG parameters before and after initiating HFNC between June 2015 and June 2017 were analyzed in a tertiary academic center. Patients' baseline characteristics were evaluated and sequential ABG changes were compared and subgrouped as chronic obstructive pulmonary disease (COPD), respiratory acidosis, hypercapnia, and high lactate.Results: A total of 120 patients were enrolled in the study. There was a significant difference between the mean partial pressure of oxygen in arterial blood (PaO2), lactate, and peripheral oxygen saturation (SpO2) values between sequential ABGs after HFNC (P <0.001). In the COPD group (n=32), there was a significant difference between initial ABG means of PaO2, lactate, and SpO2 values and sequential ABG means (p<0.001). Hypercapnic patients PaCO2 levels were significantly lower after HFNC (p<0.001), while in the COPD group there was no significant change in PaCO2 values (p=0.068).Conclusions: Treatment with HFNC produced improvement of blood gas parameters in subjects with acute respiratory failure in the emergency department (ED). These results suggest that HFNC can be used in hypercapnic patients as well as hypoxemic patients. Further randomized controlled studies required to establish the impact of HFNC in the ED.
Highlights
High-flow nasal cannula (HFNC) oxygen has been used as an adjunct treatment of patients with acute respiratory failure in the emergency departments (ED) and intensive care units
We aimed to examine the changes in arterial blood gas (ABG) parameters with HFNC in ED which would provide insight into the safety and efficiency of the treatment
Chronic hypercapnia patients were not differentiated from acute hypercapnia patients in our study, but as illustrated in Figure 2, most patients with hypercapnia had their PaCO2 reduced by HFNC, our data suggests whether PaCO2 levels increased chronic or in acute settings, most patients with hypercapnia might benefit from HFNC in ED
Summary
High-flow nasal cannula (HFNC) oxygen has been used as an adjunct treatment of patients with acute respiratory failure in the emergency departments (ED) and intensive care units. HFNC delivers humidified and heated air-oxygen mixture at flow rates up to 60 L/min, through a nasal cannula. Physiological short term effects of HFNC include reducing partial carbon dioxide (PaCO2) as well as improving oxygenation. While supplemental oxygen administration is still considered the first-line treatment of acute respiratory failure (ARF), HFNC provides advantages such as high-flow rates parallel to patients’ inspiratory flow creating positive end-expiratory pressure (PEEP) [1,2], reducing anatomic dead space [3], providing humidified and heated air which improves CO2 excretion [4], sputum clearance, and mucociliary motion [5]. Effects of HFNC on arterial blood gas (ABG) parameters especially partial carbon dioxide (PaCO2) require further investigation to provide insight into the efficacy and safety of the treatment
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
