Use Of HFNC Research Articles

High Flow Nasal Cannula Oxygen Therapy (HFNC) With Different Temperatures in COVID-19 Patients: A Randomized Clinical Trial

Background: The effect of using high flow oxygen delivery through the nasal cannula (HFNC) in COVID-19 patients has been associated with different results. This study aimed to evaluate the effect of different HFNC temperatures in COVID-19 patients. Methods: Patients were randomly divided into three groups under high current oxygenation with temperatures of 31, 34, and 37. Except for the temperature, other device settings were set equally. After 24 hours, clinical conditions were on the agenda and compared with the conditions before the intervention. Results: Fever, sore throat, malaise, diarrhea in patients of 31 degree group and indicators of nausea, cough, body pain, headache have changed the most in 37 degree group. Abdominal pain has shown the greatest change in the 34 degree group. PR, DBP, and SpO2 indices changed the most at 31 degrees and RR and SBP at 37 degrees. PR, RR, SBP and SPO2 indices showed significant values in intra-group comparison, and in inter-group comparison, only PR, RR indices had significant differences. In intra-group analysis, PaCO2, WBC, CRP, ESR and ferritin had significant changes, and in inter-group comparison, none of the indicators had significant differences. Conclusion: Based on the results of the present study, reducing the temperature in the use of HFNC can improve the clinical conditions of patients with COVID-19.

A randomized, embedded, pragmatic, Bayesian clinical trial examining clinical decision support for high flow nasal cannula management in children with bronchiolitis: design and statistical analysis plan

BackgroundHigh flow nasal cannula (HFNC) has been increasingly adopted in the past 2 decades as a mode of respiratory support for children hospitalized with bronchiolitis. The growing use of HFNC despite a paucity of high-quality data regarding the therapy’s efficacy has led to concerns about overutilization. We developed an electronic health record (EHR) embedded, quality improvement (QI) oriented clinical trial to determine whether standardized management of HFNC weaning guided by clinical decision support (CDS) results in a reduction in the duration of HFNC compared to usual care for children with bronchiolitis.MethodsThe design and summary of the statistical analysis plan for the REspiratory SupporT for Efficient and cost-Effective Care (REST EEC; “rest easy”) trial are presented. The investigators hypothesize that CDS-coupled, standardized HFNC weaning will reduce the duration of HFNC, the trial’s primary endpoint, for children with bronchiolitis compared to usual care. Data supporting trial design and eventual analyses are collected from the EHR and other real world data sources using existing informatics infrastructure and QI data sources. The trial workflow, including randomization and deployment of the intervention, is embedded within the EHR of a large children’s hospital using existing vendor features. Trial simulations indicate that by assuming a true hazard ratio effect size of 1.27, equivalent to a 6-h reduction in the median duration of HFNC, and enrolling a maximum of 350 children, there will be a > 0.75 probability of declaring superiority (interim analysis posterior probability of intervention effect > 0.99 or final analysis posterior probability of intervention effect > 0.9) and a > 0.85 probability of declaring superiority or the CDS intervention showing promise (final analysis posterior probability of intervention effect > 0.8). Iterative plan-do-study-act cycles are used to monitor the trial and provide targeted education to the workforce.DiscussionThrough incorporation of the trial into usual care workflows, relying on QI tools and resources to support trial conduct, and relying on Bayesian inference to determine whether the intervention is superior to usual care, REST EEC is a learning health system intervention that blends health system operations with active evidence generation to optimize the use of HFNC and associated patient outcomes.Trial registrationClinicalTrials.gov NCT05909566. Registered on June 18, 2023.

A two-tiered high-flow nasal cannula approach does not increase intensive care utilization and hospital length of stay in bronchiolitis

While concerns about high-flow nasal cannula oxygen (HFNC) overuse and associated increased use of hospital resources are rapidly spreading, a two-tiered approach in its use is recommended by recent bronchiolitis guidelines. However, data on its effects in practice have not been reported. We aimed to analyze the trends in use of HFNC, hospitalizations, length of stay (LOS), and intensive care unit (ICU) admissions for bronchiolitis in a tertiary care center using a two-tiered HFNC approach since its introduction in practice. We retrospectively included data of children < 12 months of age who presented to the Paediatric Emergency Department (PED) and were hospitalized for bronchiolitis at our institution in the epidemic season between October 1st and April 30th during the years 2012–2023 and compared the clinical data across the years. Of the 687 hospitalized children included, 79.9% required oxygen supplementation. Use of HFNC significantly increased since its implementation (from 25% in 2012–2013 to over 60% since 2019–2020, p < 0.0001) and was most frequently administered as rescue treatment (in 57.5% of patients). There was no increased trend in ICU admissions (between 1.5% and 10.0% of hospitalizations across seasons, p = 0.40), while LOS, after increasing between 2013 and 2016 (medians between 4.0 and 5.4 days), remained stable thereafter (medians between 3.8 and 4.3 days).Conclusions: The use of HFNC according to a two-tiered approach does not appear to be associated with an increase in ICU utilization or LOS.What is Known:• Bronchiolitis is one of the most common reasons for hospitalization in infants.• Use high-flow nasal canulae oxygen (HFNC) has rapidly spread outside the intensive care unit (ICU) to treat infants with bronchiolitis, although increasing evidence has dampened the initial enthusiasm about their effectiveness.• Concerns nowadays are rising about HFNC overuse and associated increased use of hospital resources, including escalation of care to ICU.What is New:• A more selective use of HFNC according to a “two-tiered approach”, intended as a second-line rescue treatment in non-severely ill children who fail standard oxygen therapy, is not associated with increased ICU and length of hospital stay.

The effect of mechanical ventilation compared to high-flow nasal cannula on gastric residual volume and reflux events using novel automated technology

Background & aimHigh flow nasal cannula (HFNC) oxygen therapy is frequently used following extubation. A case report, utilizing an innovative medical technology (The smART+ Platform, ART MEDICAL Ltd., Netanya, Israel) that enables the detection of gastric refluxes and gastric residual volumes (GRV), has suggested that HFNC may be associated with increased reflux events and GRV. This study measured reflux events and GRV using smART+ in mechanically ventilated patients before and after extubation while they were receiving HFNC therapy. We aim to show if there a significant difference in reflux events and GRV between HFNC users and mechanically ventilated patients. MethodsThis is a post hoc analysis examines data of a randomized controlled trial (RCT) involving critically ill adult patients who received enteral nutrition through the smART+ Platform. The study was approved by the local ethics committee. We compared the frequency and amplitude of reflux events and GRV in mechanically ventilated patients. These parameters were assessed both three hours before extubation and subsequently after extubation when the patients were connected to HFNC. Patients served as their own controls. To evaluate the differences between the pre- and post-extubation measurements, we applied a parametric paired t-test. ResultsTen patients (mean age of 58 years; mean APACHE II score 22; mean 3.9 days mechanical ventilation) were included. Three hours prior extubation the mean GRV was 4.1 ml/h compared to 14.03 ml/h on HFNC (p=0.004). The mean frequency of major reflux events was 2.33/h in ventilated patients versus 4.4/h in the HFNC patients (p=0.73). The mean frequency of major reflux events was 9.17/h in ventilated patients versus 9.83/h in HFNC patients (p=0.14). ConclusionsLeveraging the smART+ Platform, we demonstrated that the use of HFNC significantly increases GRV compared with patients on mechanical ventilation and may increase the frequency of major reflux events, thereby increasing risk of aspiration. Further studies are required to support our conclusions.

Association between high-flow nasal cannula use and mortality in patients with sepsis-induced acute lung injury: a retrospective propensity score-matched cohort study

BackgroundHigh-flow nasal cannula (HFNC) has emerged as a promising noninvasive method for delivering oxygen to critically ill patients, particularly those with sepsis and acute lung injury. However, uncertainties persist regarding its therapeutic benefits in this specific patient population.MethodsThis retrospective study utilized a propensity score-matched cohort from the Medical Information Mart in Intensive Care-IV (MIMIC-IV) database to explore the correlation between HFNC utilization and mortality in patients with sepsis-induced acute lung injury. The primary outcome was 28-day all-cause mortality.ResultsIn the propensity score-matched cohort, the 28-day all-cause mortality rate was 18.63% (95 out of 510) in the HFNC use group, compared to 31.18% (159 out of 510) in the non-HFNC group. The use of HFNC was associated with a lower 28-day all-cause mortality rate (hazard ratio [HR] = 0.53; 95% confidence interval [CI] = 0.41–0.69; P < 0.001). HFNC use was also associated with lower ICU mortality (odds ratio [OR] = 0.52; 95% CI = 0.38–0.71; P < 0.001) and lower in-hospital mortality (OR = 0.51; 95% CI = 0.38–0.68; P < 0.001). Additionally, HFNC use was found to be associated with a statistically significant increase in both the ICU and overall hospitalization length.ConclusionsThese findings indicate that HFNC may be beneficial for reducing mortality rates among sepsis-induced acute lung injury patients; however, it is also associated with longer hospital stays.

242: Prolonged HFNC use for COVID-19 related ARDS prior to VV-ECMO: Single center case series

242: Prolonged HFNC use for COVID-19 related ARDS prior to VV-ECMO: Single center case series

Quality Improvement to Reduce High-Flow Nasal Cannula Overuse in Children With Bronchiolitis.

High-flow nasal cannula oxygen therapy (HFNC) is increasingly used to treat bronchiolitis. However, HFNC has not reduced time on supplemental oxygen, length of stay (LOS), or ICU admission. Our objective was to reduce HFNC use in children admitted for bronchiolitis from 41% to 20% over 2 years. Using quality improvement methods, our multidisciplinary team formulated key drivers, including standardization of HFNC use, effective communication, knowledgeable staff, engaged providers and families, data transparency, and high-value care focus. Interventions included: (1) standardized HFNC initiation criteria, (2) staff education, (3) real-time feedback to providers, (4) a script for providers to use with families about expectations during admission, (5) team huddle for patients admitted on HFNC to discuss necessity, and (6) distribution of a bronchiolitis toolkit. We used statistical process control charts to track the percentage of children with bronchiolitis who received HFNC. Data were compared with a comparison institution not actively involved in quality improvement work around HFNC use to ensure improvements were not secondary to the COVID-19 pandemic alone. Over 10 months of interventions, we saw a decrease in HFNC use for patients admitted with bronchiolitis from 41% to 22%, which was sustained for >12 months. There was no change in HFNC use at the comparison institution. The overall mean LOS for children with bronchiolitis decreased from 60 to 45 hours. We successfully reduced HFNC use in children with bronchiolitis, improving delivery of high-value and evidence-based care. This reduction was associated with a 25% decrease in LOS.

Clinical Observation of Hfnc Use Along With Non-rebreather Mask on Critical Covid-19 Diabetic Patients

Purpose: This study aimed to observe and compare the efficacy of High-flow Nasal Cannula (HFNC) with/without a non-rebreather mask (NRM) on ICU-admitted COVID-19 diabetic patients.&#x0D; Methodology: We collected epidemiological, biochemical, and clinical information from patients (diabetic = 136; non-diabetic = 104) admitted into four hospitals in Chattogram, Bangladesh. SPSS v25 was used to analyze the data with the Chi-Square, Fisher’s Exact, and Independent Samples T-test. We also built regression models to find out the impact of the variables.&#x0D; Results: Most of the patients with fever (59.1%) and hypertension (68.3%) had diabetes. We also noticed diabetic patients stayed in ICU longer (9.06±5.70) than non-diabetic patients (7.41±5.11). Moreover, elevated creatinine level was found in most diabetic cases (70.4%). After only HFNC administration, the partial pressure of oxygen significantly improved in non-diabetic patients. However, both diabetic and non-diabetic patients were observed to have an almost equal partial pressure of oxygen after HFNC with NRM management. Patients with elevated blood sugar additionally needed NRM more than fivefold compared to those with normal blood sugar levels. Besides, age and hypertension were significantly associated with HFNC+NRM-treated diabetic patients.&#x0D; Future Implications: The results of this study imply that oxygen supply with HFNC and NRM may be beneficial for elderly/hypertensive diabetic patients with COVID-19-associated AHRF; and that increased blood glucose level could be a determinant for the need for HFNC + NRM treatment.&#x0D; Bioresearch Commu. 9(2): 1285-1296, 2023 (July)

Modified Respiratory Rate Oxygenation Index: An Early Warning Index for the Need of Intubation in COVID-19 Patients with High-Flow Nasal Cannula Therapy

BackgroundHigh-flow nasal cannula oxygen therapy (HFNC) is recommended for patients with COVID-19. However, the increasing use of HFNC brings a risk of delayed intubation. The optimal timing of switching from HFNC to invasive mechanical ventilation (IMV) remains unclear. An effective predictor is needed to assist in deciding on the timing of intubation. Respiratory rate and oxygenation (ROX) index, defined as (SpO2/FiO2) / respiratory rate, has already shown good diagnostic accuracy. Modified ROX (mROX) index, defined as (PaO2 /FiO2) / respiratory rate, might be better than the ROX index in predicting HFNC failure. ObjectiveThe aim was to evaluate the predictive value of mROX for HFNC failure in patients with COVID-19. MethodsSevere or critical patients with COVID-19 treated with HFNC were enrolled in two clinical centers. Laboratory indicators, respiratory parameters, and mROX index at 0 h and 2 h after initial HFNC were collected. Based on the need for IMV after HFNC initiation, the patients were divided into an HFNC failure group and an HFNC success group. The predictive value of mROX index for IMV was evaluated by the area under the receiver operating characteristic curve (AUROC) and logistic regression analysis. We performed Kaplan–Meier survival analysis using the log-rank test. ResultsSixty patients with COVID-19 (mean ± SD age, 62.8 ± 14.1 years; 42 patients were male) receiving HFNC were evaluated, including 18 critical and 42 severe cases. A total of 33 patients had hypertension; 14 had diabetes; 17 had chronic cardiac disease; 11 had chronic lung disease; 13 had chronic kidney disease; and 17 had a history of stroke. The AUROC of mROX index at 2 h was superior to that of other respiratory parameters to predict the need for IMV (0.959; p < 0.001). At the mROX index cutoff point of 4.45, predicting HFNC failure reached the optimal threshold, with specificity of 94% and sensitivity of 92%. Logistic regression analysis showed that 2-h mROX index < 4.45 was a protective factor for IMV (odd radio 0.18; 95% CI 0.05–0.64; p = 0.008). In the HFNC failure group, the median time from HFNC to IMV was 22.5 h. The 28-day mortality of the late intubation patients (≥ 22.5 h) was higher than that of the early intubation patients (< 22.5 h) (53.8% vs. 8.3%; p = 0.023). ConclusionsmROX at 2 h is a good early warning index of the need for IMV in patients with COVID-19 after HFNC initiation. Early intubation may lead to better survival in patients with 2-h mROX index < 4.45.

Association of serum lipid profile ratios with disease severity and in-hospital outcome of patients with COVID-19

Background: The association of lipid ratios with the severity and hospital outcome of COVID-19 patients has been a topic of interest in the medical community. Lipids, particularly cholesterol and triglycerides, play a significant role in the human body, including cell membrane formation, energy storage and the regulation of various biological processes. The aim of this study was to assess the association of lipid ratio with the severity and hospital outcome of COVID-19 patients. Methods: This observational study was carried out in COVID unit of Bangabandhu Sheikh Mujib Medical University (BSMMU) among hospital admitted COVID patients from March 2021 to February 2022. Results: Total patients were 138 including 65.9% males. Majority (27.5%) were in the 41-50 age group. One third (31.2%) were clinically severe COVID-19. There was overall significant difference of lipid ratio in different severity except LDL/HDL group (p&gt;0.05). The correlation coefficients of disease severity with TC/HDL (rs)=.338, LDL/HDL (rs)=.289 and TG/HDL (rs)=.444. There was significant correlation between disease severity and lipid ratio having moderate correlation with TG/HDL and weak correlation with TC/HDL and LDL/HDL. The correlation coefficients between TC/HDL and hospital outcomes of use/development of rebreather (rs)=.217, HFNC (rs)=.282, ARDS (rs)=.307, arrhythmia (rs) = .201, HDU/ICU (rs)=.200 and ventilator (rs)=.072. There was significant correlation between TC/HDL and development of ARDS, use of rebreather and HFNC and no other significant correlation with other outcomes. The correlation coefficients between LDL/HDL and hospital outcomes of use/development of rebreather (rs)=.211, HFNC (rs)=.132, ARDS (rs)=.286, arrhythmia (rs)=.106, HDU/ICU (rs)=.064 and ventilator (rs)=.028. There was no significant correlation between LDL/HDL and hospital outcomes. The correlation coefficients between TG/HDL and hospital outcomes of use/development of rebreather (rs)=.427, HFNC (rs)=.271, ARDS (rs)=.502, arrhythmia (rs)=.088, HDU/ICU (rs)=.158 and ventilator (rs) =.041. There was significant correlation between TG/HDL and development of ARDS, also with use of rebreather and HFNC. No other significant correlation found with other outcomes. Conclusion: From the findings of this current study, in can be concluded that lipid ratios are associated with disease severity and hospital outcome of COVID-19 patients. There was moderate association between disease severity and TG/HDL and weak association with TC/HDL and LDL/HDL. There was also association between TC/HDL and the development of ARDS and the use of HFNC and between TG/HDL and the development of ARDS, the use of rebreather, and HFNC. BIRDEM Med J 2023; 13(2): 98-102

Association of Insulin Resistance Markers TyG Index, Lipid Ratio &amp; Lipid Accumulation Product (LAP) with the Severity and Hospital Outcome of COVID-19 Patients

Introduction: COVID-19 (Corona virus disease 2019) pandemic has been causing significant morbidity &amp; mortality world-wide. Insulin resistance markers such as TyG index, lipid ratio, and LAP have been studied in relation to the severity and hospital outcome of COVID-19 patients. Early diagnosis with severity assessment and optimum supportive care is the mainstay of treatment. Aim of the Study: The aim of this study was to assess the association of insulin resistance markers TyG index, lipid ratios &amp; lipid accumulation product (LAP) with the severity and hospital outcome of COVID-19 patients. Methods: This prospective observational study was carried out in COVID unit of BSMMU (Bangabandhu Sheikh Mujib Medical University) among hospital admitted COVID patients from March 2021 to February 2022. Total 138 COVID-19 patients were enrolled in this study. Result: Majority of patients (27.5%) was in 41-50 years age group and there was male predominance (65.9%). Majority (31.2%) of the study patients were clinically severe. There is significant correlation between disease severity and IR markers with moderate correlation with LDL/HDL and strong correlation with all other IR markers. There was significant correlation between TC/HDL and development of ARDS and &amp; of HFNC with no other significant correlation with other outcomes. There was no significant correlation between LDL/HDL and hospital outcomes. There was significant correlation between TG/HDL and development of ARDS, also with use of rebreather and HFNC. No other significant correlation found with other outcomes. There was significant correlation between TyG index and use of rebreather &amp; development of ARDS. No other significant correlation found with other outcomes. There was significant correlation between LAP and development of ARDS, use of rebreather &amp; HFNC with no other significant correlation with other outcomes. Conclusion: In conclusion, this study found the insulin resistance markers TyG index. .......

Use of high-flow nasal cannula in patients with COVID-19: A retrospective study

Abstract Background: During COVID-19 pandemia, the healthcare systems all over the world had to confront many different and complicated issues. One of them was the way to support the patients’ respiratory system. Generally, the HFNC therapy was applied in the past for respiratory support, but we did not have studies to establish its efficiency. Therefore, with the recent study, despite the small number of patients, an effort was made to apply the HFNC therapy so as to avoid intubation and invasive mechanical ventilation. Methods: This current study is a retrospective. Patients’ medical data admitted in the Covid – 19 ward from Agios Pavlos General hospital in Thessaloniki from October 25, 2020 to May 25, 2021 were reviewed. General clinical outcomes, the success of HFNC therapy, and related respiratory support methods were evaluated. Results: The present study included 39 patients (27 men and 12 women), whose mean age was 64,5±10,3 years old, 44% of the population had a clear medical history, and 56,4% had some comorbidities. After applying HFNC therapy, 66,7% withdrew successfully, and 33,3% were intubated. The mean time of HFNC therapy is 3,3±2,4 days, while the mean total length of hospitalization was 18,3±10,9. Conclusions: This current study describes the application of HFNC during the COVID-19 pandemia, and the conclusion is that the use of HFNC is an effective way to treat COVID-19 infected patients but under close monitoring. It had been shown that the application of HFNC can reduce the rate of intubation and mortality. Nevertheless, the conclusions of this particular study cannot be generalized.

Comparison of high-flow nasal cannula and conventional oxygen therapy for high-risk patients during bronchoscopy examination: protocol for a randomized controlled trial

IntroductionHigh-flow nasal cannula (HFNC) has been proven to improve oxygenation and avoid intubation in hypoxemic patients. It has also been utilized during endoscopy examination to reduce the incidence of hypoxia. However, little is known about the effects of HFNC versus conventional oxygen therapy (COT) on oxygenation during bronchoscopy examination via nasal route; particularly, no study has compared the use of HFNC with that of COT at similar FIO2 for patients who have high-risk factors of desaturation during bronchoscopy examination.Methods and analysisThis randomized controlled trial will be implemented in four academic centers in China. Patients who have high-risk factors including hypoxemia, hypercapnia, morbid obesity, and narrow airway will be enrolled to use HFNC or COT during bronchoscopy examination. In the HFNC group, the initial gas flow will be set at 50 L/min with a fraction of inspired oxygen (FIO2) at 0.45, if the patient tolerates, the flow can be increased to 60L/min at most, while in the COT group, oxygen flow will be set at 6 L/min via a conventional nasal cannula. After 5 min pre-oxygenation, the bronchoscope will be inserted via the nasal route. Vital signs, oxygenation (SpO2), and transcutaneous CO2 (PtCO2) will be continuously monitored. The primary outcome is the incidence of hypoxemia, defined as SpO2 < 90% for 10 s during bronchoscopy examination, and secondary outcomes include the need for treatment escalation and adverse events.DiscussionHypoxia is a common complication of bronchoscopy, our study attempted to demonstrate that HFNC may reduce the probability of hypoxia during bronchoscopy in high-risk patients. The results will be disseminated through peer-reviewed journals and national and international conferences.Trial registrationhttp://www.chictr.org.cn/: ChiCTR2100055038. Registered on 31 December 2021.

HIGH FLOW NASAL CANNULA OXYGEN THERAPY IN PEDIATRIC PATIENTS

With the spread of clinical applications, the interest in the use of high-flow nasal cannula, which warms and humidifies oxygen with the help of traditional nasal cannula, has increased. Many international protocols on the use of high-flow nasal cannula oxygen therapy (HFNC) are available. This study was conducted to evaluate the oxygen therapy methods used in pediatric services and to specify the roles and responsibilities of nurses in the application of HFNC, one of these methods. Because nurses are responsible for the use of HFNC, monitoring the effectiveness of the treatment, monitoring children during HFNC and helping them to carry out the activities of daily living, HFNC-related nursing approach is of importance.

Use of high-flow nasal cannula oxygen and risk factors for high-flow nasal cannula oxygen failure in critically-ill patients with COVID-19

BackgroundHigh-flow nasal oxygen therapy (HFNC) may be an attractive first-line ventilatory support in COVID-19 patients. However, HNFC use for the management of COVID-19 patients and risk factors for HFNC failure remain to be determined.MethodsIn this retrospective study, we included all consecutive COVID-19 patients admitted to our intensive care unit (ICU) in the first (Mars-May 2020) and second (August 2020- February 202) French pandemic waves. Patients with limitations for intubation were excluded. HFNC failure was defined as the need for intubation after ICU admission. The impact of HFNC use was analyzed in the whole cohort and after constructing a propensity score. Risk factors for HNFC failure were identified through a landmark time-dependent cause-specific Cox model. The ability of the 6-h ROX index to detect HFNC failure was assessed by generating receiver operating characteristic (ROC) curve.Results200 patients were included: HFNC was used in 114(57%) patients, non-invasive ventilation in 25(12%) patients and 145(72%) patients were intubated with a median delay of 0 (0–2) days after ICU admission. Overall, 78(68%) patients had HFNC failure. Patients with HFNC failure had a higher ICU mortality rate (34 vs. 11%, p = 0.02) than those without. At landmark time of 48 and 72 h, SAPS-2 score, extent of CT-Scan abnormalities > 75% and HFNC duration (cause specific hazard ratio (CSH) = 0.11, 95% CI (0.04–0.28), per + 1 day, p < 0.001 at 48 h and CSH = 0.06, 95% CI (0.02–0.23), per + 1 day, p < 0.001 at 72 h) were associated with HFNC failure. The 6-h ROX index was lower in patients with HFNC failure but could not reliably predicted HFNC failure with an area under ROC curve of 0.65 (95% CI(0.52–0.78), p = 0.02). In the matched cohort, HFNC use was associated with a lower risk of intubation (CSH = 0.32, 95% CI (0.19–0.57), p < 0.001).ConclusionsIn critically-ill COVID-19 patients, while HFNC use as first-line ventilatory support was associated with a lower risk of intubation, more than half of patients had HFNC failure. Risk factors for HFNC failure were SAPS-2 score and extent of CT-Scan abnormalities > 75%. The risk of HFNC failure could not be predicted by the 6-h ROX index but decreased after a 48-h HFNC duration.

Acceptability of Deimplementing High-Flow Nasal Cannula in Pediatric Bronchiolitis.

High-flow nasal cannula (HFNC) in children hospitalized with bronchiolitis does not significantly improve clinical outcomes but can increase costs and intensive care unit use. Given widespread HFNC use, it is imperative to reduce use. However, there is limited information on key factors that affect deimplementation. To explore acceptability of HFNC deimplementation, perceptions of HFNC benefits, and identify barriers and facilitators to deimplementation. We conducted a study of health care providers that included quantitative survey data supplemented by semistructured interviews. Data were analyzed using univariate tests and thematic content analysis. A total of 152 (39%) providers completed the survey; 9 participated in interviews. Eighty-three (55%) providers reported feeling positively about deimplementing HFNC. Reports of feeling positively increased as perceived familiarity with evidence increased (P = .04). Physicians were more likely than nurses and respiratory therapists to report feeling positively (P = .003). Hospital setting and years of clinical experience were not associated with feeling positively (P = .98 and .55, respectively). One hundred (66%) providers attributed nonevidence-based clinical benefits to HFNC. Barriers to deimplementation included discomfort with not intervening, perception that HFNC helps, and variation in risk tolerance and clinical experience. Facilitators promoting deimplementation include staff education, a culture of safely doing less, and enhanced multidisciplinary communication. Deimplementation of HFNC in children with bronchiolitis is acceptable among providers. Hospital leaders should educate staff, create a culture for safely doing less, and enhance multidisciplinary communication to facilitate deimplementation.

Effect of high-flow nasal cannula on mechanical ventilator duration in bronchiolitis patients

ObjectivesHigh-flow nasal cannula (HFNC) therapy is a widely used non-invasive respiratory support that may decrease invasive mechanical ventilation. This study evaluated the real-world effect of HFNC on the duration of mechanical ventilation among acute bronchiolitis patients on a nationwide level. MethodsWe retrospectively analyzed bronchiolitis patients (28 days–3 years old) who were admitted to tertiary hospitals for respiratory support from 2012 to 2019 using the Korean National Health Insurance database. We defined the pre-/post-HFNC period as 12 months periods before and after the initiation of HFNC in each hospital, allowing 6 months for a transition period. We compared ventilator-free days (VFDs) of two periods using a multivariable regression model. ResultsIn 45 hospitals, 3359 and 3565 patients of pre-HFNC and post-HFNC periods were evaluated. During the post-HFNC period, 11% of patients used HFNC, and 18.7% used mechanical ventilation. VFDs did not vary in the two periods (26.8 vs. 26.7 days, p = 0.46). In the adjusted model, VFDs did not increase in the post-HFNC period (0.08 days, 95% confidence interval: 0.09, 0.25). HFNC application rate in each hospital was not associated with an increase in mean VFDs of pre- and post-HFNC (p = 0.24). ConclusionsThe application of HFNC did not increase VFDs in bronchiolitis patients in a nationwide tertiary hospital setting. This finding suggests that bronchiolitis patients may not benefit from the routine use of HFNC as rescue therapy in terms of reducing invasive procedures or utilizing resources.

ONE-YEAR REVIEW OF COVID-19 IN THE ICUS OF PHILADELPHIA AREA HOSPITALS

TYPE: Abstract TOPIC: Education, Research, and Quality Improvement PURPOSE: The purpose of this study is to identify different factors associated with trend in mortality in the ICU COVID-19 patients. METHODS: This is a retrospective cohort study of ICU COVID-19 patients admitted over one year at our enterprise. The year was divided into four quarters. Chi-square test, Fisher exact test, Cochran-Mantel-Haenszel method, multinomial logistic regression models, independent sample t-test, Mann-Whitney U test and ANOVA were used. RESULTS: Patients who died were older, had higher prevalence of diabetes. Use of invasive mechanical ventilation, BiPAP and ECMO were associated with higher mortality while high flow nasal cannula, remdesivir and dexamethasone were associated with lower mortality. Length of stay in the ICU and hospital were significantly longer in the patients who died. Mortality was significantly lower in the second quarter of the year compared to first, third and fourth quarters (24% vs. >40 %). CONCLUSIONS: We conclude that mortality of COVID-19 patients in ICU may be associated with the overall ICU burden with other COVID-19 patients at the same time. Although use of HFNC, remdesivir and dexamethasone were found to be associated with increased survival in our study, it did not explain significantly higher mortality in third and fourth quarters of the study period. CLINICAL IMPLICATIONS: Strict measures should be taken to flatten the curve and send critically ill COVID-19 patients to less affected ICUs of the other hospitals of the area. DISCLOSURE: Nothing to declare. KEYWORD: COVID-19

Humidified High Flow Nasal Cannula (HHFNC) Therapy in Critically Ill Children: Nation-Wide Survey

Objective: To determine the experience regarding current practices of HHFNC in terms of techniques uses, indications and complications among severely ill children. Material and methods: This prospective online survey was conducted to examine current HHFNC practice in neonatal and paediatric intensive care units of the Pakistan. There was no agreement in this survey on how to define HFNC in paediatric patients or how to establish or alter flow. An online questionnaire was used for data collection to assess the current HHFNC practice in Pakistan. The survey questionnaire was based on information regarding the hospital, HHFNC use, indications, and the consequences. Furthermore, questions were raised about individual practice and whether or not HHFNC had been established as a safe therapeutic intervention. If a respondent, such as a physician, nurse or the resident had used HHFNC before, additional questions have been asked concerning the indications for usage and the weaning procedure. Statistical analysis was performed using SPSS version 26. Results: The response was received from 204 physicians and nurses. Majority of responders 85% has experienced to used HFNC. 63% of the responders have been using HFNC for more than 3 years. Acute respiratory failure was considered a good indication for HFNC by all 193(95%). Many Physicians used HFNC initiation and weaning protocol. According to the complications the abdominal distension was experienced by 9.8% preteritions, followed by nasal mucosal by 29.4%, irritability 19.16% and Pneumothorax/Barotrauma experienced by 22.5% of the pediatricians, while sedation have experienced while on HFNC by the 15.2% of the participants. According to respondent’s experience the 89% of the parents were satisfied with the use of HFNC and 98.5% of physicians recommended to other colleagues. Conclusions: As per study conclusion this survey presented the first national assessment of the increasing usage of HFNC as a source of oxygen for children, with HFNC being largely acknowledged as a noninvasive and safe technique. There were a variety of indicators. This was the first national review of HFNC's expanding usage in paediatric critical care. Keywords: Pediatric ICU, HHFNC, indication, complications, satisfaction

High flow nasal cannula outside the ICU provides optimal care and maximizes hospital resources for patients with multiple rib fractures

BackgroundHigh flow nasal cannula (HFNC) use reduces work of breathing and improves oxygenation for patients with hypoxemic respiratory failure. Limited prior work has explored protocolized use of HFNC for trauma patients outside the Intensive Care Unit (ICU). The purpose of this study is to describe and evaluate use of HFNC for patients with rib fractures when therapy was standard of care on all floors of the hospital. MethodsIn 2018, the study hospital expanded use of HFNC (AIRVO; Fisher Paykel, Auckland, NZ) to all floors of the hospital, making it available in the ICU, Emergency Department (ED), and on general inpatient floors. The study group included adult patients with three or more rib fractures who received HFNC at any location in the hospital (Phase 2: January 2018-December 2019). The study group was compared to a historical control group when HFNC was available only in the ICU (Phase 1: March 2013-July 2015). Patients were excluded from the study if they received invasive mechanical ventilation prior to HFNC. Primary outcomes were mechanical ventilation rates, ICU days, length of hospitalization, and mortality. ResultsDuring the study period, 63 patients received HFNC, with 35% of patients (n = 22) receiving the duration of therapy outside the ICU. When compared to the control group (N = 63), there were no significant differences in total hospital days (9 vs. 9, p=.64), mechanical ventilation (19% vs. 13%, p=.47), or mortality (3% vs. 5%, p = 1.00). Twenty-seven percent of patients (n = 17) in the study group avoided the ICU during hospitalization. ConclusionsFindings suggest that HFNC therapy can be safely initiated and managed on all hospital floors for patients with multiple rib fractures. Making the therapy available outside the ICU may reduce healthcare resource use without adversely affecting patient outcomes.