Efficacy and safety of high-flow nasal cannula therapy in elderly patients with acute respiratory failure

Pulmonology. 2024 Sep-Oct;30(5):437-444. doi: 10.1016/j.pulmoe.2023.01.004. Epub 2023 Feb 13.

Abstract

Introduction: To assess the efficacy and safety of high-flow nasal cannula (HFNC) in elderly patients with acute respiratory failure (ARF) not due to COVID-19, refractory to treatment with conventional oxygen therapy and/or intolerant to noninvasive ventilation (NIV) or continuous positive airway pressure (CPAP) and without criteria for admission to intensive care units (ICU).

Methods: Prospective observational study of patients with ARF treated with HFNC who presented clinical and arterial blood gas deterioration after 24 h of medical treatment and oxygenation by conventional systems. The degree of dyspnoea, gas exchange parameters (arterial O2 pressure/inspired O2 fraction ratio (PaO2/FiO2); oxygen saturation measured by oximetry/ inspired fraction of oxygen (Sp02/Fi02), ROX index), degree of patient tolerance and mortality were evaluated. These were measured at discharge from the emergency department (ED), 24 h after treatment with conventional oxygenation and 60, 120 min and 24 h after initiation of HFNC. The results were analyzed for all patients as a whole and for patients with hypercapnia (arterial carbon dioxide tension (PaCO2) < 45 mmHg) separately.

Results: 200 patients were included in the study between November 2019 and November 2020, with a mean age of 83 years, predominantly women (61.9%), obese (Body Mass Index (BMI) 31.1), with high comorbidity (Charlson index 4) and mild-moderate degree of dependence (Barthel 60). A number of 128 patients (64%) were hypercapnic. None had respiratory acidosis (pH 7.39). Evaluation at 60 min, 120 min and 24 h showed significant improvement in all patients and in the subgroup of hypercapnic patients with respect to baseline parameters in respiratory rate (RR), dyspnoea, ROX index, PaO2/FiO2, SpO2/FiO2 and patient comfort. No changes in PaCO2 or level of consciousness were observed. HFNC was well tolerated. Ten patients (5%) died due to progression of the disease causing ARF.

Conclusions: HFNC is an effective and safe alternative in elderly patients with ARF not due to COVID-19, refractory to treatment with conventional oxygen therapy and/or intolerant to NIV or CPAP and without criteria for admission to ICU.

Keywords: Acute on chronic respiratory failure; Acute respiratory failure; Elderly; Emergency department; High-flow nasal cannula therapy.

Publication types

  • Observational Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • COVID-19 / complications
  • COVID-19 / therapy
  • Cannula*
  • Female
  • Humans
  • Hypercapnia / etiology
  • Hypercapnia / therapy
  • Male
  • Noninvasive Ventilation / methods
  • Oxygen Inhalation Therapy* / methods
  • Prospective Studies
  • Respiratory Insufficiency* / therapy
  • Treatment Outcome