Nasal high-flow oxygen therapy in ICU: A before-and-after study

Area of Science:

• Critical Care Medicine
• Respiratory Therapy

Background:

• Non-intubated intensive care unit (ICU) patients often receive supplemental oxygen via high-flow face mask (HFFM), simple face mask (FM), or nasal prongs (NP).
• High-flow nasal prongs (HFNP) present superior performance capabilities that may meet all oxygen therapy needs for these patients.

Purpose of the Study:

• To evaluate the feasibility, safety, and cost-effectiveness of implementing a protocol prioritizing HFNP for non-intubated ICU patients.
• To assess the impact of HFNP as a primary oxygen delivery device on resource utilization and patient outcomes.

Main Methods:

• A prospective 4-week before-and-after study was conducted in a 22-bed tertiary ICU in Melbourne, Australia.
• The study compared oxygen delivery device usage, costs, and safety outcomes over two periods, 6 months apart, including 117 adult patients.

Main Results:

• HFNP use significantly increased (31.6% to 81.7%), while HFFM, FM, and NP use decreased significantly.
• Post-extubation, HFNP use rose dramatically (8.6% to 87.5%), with significant cost savings per patient (AUD $32.56 vs. $17.62).
• No significant differences in intubation, re-intubation, readmission, or non-invasive ventilation rates were observed between periods.

Conclusions:

• Utilizing HFNP as the primary oxygen delivery method for non-intubated ICU patients is feasible, safe, and cost-effective.
• The study supports further multi-center evaluations of HFNP protocols in non-ventilated ICU patients.