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Efficacy of high-flow nasal cannula therapy in bedridden patients
Kenji Inoue1, Tomohiro Kumada1, Tatsuya Fujii1
1Department of Pediatrics, Shiga Medical Center for Children, Moriyama, Japan.
Insights
High-flow nasal cannula therapy (HFNC) effectively treats bedridden patients with acute respiratory distress. Close monitoring and the option to switch to non-invasive positive pressure ventilation are crucial for optimal outcomes.
Area of Science:
- Respiratory Medicine
- Critical Care
Background:
- High-flow nasal cannula therapy (HFNC) is established for pediatric acute respiratory distress.
- Efficacy of HFNC in bedridden adults with acute respiratory distress is not well-documented.
Purpose of the Study:
- To evaluate the effectiveness of HFNC in bedridden patients experiencing acute respiratory distress.
Main Methods:
- Retrospective review of 25 bedridden patients treated with HFNC via home ventilator (CPAP mode).
- Assessment of cardiorespiratory parameters and distress symptoms pre- and post-HFNC initiation.
- Monitoring for need of escalation to non-invasive positive pressure ventilation.
Main Results:
- Significant improvements observed in heart rate, respiratory rate, oxygen saturation, and CO2 levels (P < 0.05).
- Respiratory distress symptoms ameliorated in most patients within 1-3 hours.
- Two patients required immediate switch to non-invasive ventilation; five episodes necessitated later escalation.
Conclusions:
- HFNC with a home ventilator in CPAP mode is a viable treatment for bedridden patients with acute respiratory distress.
- Readiness to transition to non-invasive positive pressure ventilation is essential for managing treatment failures or deterioration.
Background:
A growing number of studies have demonstrated the efficacy of high-flow nasal cannula therapy (HFNC) for treating children with acute respiratory distress. However, it remains unknown whether HFNC is effective in bedridden patients with acute respiratory distress.
Method:
We retrospectively reviewed the medical records of bedridden patients with acute respiratory distress who were treated with HFNC using a home ventilator in continuous positive airway pressure mode at our center between March 2014 and August 2016. We assessed heart rate, respiratory rate, oxygen saturation measured using a pulse oximeter, the partial pressure of venous carbon dioxide, or the transcutaneous partial pressure of carbon dioxide, and symptoms of respiratory distress before and after the initiation of HFNC.
Results:
During the 2-year-study period, 25 patients were treated with HFNC. The patients' mean heart rate, respiratory rate, oxygen saturation measured using a pulse oximeter, and pressure of venous carbon dioxide/the transcutaneous partial pressure of carbon dioxide values improved significantly (P < 0.05). Symptoms of respiratory distress were considerably ameliorated at 1-3 h after the HFNC initiation, except in two patients. In these two patients, the HFNC was replaced with non-invasive positive pressure ventilation. Non-invasive positive pressure was also required at 16 to 168 h after the initiation of HFNC in five of the 28 episodes in which the patient was initially responsive to HFNC, as the patients' respiratory symptoms gradually deteriorated.
Conclusion:
Performing HFNC with a home ventilator in continuous positive airway pressure mode is effective at treating bedridden patients with acute respiratory distress. However, it is essential that the HFNC can be switched to non-invasive positive pressure if needed.
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