Nasal high flow therapy in the emergency department - A prospective study

Globally, emergency department (ED) nurses routinely care for patients requiring respiratory support; this support may include nasal high flow (NHF) therapy.

The study objective was to profile and evaluate the outcomes of ED patients receiving NHF respiratory support compared to those receiving all other forms of respiratory support.

A prospective, observational, multicenter method was used to capture real-time, real-world epidemiological data at four New Zealand EDs for two 12-hour periods in April and May 2023. N = 898 patients presented to the participating EDs; the minority, n = 76 (8.46 %), received respiratory support, with a subset of these (n = 12, 15.7 %) receiving NHF.

Most of those receiving NHF were male (n = 8, 66 %), of New Zealand European ethnicity (n = 4, 33 %), with a mean age of 69.91 years (SD 18.93). These participants had a mean triage score of 2.66 (SD 0.65) and a mean modified early warning score of 7.58 (SD 3.32). 'Respiratory' was the most common participant diagnostic category (n = 5, 41.5 %). The most common reason for NHF delivery was 'oxygenation improvement' (n = 4, 33.3 %). Those receiving NHF appeared to require less escalation of respiratory support versus those receiving other forms of respiratory support (n = 1, 8.3 %, versus n = 21, 32.8 %). No significant difference in treatment effect was seen for escalation to NHF versus other forms of respiratory support (RR 0.31, 95 % CI 0.04 to 2.12, P = 0.23, NNT (benefit) 5.87, 95 % CI 2.43 to 14.07). The median overall length of stay for those admitted to the hospital was eight days (4-15). This was seen to be significantly higher for those receiving NHF in the ED (Mann-Whitney U, 183, P = 0.004).

Given the methods used, all findings must be viewed with caution. The study reports that a minority of ED patients requiring respiratory support receive NHF. However, these patients appear to have high acuities, a high need for hospitalization, and an increased length of stay (LOS). Collectively, these data suggest that these patients are high consumers of healthcare resources. These New Zealand study findings may have implications for research and care planning across health sectors, including the ED.

What is already known about this topic? Nasal high-flow therapy, which provides respiratory support, is provided in the emergency department to patients with many conditions. What does this paper add to the currently published literature? This description of the epidemiology of emergency department patients provided nasal high flow here may inform benchmarking for future ED clinical practice and research. What is the most important implication for clinical emergency nursing practice? The patients profiled in this study are vulnerable, have high acuity, and require targeted respiratory support to improve their outcomes.