Frailty as a Predictor of Outcomes in Optiflow

Area of Science:

• Critical Care Medicine
• Respiratory Medicine
• Geriatric Medicine

Background:

• High-flow nasal cannula (HFNC) oxygen therapy is increasingly used for hypoxic respiratory failure.
• Evidence is limited regarding the impact of patient frailty on HFNC outcomes.
• Clinical Frailty Score (CFS) is a measure of patient frailty.

Purpose of the Study:

• To investigate whether a higher Clinical Frailty Score (CFS) is associated with worse outcomes in patients receiving HFNC.
• To assess the impact of frailty on mortality and weaning rates in patients treated with HFNC.

Main Methods:

• Retrospective cohort study of 96 patients treated with HFNC at Kingston Hospital.
• Patients categorized into three groups based on CFS: 1-4, 5-6, and 7-8.
• Statistical analysis included Chi-squared tests and Kruskal-Wallis H tests.

Main Results:

• Higher 30-day mortality was observed in the most frail group (CFS 7-8) compared to the least frail (CFS 1-4), though not statistically significant (p=0.48).
• Frail patients with pneumonia (CFS 7-8) had significantly higher 30-day mortality (75%) than non-frail patients (p=0.034).
• In-hospital mortality while receiving HFNC was higher in frailer groups (CFS 5-6 and 7-8) compared to the less frail group (CFS 1-4) (p=0.360).

Conclusions:

• Frail patients treated with HFNC experienced higher mortality and lower weaning rates.
• The efficacy of HFNC may be limited in frail patients, particularly those with pneumonia.
• Further research is needed to fully assess HFNC efficacy in frail populations.