Nasal high flow can decrease the need for escalation and might decrease the need for intubation.
(Meta-analysis; nasal high flow compared with COT and NIV)
- Huang, et al. Emerg Med Int. 2019.
- Huang, et al. Emerg Med Int. 2019.
What clinical evidence is there, specific to the ED?
Reducing escalation in ED
Bell. 20151
Higher proportion of patients had > 20% reduction in respiratory rate using NHF: 66.7% NHF vs. 38.5% conventional oxygen therapy (COT), p=0.005.
Showed in an ED randomized control trial that NHF was associated with a lower proportion of patients requiring escalation in ventilation therapy.
“Patients with HFNC were much more likely to recover from respiratory failure.”
(Compared with COT in patients with acute hypoxemic respiratory failure)
- Mace, et al. Am J Emerg Med. 2019.
- Mace, et al. Am J Emerg Med. 2019.
Optiflow in the ED: clinical studies summary
References
- Bell N, Hutchinson CL, Green TC, Rogan E, Bein KJ, Dinh MM. Randomised control trial of humidified high flow nasal cannulae versus standard oxygen in the emergency department. Emerg Med Australas. 2015;27(6):537–541
- Huang CC, Lan HM, Li CJ, et al. Use High-Flow Nasal Cannula for Acute Respiratory Failure Patients in the Emergency Department: A Meta-Analysis Study. Emerg Med Int. 2019;2019:2130935. Published 2019 Oct 13.
- Huang CC, Lan HM, Li CJ, et al. Use High-Flow Nasal Cannula for Acute Respiratory Failure Patients in the Emergency Department: A Meta-Analysis Study. Emerg Med Int. 2019;2019:2130935. Published 2019 Oct 13.
- Lenglet H, Sztrymf B, Leroy C, Brun P, Dreyfuss D, Ricard JD. Humidified high flow nasal oxygen during respiratory failure in the emergency department: feasibility and efficacy. Respir Care. 2012;57(11):1873–1878.
- Macé J, Marjanovic N, Faranpour F, et al. Early high-flow nasal cannula oxygen therapy in adults with acute hypoxemic respiratory failure in the ED: A before-after study. Am J Emerg Med. 2019;37(11):2091–2096.
- Jeong JH, Kim DH, Kim SC, et al. Changes in arterial blood gases after use of high-flow nasal cannula therapy in the ED. Am J Emerg Med. 2015;33(10):1344–1349.
- Makdee O, Monsomboon A, Surabenjawong U, et al. High-Flow Nasal Cannula Versus Conventional Oxygen Therapy in Emergency Department Patients With Cardiogenic Pulmonary Edema: A Randomized Controlled Trial. Ann Emerg Med. 2017;70(4):465–472.e2.
- Rittayamai N, Tscheikuna J, Praphruetkit N, Kijpinyochai S. Use of High-Flow Nasal Cannula for Acute Dyspnea and Hypoxemia in the Emergency Department. Respir Care. 2015;60(10):1377–1382.