Division of Pulmonology, Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea.
Department of Critical Care Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea.
Respir Care. 2020 Sep;65(9):1276-1284. doi: 10.4187/respcare.07403. Epub 2020 Mar 24.
The use of high-flow nasal cannula (HFNC) is rapidly increasing without clear indications, creating the potential for overuse or misuse and the accompanying risk of adverse events. The purpose of this study was to determine the factors associated with HFNC failure by examining the current clinical practice of HFNC.
From July 1, 2017, to June 30, 2018, in 5 university-affiliated hospitals in the Republic of Korea, a total of 1,161 admitted adult subjects who had HFNC administered were retrospectively enrolled and their medical records were reviewed.
Pulmonary diseases including pneumonia ( = 757, 65.2%) were the most common reason for use of HFNC. Subjects with do-not-resuscitate (DNR) or do-not-intubate (DNI) orders comprised 33.8% of the study population ( = 392); 563 subjects (48.5%) were escalated directly to HFNC from low-flow devices without applying reservoir or other high-flow devices. In the non-DNR/DNI subjects, arterial blood gas was not monitored in 15.2% and 14.8% of subjects before and after HFNC application, respectively, and it was not monitored in 28.0% just before HFNC weaning. The HFNC failure rate was 27.0% in non-DNR/DNI subjects, and the HFNC failure was significantly associated with the decision by residents to apply HFNC (odds ratio [OR] 2.03, 95% CI 1.29-3.18, = .002), high breathing frequency (OR 1.07, 95% CI 1.04-1.10, < .001) ≤ 6 h before HFNC application, low [Formula: see text] (OR 0.92, 95% CI 0.89-0.95, < .001) ≤ 6 h before HFNC application, low [Formula: see text] (OR 0.95, 95% CI 0.93-0.98, < .001) ≤ 6 h before HFNC application, and the ratio of [Formula: see text]/[Formula: see text] to breathing frequency (ROX index) ≤ 6 h after HFNC application (OR 0.88, 95% CI 0.84-0.92, < .001).
HFNC was practiced without applying reservoir or other high-flow devices before application and without appropriate arterial blood gas monitoring during HFNC therapy. HFNC failure was significantly associated with the decision by the resident to use HFNC, breathing frequency, [Formula: see text], and [Formula: see text] ≤ 6 h before HFNC application, and with the ROX index ≤ 6 h after HFNC application.
高流量鼻导管（HFNC）的使用正在迅速增加，而没有明确的适应证，这可能导致过度使用或误用，并伴随不良事件的风险。本研究的目的是通过检查 HFNC 的当前临床实践，确定与 HFNC 失败相关的因素。
2017 年 7 月 1 日至 2018 年 6 月 30 日，在韩国的 5 所大学附属医院，共回顾性纳入了 1161 名接受 HFNC 治疗的成年住院患者，并对其病历进行了审查。
肺部疾病（包括肺炎，757 例，占 65.2%）是使用 HFNC 的最常见原因。有不复苏（DNR）或不插管（DNI）医嘱的患者占研究人群的 33.8%（392 例）；563 例（48.5%）患者在未应用储氧器或其他高流量设备的情况下直接从低流量设备升级为 HFNC。在非 DNR/DNI 患者中，分别有 15.2%和 14.8%的患者在 HFNC 应用前和应用后未监测动脉血气，28.0%的患者在 HFNC 脱机前未监测动脉血气。非 DNR/DNI 患者的 HFNC 失败率为 27.0%，HFNC 失败与住院医师决定应用 HFNC（比值比[OR] 2.03，95%置信区间[CI] 1.29-3.18，P=0.002）、高呼吸频率（OR 1.07，95%CI 1.04-1.10，P<0.001）≤6 h 前、低 [Formula: see text]（OR 0.92，95%CI 0.89-0.95，P<0.001）≤6 h 前、低 [Formula: see text]（OR 0.95，95%CI 0.93-0.98，P<0.001）≤6 h 前以及 HFNC 应用后 6 h 内 ROX 指数（[Formula: see text]/[Formula: see text]与呼吸频率的比值）≤6 h（OR 0.88，95%CI 0.84-0.92，P<0.001）显著相关。
HFNC 在应用前未应用储氧器或其他高流量设备，在 HFNC 治疗期间也未进行适当的动脉血气监测。HFNC 失败与住院医师使用 HFNC 的决定、呼吸频率、[Formula: see text]、[Formula: see text]≤6 h 前以及 HFNC 应用后 6 h 内的 ROX 指数≤6 h 显著相关。
