Effect of High Flow Nasal Cannula Comparing with Noninvasive Positive Pressure Ventilation in Patient with Acute Hypoxemic Respiratory Failure
Files
Date
2021-09-17
Authors
Sarees, Isra
Journal Title
Journal ISSN
Volume Title
Publisher
An Najah National University
Abstract
Background: Acute respiratory failure (ARF) is a serious health condition that can be associated with fatal complications that require immediate medical intervention and is associated with a high proportion of 30% of patients admitted to the intensive care unit. Noninvasive positive-pressure ventilation (NIPPV) and high-flow nasal cannula (HFNC) are commonly used oxygen therapy modalities used among patients with respiratory failures in the intensive care unit (ICU). This study was conducted to assess the effects of NIPPV and HFNC among patients with acute hypoxemic respiratory failure (AHRF) in ICU at An-Najah National University Hospital.
Methods: This study was a retrospective cohort study, all patients with AHRF treated with HFNC and/or NIPPV at the ICU at An-Najah National University Hospital (NNUH) in August 2018 to July 2019. All data were extracted from clinical records via electronic system of the hospital and from the patients’ records.
Results: The median age of the patients was 52.5 with an IQR of 16.5 years, the median number of cigarettes smoked was 25 with an IQR of 10 per day, and the median BMI was 25.9 with an IQR of 4.9 kg/m2. Of the patients, 40 (57.1%) had pneumonia and 33 (47.1%) had sepsis. Patients who received NIPPV were significantly younger compared with those who received HFNC (Pearson’s Chi-square = 8.57, p value = 0.007). The respiratory and heart rate were significantly higher (p value < 0.05) for patients who received NIPPV compared to patients who received HFNC at the baseline and during the 1st, 2nd, and 3rd sessions of day 1 and day 2 of the treatment. However, patients who received HFNC were more likely to have higher blood pressure and irregular ECG on day 2 and day 3 of the treatment (p value < 0.05) compared to those who received NIPPV. When the fraction of inspired oxygen was compared between both treatment methods, there was not statistically significant differences except for Day 2, Session 2 (p value < 0.05). In general, the pH and bicarbonate were significantly higher (p value < 0.05) for patients who received HFNC compared to patients who received NIPPV at the baseline and during the 1st, 2nd, and 3rd sessions of day 1, day 2, and day 3 of the treatment. On day 3, there were more acute respiratory distress syndrome and bilateral pneumonia cases in the group who received NIPPV compared to those who received HFNC treatment (p value = 0.004). In general, patients who received NIPPV were more likely (p value < 0.05) to progress from severe pain to moderate and mild pain during the treatment days compare to patients who received HFNC. Patients who received NIPPV were more likely (p value < 0.05) to report tachycardia, tachypnea, cyanosis, restlessness, and confusion compared to patients who received HFNC during the treatment days (p value < 0.05). The median hospital stay was 10.0 with an IQR of 5.0 days and the median ICU stay was 5.0 with an IQR of 4.0 days. Patients who received NIPPV were more likely (p value = 0.009) to have a longer hospital stay compare to those who received HFNC. The median SOFA score was 9.0 with an IQR of 1.0 and the median APACHE score was 19.0 with an IQR of 7.25. Patients who received NIPPV were more likely (p value = 0.017) to have a higher SOFA scores compare to those who received HFNC. There was no statistical difference between the number of patients who died, completely recovered in 24 h, 48 h, and 72 h in relation to the treatment method. However, patients who received NIPPV were more likely to be intubated (p value = 0.021) and receive vasopressors (p value = 0.002) compared to those who received HFNC.
Conclusion: Our results indicated that HFNC and NIPPV might be effective in improving prognosis and clinical outcomes of AHRF patients. Both methods were similar in terms of patient progress from severe/moderate impairment in level of consciousness to mild impairment in level of consciousness, death, ICU length of stay, and complete recovery in 24 h, 48 h, and 72 h. However, patients who received HFNC stayed less days in the hospital compared to the patients who received NIPPV. Findings of this study were comparable to those reported in different healthcare settings around the world. Future studies are still needed to determine recovery and mortality rates among both treatment methods.
Description
Keywords
Acute respiratory failure , endotracheal intubation , high-flow nasal cannula , non-invasive positive pressure ventilation.