View : 427 Download: 0
Factors Associated With Failure of High-Flow Nasal Cannula
- Title
- Factors Associated With Failure of High-Flow Nasal Cannula
- Authors
- Kim, Beong Ki; Kim, Sua; Kim, Chi Young; Cha, Jaehyung; Lee, Young Seok; Ko, Yousang; Kwack, Won Gun; Park, So Young; Kim, Je Hyeong
- Ewha Authors
- 박소영
- SCOPUS Author ID
- 박소영
- Issue Date
- 2020
- Journal Title
- RESPIRATORY CARE
- ISSN
- 0020-1324
1943-3654
- Citation
- RESPIRATORY CARE vol. 65, no. 9, pp. 1276 - 1284
- Keywords
- hypoxia; respiratory insufficiency; oxygen inhalation therapy; high-flow nasal cannula
- Publisher
- DAEDALUS ENTERPRISES INC
- Indexed
- SCIE; SCOPUS
- Document Type
- Article
- Abstract
- BACKGROUND: 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. METHODS: 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 HFNU administered were retrospectively enrolled and their medical records were reviewed. RESULTS: Pulmonary diseases including pneumonia (n = 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 (n = 392); 563 subjects (485%) 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, P = .002), high breathing frequency (OR 1.07, 95% CI 1.04-1.10, P < .001) <= 6 h before HFNC application, low S-aO2 (OR 0.92, 95% CI 0.89-0.95, P < .001) <= 6 h before HFNC application, low S-pO2 (OR 0.95, 95% CI 0.93-0.98, P < .001) <= 6 h before HFNC application, and the ratio of S-pO2/F-IO2, to breathing frequency (ROX index) <= 6 h after HFNC application (OR 0.88, 95% CI 0.84-0.92, P < .001). CONCLUSIONS: 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, S-aO2 and S-pO2 <= 6 h before HFNC application, and with the ROX index <= 6 h after HFNC application.
- DOI
- 10.4187/respcare.07403
- Appears in Collections:
- 의과대학 > 의학과 > Journal papers
- Files in This Item:
There are no files associated with this item.
- Export
- RIS (EndNote)
- XLS (Excel)
- XML