High Flow Nasal Cannula Oxygen Therapy May Benefit Elderly Patients in ICU

Doctor adjusting oxygen supply
Doctor adjusting oxygen supply
After high flow nasal cannula oxygen therapy, 15% of patients had to be intubated and mechanically ventilated, but the majority stepped down to regular oxygen therapy.

This article is part of Pulmonology Advisor‘s coverage of the CHEST 2018 meeting, taking place in San Antonio, Texas. Our staff will report on medical research related to COPD, critical care medicine, and more conducted by experts in the field. Check back regularly for more news from CHEST 2018.

SAN ANTONIO — Elderly patients admitted to the intensive care unit may benefit from high-flow nasal cannula (HFNC) oxygen therapy, according to findings presented at the CHEST Annual Meeting, held October 6-10, in San Antonio, Texas.

While HFNC oxygen therapy has been studied extensively in pediatric patients and its use has increased in adults, it has not been assessed in patients 80 years of age and older. In this study, researchers performed a retrospective chart review of 40 patients with a mean age of 89 years who required HFNC oxygen therapy in the intensive care unit for >12 hours. The mean duration of HFNC oxygen therapy was 5 days. The most common diagnosis was sepsis as a result of pneumonia and the most common indication for HFNC oxygen therapy was hypoxemia following extubation. More than 50% of patients were transitioned to HFNC oxygen therapy after extubation, and 47% of patients were transitioned from NC or bilevel positive airway pressure ventilation (BPAP).

After HFNC oxygen therapy, 15% of patients (n=6) had to be intubated and required mechanical ventilation, but the majority (85%) were scaled down to regular NC oxygen therapy. A total of 87.5% patients were discharged from the hospital vs 12.5% who died. Of the 6 intubations, 3 were re-intubations, and 5 patients died. Four patients had their status changed to “comfort care with do not intubate” after extubation to HFNC; 2 of these patients were discharged and the other 2 died.

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The researchers concluded that elderly patients may benefit from HFNC oxygen therapy, particularly after being removed from mechanical ventilation or if they find BPAP uncomfortable.

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Saradna A, Shyam BS, Chandar SP, Rai A, Kupfer Y. High flow nasal cannula oxygen use in octogenarian and nonagenarian patients: a retrospective analysis among MICU patients. Presented at: CHEST Annual Meeting 2018; October 6-10, 2018; San Antonio, TX.