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Journal of The Korean Society of Emergency Medicine 2021;32(4): 281-289. |
| 급성 호흡부전 환자에서 고유량 비강캐뉼라 적용 실패 시 기관삽관 및 기계호흡기 적용 예측 지표 |
장진국1
, 박영숙2
, 박하영1
, 황태식1
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1인제대학교 해운대백병원 응급의학과
2성균관대학교 의과대학 삼성창원병원 재활의학과 |
| Predictors of intubation and mechanical ventilation in patients with acute respiratory failure treated with high flow nasal cannula in emergency room: the usefulness of arterial blood gas analysis |
| Jin-Guk Jang1
, Young-Sook Park2
, Ha-Young Park1
, Tae-Sik Hwang1
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1Department of Emergency Medicine, Inje University Haeundae Paik Hospital, Busan, Korea
2Department of Physical Medicine and Rehabilitation, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea |
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Received: June 11, 2020; Revised: August 6, 2020 Accepted: October 16, 2020. Published online: August 31, 2021. |
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| ABSTRACT |
Objective:
The use of a high flow nasal cannula (HFNC) might cover the gap between conventional oxygen therapy and
mechanical ventilation in the management of acute respiratory failure patients and could be a significant factor in determining
patient outcomes. Early predictors of HFNC failure may help a clinician decide whether to shift the patient to a
mechanical ventilator. We aimed at identifying the predictors associated with HFNC failure and the application of a
mechanical ventilator using arterial blood gas analysis (ABGA).
Method:
We retrospectively analyzed patients who were admitted to the emergency room at a single center with respiratory
distress and a PaO2/FiO2 ratio (ratio of arterial partial pressure of oxygen to fraction of inspired oxygen) of less than
300. Comparing keeping and weaning HFNC groups with the escalation group, we sought to identify a few discriminating
factors. Initial ABGA was done when the patients entered the emergency room and this was followed up within 2 hours
after HFNC therapy.
Results:
Two hundred and eighteen patients were enrolled and of these HFNC therapy succeeded in 153 and failed in
65. At baseline Glasgow Coma Scale, follow-up (F/U) pH, ΔpH, and F/U respiratory rate-oxygenation index were lower
and pro-brain natriuretic peptide, initial lactate, F/U lactate, ΔPCO2, heart rate, acidosis, consciousness, oxygenation,
respiratory rate score, Acute Physiology And Chronic Health Evaluation score, Simplified Acute Physiology Score, and
Sequential Organ Failure Assessment score were significantly higher in the HFNC failure group. The results of the multivariate
analysis indicated that initial lactate (odds ratio [OR], 1.215; 95% confidence interval [CI], 1.081-1.366; P=0.001)
and ΔpH (OR, 0.000; 95% CI, 0.000-0.018; P<0.001) were independently associated with the prediction of application of
the mechanical ventilator.
Conclusion:
Patients who had higher initial lactate levels and insufficiently corrected pH after HFNC therapy may need
to be monitored carefully and escalation of oxygen therapy may need to be considered. |
| Key words:
High flow nasal cannula; Acute respiratory failure; Predictor; Arterial blood gas analysis |
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