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J Korean Soc Emerg Med > Volume 32(4); 2021 > Article
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
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
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
Correspondence  Tae-Sik Hwang ,Tel: 051-797-0100, Fax: 051-797-0034, Email: emhwang1@hanmail.net,
Received: June 11, 2020; Revised: August 6, 2020   Accepted: October 16, 2020.  Published online: August 31, 2021.
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).
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.
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.
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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