Initial application of high-flow nasal cannula for patients with acute dyspnea and hypoxemia in emergency department: A randomized controlled trial
10.3760/cma.j.issn.1671-0282.2022.03.017
- VernacularTitle:早期经鼻高流量氧疗在呼吸困难伴低氧血症的急诊患者中的应用:一项随机对照研究
- Author:
Qi LIU
1
;
Xiaoqian PANG
;
Feng LI
;
Chao LAN
;
Changju ZHU
;
Rongchang CHEN
Author Information
1. 郑州大学第一附属医院急诊重症监护病房，郑州 450052
- Keywords:
High-flow nasal cannula;
Dyspnea;
Hypoxemia;
Intubation rate;
Conventional oxygen therapy
- From:
Chinese Journal of Emergency Medicine
2022;31(3):356-363
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To explore whether the adoption of high-flow nasal cannula (HFNC) as an initial oxygen therapy in emergency department (ED) could reduce the intubation rate and improve the clinical outcomes of patients with dyspnea and hypoxemia compared with conventional oxygen therapy (COT).Methods:A perspective single-center randomized controlled trial was conducted in the First Affiliated Hospital of Zhengzhou University from October 1, 2019 to September 30, 2020. A total of 210 eligible patients with acute dyspnea and hypoxemia in ED were recruited and randomized (in 1:1) to receive HFNC or COT for 1 h immediately after the grouping. The primary outcome was the rate of intubation within 24 h. The secondary outcomes included total intubation rate, escalation of breathing support method, patients’ disposition, length of ICU stay and hospital mortality. Continuous outcomes were analyzed by independent samples t test or Mann-Whitney U test according to the data distribution. Discontinuous outcomes were compared with the Chi-square test. Kaplan-Meier curve analysis was performed for 60-day survival. Results:Finally, 105 patients were recruited in each group. HFNC reduced the intubation rate within the first 24 h (4.8% vs. 14.3%, P = 0.019) and the rate of patients escalated to upgrade oxygen therapy (34.3% vs. 53.3%, P = 0.005), but did not affect the total intubation rate during the whole attendance ( P = 0.509). In ED, HFNC helped more patients to achieve the targeted saturation of pulse oxygen (90.5% vs. 78.1%, P = 0.02), and reduced respiratory rate (RR) to < 25 breaths per min (68.6% vs. 49.0%, P = 0.004), but did not affect the length of hospital stay, hospital mortality and 60-day survival rate ( P > 0.05). Conclusions:Initial application of HFNC in ED could reduce the intubation rate within 24 h, decrease the rate of escalation of oxygen therapy, improve oxygenation and relieve dyspnea.
