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Effects of high-flow nasal cannula in patients with mild to moderate hypercapnia: a prospective observational study

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Abstract
Background: Evidence for using high-flow nasal cannula (HFNC) in hypercapnia is still limited. Most of the clinical studies had been conducted retrospectively, and there had been conflicting reports for the effects of HFNC on hypercapnia correction in prospective studies. Therefore, more evidence is needed to understand the effect of the HFNC in hypercapnia.

Methods: We conducted a multicenter prospective observational study after applying HFNC to 45 hospitalized subjects who had moderate hypercapnia (arterial partial pressure of carbon dioxide [PaCO2], 43-70 mm Hg) without severe respiratory acidosis (pH <7.30). The primary outcome was a change in PaCO2 level in the first 24 hours of HFNC use. The secondary outcomes were changes in other parameters of arterial blood gas analysis, changes in respiration rates, and clinical outcomes.

Results: There was a significant decrease in PaCO2 in the first hour of HFNC application (-3.80 mm Hg; 95% confidence interval, -6.35 to -1.24; P<0.001). Reduction of PaCO2 was more prominent in subjects who did not have underlying obstructive lung disease. There was a correction in pH, but no significant changes in respiratory rate, bicarbonate, and arterial partial pressure of oxygen/fraction of inspired oxygen ratio. Mechanical ventilation was not required for 93.3% (42/45) of our study population.

Conclusions: We suggest that HFNC could be a safe alternative for oxygen delivery in hypercapnia patients who do not need immediate mechanical ventilation. With HFNC oxygenation, correction of hypercapnia could be expected, especially in patients who do not have obstructive lung diseases.

Keywords: carbon dioxide; hypercapnia; mechanical ventilation; nasal cannula.
Author(s)
고윤석김원영임채만허진원홍상범Eun Young KimGa Jin SeoHee Jung SuhHyung Koo KangJea Jun HwangKyung Hun NamSo Young ParkSo-Hee ParkSung Wook KangSung-Soon Lee
Issued Date
2021
Type
Article
Keyword
carbon dioxidehypercapniamechanical ventilationnasal cannula마취과학
DOI
10.4266/acc.2020.01102
URI
https://oak.ulsan.ac.kr/handle/2021.oak/7100
https://ulsan-primo.hosted.exlibrisgroup.com/primo-explore/fulldisplay?docid=TN_cdi_nrf_kci_oai_kci_go_kr_ARTI_9856268&amp;context=PC&amp;vid=ULSAN&amp;lang=ko_KR&amp;search_scope=default_scope&amp;adaptor=primo_central_multiple_fe&amp;tab=default_tab&amp;query=any,contains,Effects%20of%20high-flow%20nasal%20cannula%20in%20patients%20with%20mild%20to%20moderate%20hypercapnia:%20a%20prospective%20observational%20study&amp;offset=0&amp;pcAvailability=true
Publisher
Acute and Critical Care
Location
대한민국
Language
영어
ISSN
2586-6052
Citation Volume
36
Citation Number
3
Citation Start Page
249
Citation End Page
255
Appears in Collections:
Medicine > Medicine
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