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Failure of High-Flow Nasal Cannula Therapy in Pneumonia and Non-Pneumonia Sepsis Patients: A Prospective Cohort Study

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Abstract
Despite the increasing use of high-flow nasal cannulas (HFNCs) to treat critically ill patients, data on their effectiveness for sepsis patients remains very limited. We studied a prospective cohort of sepsis patients from the Korean Sepsis Registry (18 intensive care units (ICUs)). Patients started on HFNC therapy for hypoxemia within the first three ICU days were enrolled. HFNC failure was defined as intubation or ICU death, and the primary outcome was early HFNC failure occurring within 72 h of HFNC initiation. Of 901 patients with sepsis admitted to the ICU, 206 who received HFNC therapy were finally included (117 with pneumonia vs. 89 with non-pneumonia sepsis; median age, 71.0 (63.0-78.0) years; PaO2/FiO2 ratio, 160.2 (107.9-228.2) mm Hg; septic shock, n = 81 (39.3%)). During HFNC therapy, 72 (35.0%) patients were intubated and 51 (24.8%) died. HFNC failure developed in 95 (46.1%) patients, and among them, early failure rate was 85.3% (81/95). On multivariate analysis, an immunocompromised state (odds ratio (OR) = 2.730), use of a combination of antibiotics (OR = 0.219), and the PaO2/FiO2 ratio (OR = 0.308) were significantly associated with early HFNC failure in pneumonia sepsis patients. However, in non-pneumonia sepsis patients, lactate levels (OR = 1.532) were significantly associated with early HFNC failure. In conclusion, a high proportion of sepsis patients experience HFNC failure, usually within 72 h after therapy initiation, which emphasizes the importance of close monitoring. Furthermore, unlike in pneumonia sepsis, organ failure (i.e., lactate) might serve as a prognostic marker in non-pneumonia sepsis (i.e., type IV respiratory failure).
Author(s)
오동규임채만홍상범Eunhye KimGee Young SuhKyeongman JeonMi-Hyeon ParkOn Behalf Of The Korean SepsisSang-Min LeeSunghoon ParkSunghoon ParkYeon Joo LeeYoung-Jae Cho
Issued Date
2021
Type
Article
Keyword
AntibioticsComplianceFailurehigh flow nasal cannulaIntubationMortalityNosocomial infectionsoutcomesOxygen therapyPathogensPneumoniaRisk factorsSepsisSteroidsVentilators
DOI
10.3390/jcm10163587
URI
https://oak.ulsan.ac.kr/handle/2021.oak/7108
https://ulsan-primo.hosted.exlibrisgroup.com/primo-explore/fulldisplay?docid=TN_cdi_doaj_primary_oai_doaj_org_article_fa622b1cbd17474cbd3fb757a7c76e9c&context=PC&vid=ULSAN&lang=ko_KR&search_scope=default_scope&adaptor=primo_central_multiple_fe&tab=default_tab&query=any,contains,Failure%20of%20High-Flow%20Nasal%20Cannula%20Therapy%20in%20Pneumonia%20and%20Non-Pneumonia%20Sepsis%20Patients:%20A%20Prospective%20Cohort%20Study&offset=0&pcAvailability=true
Publisher
JOURNAL OF CLINICAL MEDICINE
Location
스위스
Language
영어
ISSN
2077-0383
Citation Volume
10
Citation Number
16
Citation Start Page
0
Citation End Page
0
Appears in Collections:
Medicine > Medicine
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