High Flow Nasal Cannula in the Emergency Department

Study Overview
=================
Brief Summary
-----------------
The aim of this study was to describe the changes in respiratory rate, heart rate and dyspnea, before and after using HFNC in patients presenting to our emergency department with ARF.

Detailed Description
-----------------
A retrospective cohort study was performed. To all adults presenting to the emergency department who used high flow nasal cannula to treat clinical signs of acute respiratory failure based on the presence of a breathing frequency ≥ 25 breath/min and increase work of breathing evidence by dyspnea, in-drawing, accessory-muscle use and/or diaphoresis despite conventional oxygen therapy ≥ 6 l/min. Demographic variables and clinical and gasometric parameters before and after two hours using HFNC were recorded.

Official Title
-----------------
Use of High-Flow Nasal Cannula for Acute Respiratory Failure in the Emergency Department

Conditions
-----------------
Acute Respiratory Failure

Intervention / Treatment
-----------------
* Device: High Flow Nasal Cannula Oxygen


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: patients aged ≥ 18 years attended between July 1st, 2015 and January 31st , 2017 in the Emergency Department of the Hospital Italiano de Buenos Aires with clinical signs of acute respiratory failure Exclusion Criteria: - Pulse oximetry > 90% breathing room air

Ages Eligible for Study
-----------------
Minimum Age: 18 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Arms and Interventions

| Intervention/Treatment |
| --- |
|Device: High Flow Nasal Cannula Oxygen|The high flow device that we used was an air oxygen blender (Whisper FlowⓇ), which allows FiO2 adjustment between 0.30 and 1.0 and can deliver a gas flow from 10 to 150 l/min. The gas mixture was routed from a heated humidifier (MR850 with MR 290 chamber) through a one line heated inspiratory circuit (RT241) to the subject at a temperature of 37°C via a nasal cannula (OptiflowⓇ).|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Heart Rate | The closest value of Heart Rate before starting HFNC, and two hours later was collected from the electronic clinical history. | 2 hours | 
| Respiratory Rate | The closest value of Respiratory Rate before starting HFNC, and two hours later was collected from the electronic clinical history. | 2 hours | 
| Dyspnea | The closest value of Dyspnea (Modified Borg Dyspnea scale) before starting HFNC, and two hours later was collected from the electronic clinical history. The Modified Borg Dyspnea Scale is a rated numerical score used to measure dyspnea. This scale has a minimum value of 0 ( represent no dyspnea) and a maximum value of 10 (worse dyspnea). | 2 hours | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Initial HFNC setting | The gas flow rate and the fraction of inspired oxygen at the HFNC initiation of treatment were collected from the electronic clinical history. | 2 hours | 
| Acute respiratory failure etiology | Presence of a breathing frequency ≥ 25 breath/min and increase work of breathing evidence by dyspnea, in-drawing, accessory-muscle use and/or diaphoresis despite conventional oxygen therapy ≥ 6 l/min. | 3 minutes | 
| Average time of use the HFNC | The total hours of use of HFNC were collected from the electronic clinical history. | until 28 days | 
| Delay of HFNC treatment | The hours between the admission to HFNC initiation were collected from the electronic clinical history. | until 24hs | 
| Efficacy of HFNC treatment | When the patient did not need for escalation to other non-invasive or invasive ventilatory support. | 28 days | 
| Failure of HFNC treatment | When the patient need non-invasive or invasive ventilatory support or died. The type of ventilatory support post-failure were collected from the electronic clinical history. | 28 days | 
| Mortality rate at 28 day from ED admission | The number of patients who died after requiring HFNCO were collected from the electronic clinical history | 28 days | 
| Palliative Care | Consensus between patient and/or patient´s family and the physician about the care for the terminally ill patient, provided by an organized health service | 28 days | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
High Flow Nasal Cannula, Emergency department, Respiratory care