High-flow nasal cannula therapy for acute respiratory failure in patients with interstitial pneumonia: a retrospective observational study

Abstract

High-flow nasal cannula (HFNC) oxygen is a therapy that has demonstrated survival benefits in acute respiratory failure (ARF). However, the role of HFNC in ARF due to interstitial pneumonia (IP) is unknown. The aim of this study was to compare the effects of HFNC therapy and non-invasive positive pressure ventilation (NPPV) in ARF due to IP. This retrospective observational study included 32 patients with ARF due to IP who were treated with HFNC (n = 13) or NPPV (n = 19). The clinical characteristics, intubation rate and 30-day mortality were analyzed and compared between the HFNC group and the NPPV group. Predictors of 30-day mortality were evaluated using a logistic regression model. HFNC group showed higher mean arterial blood pressure (median 92 mmHg; HFNC group vs 74 mmHg; NPPV group) and lower APACHEII score (median 22; HFNC group vs 27; NPPV group) than NPPV group. There was no significant difference in the intubation rate at day 30 between the HFNC group and the NPPV group (8% vs 37%: p = 0.069); the mortality rate at 30 days was 23% and 63%, respectively. HFNC therapy was a significant determinant of 30-day mortality in univariate analysis, and was confirmed to be an independent significant determinant of 30-day mortality in multivariate analysis (odds ratio, 0.148; 95% confidence interval, 0.025-0.880; p = 0.036). Our findings suggest that HFNC therapy can be a possible option for respiratory management in ARF due to IP. The results observed here warrant further investigation of HFNC therapy in randomized control trials.

Keywords: critical care; nasal cannula; pulmonary fibrosis; respiratory failure.

Fig. 1

Patient flow. ICU: intensive care unit, HFNC: high-flow nasal cannula, NPPV: non-invasive positive pressure ventilation.

Fig. 2

Distribution of APACHEII and PiO₂/F_IO₂ ratio in the HFNC group and the NPPV group White bar indicates cases alive at day30 and black bar indicates cases died within 30 days. HFNC: high-flow nasal cannula, NPPV: non-invasive positive pressure ventilation.

Fig. 3

Kaplan-Meier distribution for the probability of survival The p-value was calculated using the log-rank test. The solid line represents patients in the HFNC group, and the dotted line represents patients in the NPPV group. Survival was significantly better in the HFNC group than the NPPV group (p = 0.029). HFNC: high-flow nasal cannula, NPPV: non-invasive positive pressure ventilation.