Effectiveness of High Flow Nasal Oxygen Therapy in Pneumonia with Acute Hypoxemic Respiratory Failure in Intensive Care Unit, DMCH, Dhaka, Bangladesh

Abstract

Background: Acute hypoxemic respiratory failure is the major compilation of pneumonia. It is characterized by an impaired gas exchange between the lungs and the blood. It can be managed by administering oxygen via a nasal cannula or face mask, followed by positive pressure throughout the respiratory cycle (PEEP) in case of failure. Pressure support can be administered either through endotracheal intubation (mechanical ventilation) or a non-invasive interface Continous Positive airway pressure (CPAP) ventilation. Aims: Purpose of this study was to determine the efficacy of high flow nasal oxygen therapy in pneumonic patient with acute hypoxemic respiratory failure in intensive care unit. Methods: It is a prospective randomized control trial, carried out in the ICU at the Department of Anaesthesia, Analgesia, Palliative & Intensive Care Medicine, Dhaka Medical College Hospital, Dhaka. Study subject were pneumonic patients with Acute Hypoxemic Respiratory Failure admitted in Intensive Care Unit of Dhaka Medical College Hospital. Total 100 patients were recruited and allocated into two groups, Group-A: Patients assigned to receive High Flow Nasal Oxygen Therapy (HFNOT) and Group-B: the patients assigned to receive NIV. Then safety & effectiveness of both groups were evaluated and compared. Procedure details was recorded on specifically designed proforma. Results: In this study mean ± SD age of the Group-A was 54.37±9.24 years with a range of 18-70 years and the mean ± SD age of the Group-B patients was 55.31±9.86 years with a range of 18-70 years. Gender distribution revealed, male: female ratio 2.8:1 in study group. Age and sex difference between two groups was statistically non-significant. Haemodynamic status and baseline laboratory parameters were similar in both groups. On evaluation of outcome, present study shows successful treatment was more achieved in group-A (76.0% vs. 70.0%), although difference was statistically non-significant (p=0.501). treatment failure rate was 24.0% patients in group-A and 30.0% patients in group-B. Among the patients with treatment failure, the intubation rate in the HFNC group was similar to that of the Continous Positive airway pressure (CPAP) ventilation group, and the treatment switch rate was higher than that in the NIV group (8.0% versus 14.0%). However, there were no significant differences between the two groups in intubation or treatment switch rate. Causes of treatment failure showed that the intolerance rate of Continous Positive airway pressure (CPAP) ventilation was significantly higher than that of the HFNC (P=0.038). However, there was no difference between the two groups regarding respiratory distress, hypoxemia and carbon dioxide retention. Duration ICU stay was almost similar in both groupa (192 hours vs. 187 hours in group-A & B respectively), the difference was statistically non-significant. Conclusion: Present study concluded that High Flow Nasal Oxygen Therapy (HFNOT) was associated with better tolerance, less treatment failure rates and less incidence of complications compared to NIV.