Emergency Care Journal (Sep 2024)

Comparison of high flow and standard oxygen therapy in patients with acute hypoxemic respiratory failure in emergency department. A randomized controlled cross over superiority trial

  • Mamidi Rahul Rohan,
  • Ashima Sharma,
  • Mohammed Ismail Nizami,
  • Lubna Tarannum

DOI
https://doi.org/10.4081/ecj.2024.12815

Abstract

Read online

The aim of our study was to determine whether high flow oxygen therapy reduced the rate of endotracheal intubation and improve pulmonary outcome score. A total of 300 consecutive patients were enrolled in the study. The etiologies of acute respiratory failure were classified into trauma, lung diseases, fluid overload states and undifferentiated. Patients were randomized by block randomization method into two groups. First group received HFNC while the second received conventional oxygen therapy. Patients in both the groups were escalated to either NIV or invasive mechanical ventilator support if there were any signs of respiratory distress noted. Pulmonary outcome scoring done at 2 hours was designed to see if there was any improvement in patient’s condition in both the groups. SPSS (version 21.0, Illinois, Chicago) was used for the statistical analysis. The partial pressures of oxygen improved significantly in the HFNC group as compared to the COT group irrespective of the etiology. The partial pressures of CO2 on ABG were similar in both the groups until 12 hrs. However, pCO2 was earlier reduced in the HFNC group as compared to the COT group. Steady decrease in serum lactate levels were observed in HFNC group. The base deficit was corrected between 6-12 hours in patients of HFNC group which could not be seen in patients of COT group. There was a statistically significant difference noted at 12 and 24 hours between the two groups. The mean length of stay in HFNC group was around 4 days which was less compared to the length of hospital stay in COT which was an average of 7 days. The mortality in HFNC group was 4% and in COT group was 7.33% in our study. The study demonstrated that the use of HFNC in ED patients presenting with AHRF was associated with a greater reduction in need for escalation of ventilation requirements and improves pulmonary outcomes compared with standard oxygen therapy.

Keywords