Preprint Article Version 1 Preserved in Portico This version is not peer-reviewed

Improved Arterial Oxygenation by High Flow Nasal Cannula Oxygen Therapy in Older Patients with Severe Respiratory Failure in a Non-intensive Hospital Ward

Filippo Luca Fimognari
* ORCID logo ,
Valentina Bambara
,
Giuseppe Armentaro
,
Paola Scarpino
,
Chiara Settino
,
Marco Filice
,
Massimo Rizzo
,
Angela Sciacqua
Version 1 : Received: 25 May 2023 / Approved: 26 May 2023 / Online: 26 May 2023 (10:22:17 CEST)

How to cite: Fimognari, F.L.; Bambara, V.; Armentaro, G.; Scarpino, P.; Settino, C.; Filice, M.; Rizzo, M.; Sciacqua, A. Improved Arterial Oxygenation by High Flow Nasal Cannula Oxygen Therapy in Older Patients with Severe Respiratory Failure in a Non-intensive Hospital Ward. Preprints 2023, 2023051916. https://doi.org/10.20944/preprints202305.1916.v1 Fimognari, F.L.; Bambara, V.; Armentaro, G.; Scarpino, P.; Settino, C.; Filice, M.; Rizzo, M.; Sciacqua, A. Improved Arterial Oxygenation by High Flow Nasal Cannula Oxygen Therapy in Older Patients with Severe Respiratory Failure in a Non-intensive Hospital Ward. Preprints 2023, 2023051916. https://doi.org/10.20944/preprints202305.1916.v1

Abstract

Background. There are scant data about the effectiveness of high flow nasal cannula (HFNC) oxygen therapy in patients hospitalized with severe acute respiratory failure (ARF) in non-intensive medical wards, particularly regarding the effect on arterial oxygenation compared to conventional oxygen therapy (COT) and non-invasive ventilation (NIV) or continuous positive airway pressure (CPAP). Methods. In a retrospective observational study, oxygenation parameters were measured before and immediately after HFNC initiation in 37 consecutive patients hospitalized in a geriatric ward in 2017. Results. HFNC was used as escalation therapy for untreatable hypoxia after failure of NIV/CPAP (n=18) or COT (n=19). Twenty-two patients died, 2 were transferred to the intensive care unit, while 13 were discharged alive. A “do not intubate” status was identified in 17 of the 22 deceased patients. Partial pressure of oxygen (pO2, p< 0.0001), oxygen saturation (SO2, p< 0.0001), pO2/fraction of inspired oxygen ratio (p=0.004) and peripheral SO2 measured by pulse oximetry (p< 0.0001) significantly increased soon after HFNC application. Oxygenation improvements were greater after escalation from NIV/CPAP and in patients discharged alive. Conclusion. HFNC significantly improved oxygenation in severe ARF after failure of COT or NIV/CPAP and may be particularly suitable for older patients hospitalized in non-intensive medical wards.

Keywords

High flow nasal cannula oxygen therapy; acute respiratory failure; geriatrics; acute non-intensive hospital setting

Subject

Medicine and Pharmacology, Pulmonary and Respiratory Medicine

Copyright: This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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