Purpose
The experience with high-flow nasal cannula (HFNC) oxygen therapy in severe acute respiratory infection (
SARI) is limited. The objective was to assess the effectiveness of HFNC oxygen therapy in adult patients with SARI by confirmed 2009 influenza A/H1N1v infection (by real-time reverse transcription polymerase chain reaction testing).
Material and Methods
A single-center post hoc analysis of a cohort of intensive care unit patients admitted with SARI due to 2009 Influenza A/H1N1v was done. High-flow nasal cannula (Optiflow; Fisher & Paykel, Auckland, New Zealand) was indicated in the presence of acute respiratory failure when the patient was unable to maintain a pulse oxymetry more than 92 % with more than 9 L/min of oxygen using a standard face mask conventional delivery systems. Nonresponders were defined by their need of subsequent mechanical ventilation.
Results
Twenty-five nonintubated adult patients were admitted for SARI (21 pneumonia). Twenty were unable to maintain pulse oxymetry more than 92 % with conventional oxygen administration and required HFNC O2 therapy, which was successful in 9 (45 % ). All 8 patients on vasopressors required intubation within 24 hours. After 6 hours of HFNC O2 therapy, nonresponders presented a lower Pao2/fraction of inspired oxygen (median, 135 [interquartile range, 84-210] vs 73 [56-81] mm Hg P < .05) and needed higher oxygen flow rate. No secondary infections were reported in health care workers. No nosocomial pneumonia occurred during HFNC O2 therapy.
Conclusion
High-flow nasal cannula O2 therapy appears to be an innovative and effective modality for early treatment of adults with SARI.