title: Humidified high flow nasal oxygen during respiratory failure in the emergency department: feasibility and efficacy.
abstract: OBJECTIVE
  Heated and humidified high flow nasal cannula oxygen therapy (HFNC) represents a new alternative to conventional oxygen therapy that has not been evaluated in the emergency department (ED). We aimed to study its feasibility and efficacy in patients exhibiting acute respiratory  failure presenting to the ED.
  
  
  METHODS
  Prospective, observational study in a university hospital's ED. Patients with acute respiratory failure requiring > 9 L/min oxygen or with ongoing clinical signs of respiratory distress despite oxygen therapy were included. The device of oxygen administration  was then switched from non-rebreathing mask to HFNC. Dyspnea, rated by the Borg scale and a visual analog scale, respiratory rate, and S(pO(2)) were collected before and 15, 30, and 60 min after beginning HFNC. Feasibility was assessed through caregivers' acceptance of the  device in terms of practicality and perceived effect on the subjects, evaluated by questionnaire.
  
  
  RESULTS
  Seventeen subjects, median age 64 y (46-84.7 y), were studied. Pneumonia was the most common reason for oxygen therapy (n = 9). HFNC was associated with a significant decrease  in both dyspnea scores: Borg scale from 6 (5-7) to 3 (2-4) (P < .001), and visual analog scale from 7 (5-8) to 3 (1-5) (P < .01). Respiratory rate decreased from 28 breaths/min (25-32 breaths/min) to 25 breaths/min (21-28 breaths/min)  (P < .001), and S(pO(2)) increased from 90% (88.5-94%) to 97% (92.5-100%) (P < .001). Fewer subjects exhibited clinical signs of respiratory distress (10/17 vs 3/17, P = .03). HFNC was well tolerated and no adverse event was noted.  Altogether, 76% of healthcare givers declared preferring HFNC, as compared to conventional oxygen therapy.
  
  
  CONCLUSIONS
  HFNC is possible in the ED, and it alleviated dyspnea and improved respiratory parameters in subjects with acute hypoxemic respiratory failure.
authors.affiliation: Assistance Publique-Hôpitaux de Paris (APHP), Service de Réanimation Médicale, Hôpital Louis Mourier, F-92700, Colombes, France.
authors.forename: Hugo
authors.initials: H
authors.lastname: Lenglet
authors.forename: Benjamin
authors.initials: B
authors.lastname: Sztrymf
authors.forename: Christophe
authors.initials: C
authors.lastname: Leroy
authors.forename: Patrick
authors.initials: P
authors.lastname: Brun
authors.forename: Didier
authors.initials: D
authors.lastname: Dreyfuss
authors.forename: Jean-Damien
authors.initials: JD
authors.lastname: Ricard
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D004636:Emergency Service, Hospital; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D006813:Humidity; D008297:Male; D008875:Middle Aged; D010102:Oxygen Inhalation Therapy / Q000379:methods*; D011446:Prospective Studies; D012128:Respiratory Distress Syndrome / Q000503:physiopathology / Q000628:therapy*; D018709:Statistics, Nonparametric; D016896:Treatment Outcome