title: Humidified high flow nasal cannula supportive therapy improves outcomes in lung transplant recipients readmitted to the intensive care unit because of acute respiratory failure.
abstract: BACKGROUND
  The effectiveness of humidified high flow nasal cannula (HFNC) in lung transplant (LTx) recipients readmitted to intensive care unit (ICU) because of acute respiratory failure (ARF) has not been determined to date.
  
  
  METHODS
  Retrospective analysis of a prospectively assessed cohort of LTx patients who were readmitted to ICU because of ARF over a 5-year period. Patients received conventional oxygen therapy (COT) or HFNC (Optiflow, Fisher & Paykel, New Zealand) supportive therapy according to the attending physician's criteria. Treatment failure was defined as the need for subsequent mechanical ventilation (MV).
  
  
  RESULTS
  Thirty-seven LTx recipients required ICU readmission, with a total of 40 episodes (18 COT vs. 22 HFNC). At ICU admission, no differences in comorbidities, pulmonary function, or median sequential organ failure assessment (COT, 4 [interquartile range, 4-6] vs. HFNC, 4 [interquartile range, 4-7]; P = 0.51) were observed. Relative risk of MV in patients with COT was 1.50 (95% confidence interval [95% CI], 1.02-2.21). The absolute risk reduction for MV with HFNC was 29.8%, and the number of patients needed to treat to prevent one intubation with HFNC was 3. Multivariate analysis showed that HFNC therapy was the only variable at ICU admission associated with a decreased risk of MV (odds ratio, 0.11 [95% CI, 0.02-0.69]; P = 0.02). Moreover, nonventilated patients had an increased survival rate (20.7% vs. 100%; relative rate 4.83 [95% CI, 2.37-9.86]; P < 0.001). No adverse events were associated with HFNC use.
  
  
  CONCLUSIONS
  HFNC O2 therapy is feasible and safe and may decrease the need for MV in LTx recipients readmitted to the ICU because of ARF.
authors.affiliation: 1 Critical Care Department, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain. 2 CibeRes, Instituto de Salud Carlos III, Madrid, Spain. 3 Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain.
authors.forename: Oriol
authors.initials: O
authors.lastname: Roca
authors.forename: Marina García
authors.initials: MG
authors.lastname: de Acilu
authors.forename: Berta
authors.initials: B
authors.lastname: Caralt
authors.forename: Judit
authors.initials: J
authors.lastname: Sacanell
authors.forename: Joan R
authors.initials: JR
authors.lastname: Masclans
mesh_terms: D000208:Acute Disease; D000328:Adult; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D016040:Lung Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D010102:Oxygen Inhalation Therapy / Q000379:methods*; D010359:Patient Readmission; D012131:Respiratory Insufficiency / Q000628:therapy*; D012189:Retrospective Studies