title: Failure of high-flow nasal cannula therapy may delay intubation and increase mortality.
abstract: OBJECTIVE
  Intubation in patients with respiratory failure can be avoided by high-flow nasal cannula (HFNC) use. However, it is unclear whether waiting until HFNC fails, which would delay intubation, has adverse effects. The present retrospective observational study assessed overall ICU mortality and other hospital outcomes of patients who received HFNC therapy that failed.
  
  
  METHODS
  All consecutive patients in one tertiary hospital who received HFNC therapy that failed and who then required intubation between January 2013 and March 2014 were enrolled and classified according to whether intubation started early (within 48 h) or late (at least 48 h) after commencing HFNC.
  
  
  RESULTS
  Of the 175 enrolled patients, 130 (74.3 %) and 45 (25.7 %) were intubated before and after 48 h of HFNC, respectively. The groups were similar in terms of most baseline characteristics. The early intubated patients had better overall ICU mortality (39.2 vs. 66.7 %; P = 0.001) than late intubated patients. A similar pattern was seen with extubation success (37.7 vs. 15.6 %; P = 0.006), ventilator weaning (55.4 vs. 28.9 %; P = 0.002), and ventilator-free days (8.6 ± 10.1 vs. 3.6 ± 7.5; P = 0.011). In propensity-adjusted and -matched analysis, early intubation was also associated with better overall ICU mortality [adjusted odds ratio (OR) = 0.317, P = 0.005; matched OR = 0.369, P = 0.046].
  
  
  CONCLUSIONS
  Failure of HFNC might cause delayed intubation and worse clinical outcomes in patients with respiratory failure. Large prospective and randomized controlled studies on HFNC failure are needed to draw a definitive conclusion.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, South Korea.
authors.forename: Byung Ju
authors.initials: BJ
authors.lastname: Kang
authors.forename: Younsuck
authors.initials: Y
authors.lastname: Koh
authors.forename: Chae-Man
authors.initials: CM
authors.lastname: Lim
authors.forename: Jin Won
authors.initials: JW
authors.lastname: Huh
authors.forename: Seunghee
authors.initials: S
authors.lastname: Baek
authors.forename: Myongja
authors.initials: M
authors.lastname: Han
authors.forename: Hyun-Suk
authors.initials: HS
authors.lastname: Seo
authors.forename: Hee Jung
authors.initials: HJ
authors.lastname: Suh
authors.forename: Ga Jin
authors.initials: GJ
authors.lastname: Seo
authors.forename: Eun Young
authors.initials: EY
authors.lastname: Kim
authors.forename: Sang-Bum
authors.initials: SB
authors.lastname: Hong
mesh_terms: D000368:Aged; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D007442:Intubation, Intratracheal; D008297:Male; D008875:Middle Aged; D063087:Noninvasive Ventilation; D010102:Oxygen Inhalation Therapy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D057216:Propensity Score; D012131:Respiratory Insufficiency / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D017211:Treatment Failure