title: Nasal high-flow oxygen therapy in ICU: A before-and-after study.
abstract: BACKGROUND
  Non-intubated intensive care patients commonly receive supplemental oxygen by high-flow face mask (HFFM), simple face mask (FM) and nasal prongs (NP) during their ICU admission. However, high-flow nasal prongs (HFNP) offer considerable performance capabilities that may sufficiently meet all their oxygen therapy requirements.
  
  
  OBJECTIVE
  To assess the feasibility, safety and cost-effectiveness of introducing a protocol in which HFNP was the primary oxygen delivery device for non-intubated intensive care patients.
  
  
  METHODS
  Prospective 4-week before-and-after study (6 months apart) for all adult patients admitted to a 22-bed tertiary ICU in Melbourne, Australia.
  
  
  RESULTS
  117 patients (57 before, 60 after) were included: 86 (73.5%) received mechanical ventilation. Feasibility revealed a significant reduction in HFFM (52.6-0%, p<.001), FM (35.1-8.3%, p=.002) and NP (75.4-36.7%, p<.001) use and an increase in HFNP use (31.6-81.7%, p<.05) during the after period. Following extubation, there was a significant reduction in HFFM use (65.7% vs. 0%, p<.05) and an increase HFNP use (8.6% vs. 87.5%, p<.05). Costing was in favour of the after period with a consumable cost saving per patient (AUD $32.56 vs. $17.62, p<.05). During the after period, more patients were discharged from ICU with HFNP than during the before period (5 vs. 33 patients, p<.05) and fewer patients (5 vs. 14 patients) used three or more oxygen delivery devices. Safety outcomes demonstrated no significant difference in the number of intubations, re-intubations, readmissions or non-invasive ventilation use between the two time periods.
  
  
  CONCLUSIONS
  Using HFNP as the primary oxygen delivery method for non-intubated intensive care patients was feasible, appeared safe, and the oxygen device costs were reduced. The findings of our single-centre study support further multi-centre evaluations of HFNP therapy protocols in non-ventilated intensive care patients.
authors.affiliation: Department of Intensive Care, Austin Hospital, Melbourne Australia; School of Nursing and Midwifery, Griffith University, Brisbane Australia; School of Nursing and Midwifery, Deakin University, Melbourne, Australia. Electronic address: nigel.fealy@austin.org.au.
authors.forename: Nigel
authors.initials: N
authors.lastname: Fealy
authors.affiliation: Department of Intensive Care, Austin Hospital, Melbourne Australia.
authors.forename: Claire
authors.initials: C
authors.lastname: Osborne
authors.affiliation: Department of Intensive Care, Austin Hospital, Melbourne Australia; School of Nursing and Midwifery, Deakin University, Melbourne, Australia.
authors.forename: Glenn M
authors.initials: GM
authors.lastname: Eastwood
authors.affiliation: Department of Intensive Care, Austin Hospital, Melbourne Australia; Australian and New Zealand Intensive Care Research Centre (ANZICS-RC), School of Preventative Medicine and Public Health, Monash University, Melbourne, Australia.
authors.forename: Neil
authors.initials: N
authors.lastname: Glassford
authors.affiliation: Department of Intensive Care, Austin Hospital, Melbourne Australia.
authors.forename: Graeme
authors.initials: G
authors.lastname: Hart
authors.affiliation: Department of Intensive Care, Austin Hospital, Melbourne Australia; Australian and New Zealand Intensive Care Research Centre (ANZICS-RC), School of Preventative Medicine and Public Health, Monash University, Melbourne, Australia.
authors.forename: Rinaldo
authors.initials: R
authors.lastname: Bellomo
mesh_terms: D000368:Aged; D001315:Australia; D003362:Cost-Benefit Analysis; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008397:Masks; D008875:Middle Aged; D010102:Oxygen Inhalation Therapy / Q000295:instrumentation / Q000379:methods*; D061214:Patient Safety; D010865:Pilot Projects; D011446:Prospective Studies; D012121:Respiration, Artificial; D016896:Treatment Outcome
keywords: Acute nursing care; Critical illness; Intensive care nasal high-flow; Nasal cannulae; Nasal prongs; Oxygen therapy