title: Efficacy of High-Flow Nasal Cannula Therapy in Acute Hypoxemic Respiratory Failure: Decreased Use of Mechanical Ventilation.
abstract: BACKGROUND
  We evaluated the efficacy of high-flow nasal cannula (HFNC) therapy, a promising respiratory support method for acute hypoxemic respiratory failure (AHRF).
  
  
  METHODS
  We conducted a retrospective single-center cohort study comparing the periods before (June 2010 to May 2012) and after (June 2012 to May 2014) HFNC introduction (pre- and post-HFNC periods). During these periods, we retrieved cases of AHRF treated with any respiratory support (invasive ventilation, noninvasive ventilation [NIV], and HFNC) and compared in-hospital mortality, ICU/intermediate care unit/hospital stay, and need for mechanical ventilation.
  
  
  RESULTS
  Eighty-three subjects (65 treated with NIV, and 18 treated with invasive ventilation) and 89 subjects (33 treated with HFNC, 43 treated with NIV, and 13 treated with invasive ventilation) identified from 782 pre-HFNC and 930 post-HFNC records of acute respiratory failure who required emergent admissions to the respiratory care department were analyzed. Overall, the in-hospital mortality rate was similar, although there was a non-significant and slight decrease from 35 to 27% (P = .26). There was no significant difference among ICU, intermediate care unit (P = .80), and hospital (P = .33) stay. In the post-HFNC period, significantly fewer subjects required mechanical ventilation (NIV or invasive ventilation) (100% vs 63%, P < .01). Additionally, there were significantly fewer ventilator days (median [interquartile range] of 5 [2-11] vs 2 [1-5] d, P < .05) and more ventilator-free days (median [interquartile range] of 18 [0-25] vs 26 [20-27] d, P < .01).
  
  
  CONCLUSIONS
  HFNC might be an alternative for AHRF subjects with NIV intolerance.
authors.affiliation: Department of Respiratory Medicine kazuma_n1101@yahoo.co.jp.
authors.forename: Kazuma
authors.initials: K
authors.lastname: Nagata
authors.affiliation: Clinical Research Center Department of Clinical Epidemiology, Center for Clinical Research and Education, Hyogo College of Medicine, Nishinomiya, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Morimoto
authors.affiliation: Department of Respiratory Medicine.
authors.forename: Daichi
authors.initials: D
authors.lastname: Fujimoto
authors.affiliation: Department of Respiratory Medicine.
authors.forename: Takehiro
authors.initials: T
authors.lastname: Otoshi
authors.affiliation: Department of Respiratory Medicine.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Nakagawa
authors.affiliation: Department of Respiratory Medicine.
authors.forename: Kojiro
authors.initials: K
authors.lastname: Otsuka
authors.affiliation: Department of Anesthesia.
authors.forename: Ryutaro
authors.initials: R
authors.lastname: Seo
authors.affiliation: Department of Emergency Medicine, Kobe City Medical Center General Hospital, Kobe, Japan.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Atsumi
authors.affiliation: Department of Respiratory Medicine.
authors.forename: Keisuke
authors.initials: K
authors.lastname: Tomii
mesh_terms: D000368:Aged; D057785:Catheters; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D000860:Hypoxia / Q000401:mortality / Q000628:therapy*; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010102:Oxygen Inhalation Therapy / Q000295:instrumentation / Q000379:methods* / Q000401:mortality; D012121:Respiration, Artificial / Q000706:statistics & numerical data*; D012131:Respiratory Insufficiency / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: acute hypoxemic respiratory failure; high-flow nasal cannula; invasive ventilation; noninvasive ventilation; respiratory support; ventilator-free days