Article Text
PDF
Abstract
Background Non-invasive respiratory support is a frequent indication for intermediate care unit (IMCU) admission. Extending the possibilities of respiratory support at the IMCU with high-flow nasal cannula oxygen therapy (HFNC) may prevent intensive care unit (ICU) transfer and invasive ventilation. However, the safety and limitations of HFNC administration in the stand-alone IMCU setting are not yet studied. This study therefore aims to investigate to what extent and in which patients HFNC can safely be administered at a stand-alone mixed surgical IMCU.
Methods A case series, using retrospectively collected data, was performed after the first year of introducing HFNC at a stand-alone IMCU. The following variables were collected: indication to start HFNC, vital parameters and arterial blood gas measurements. Primary outcome was 30-day mortality. Secondary outcome was transfer to the ICU.
Results A total of 96 admissions were included. The indications to start HFNC at the IMCU were predominantly pathologies of pulmonary origin (n=67, 69.8%). Less frequent indications were prolonged support postweaning (n=15), non-pulmonary sepsis (n=7) and post-trauma resuscitation (n=6). The average PaO2/FiO2ratio at start of HFNC was 152 (95% CI 139 to 165). 30-day mortality was 7, of which 5 were admitted with treatment restrictions (no ICU policy) and 2 deaths were unrelated to HFNC. Transfer to the ICU occurred in 18 (18.8%) admissions, of which 12 received invasive mechanical ventilation. Reason for ICU transfer was mainly PaO2/FiO2 ratio<100 under maximum non-invasive treatment (n=12, 66.7%). Application of HFNC at the IMCU prevented 162 days of ICU admission.
Discussion Administration of HFNC at a stand-alone surgical IMCU may be safe as it expands the range of supportive possibilities and thereby reduces the need for ICU admissions.Pulmonary indications to start HFNC increase the risk of ICU transfer and mechanical ventilation.
Level of evidence Level VI.
- acute care
- acute care surgery
- critical care
- trauma/ critical care
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
Statistics from Altmetric.com
Footnotes
Contributors JDJP made substantial contributions to design, data collection, data analysis and the interpretation. He was the main author involved in drafting and finalizing the manuscript. LPHL was involved in the design and critically revised the manuscript. He has given final approval of this manuscript to be published. MP made substantial contributions to conception and design and critically revised the manuscript. He has given final approval of the version to be published. JM has critically revised the manuscript. He has given final approval of the version to be published. FH contributed to the design and actively participated in data collection, analysis and its interpretation. He was involved in drafting the manuscript and revising it critically.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent Not required.
Ethics approval Institutional review board of the University Medical Centre Utrecht (protocol number 17-326/C).
Provenance and peer review Not commissioned; externally peer reviewed.