Date Available

4-26-2017

Year of Publication

2017

Degree Name

Doctor of Nursing Practice

Advisor

Dr. Melanie Hardin-Pierce

Committee Member

Dr. Jason Mann

Committee Member

Dr. Elizabeth Burckardt

Co-Director of Graduate Studies

Dr. Peter Morris

Abstract

Background: High flow nasal cannula therapy is becoming a more common therapy in the adult population. Multiple studies have been conducted on the potential benefits of this therapy such as increased patient tolerance of the therapy, improved secretion clearance and the ability for providers to deliver a greater range of FiO2 settings at a wider range of flow rates. With the increasing utility of this therapy, the research for best practices, setting (FiO2 and LPM) and duration of therapy to guide clinicians is lacking.

Aim: 1) Does high flow nasal cannula therapy reduce the need for intubation or re-intubation in patients with hypoxic respiratory failure, as compared to continuous positive airway pressure or bi-level positive airway pressure therapy? 2) How do variations in setting of high flow nasal cannula therapy affect the need for intubation or re-intubation, mortality and hospital length of stay?

Methods: Subjects for this study were adults, ages 18-99 years old with a diagnosis of respiratory failure. Group 1 (n=213) was created to determine whether initial high flow treatment for respiratory failure may decrease intubation rates, as compared to continuous positive airway pressure or bi-level positive airway pressure therapy. Group 2 (n=88) examined whether high flow nasal cannula therapy was associated with lower re-intubation rates when high flow was administered to post ventilator respiratory failure patients. An in-group analysis of high flow nasal cannula therapy was done in both groups to examine how variation in setting affected patient outcomes. Statistical analysis was performed with SPSS version 24.

Results: In Group 1, the analysis of high flow nasal cannula therapy vs. continuous positive airway pressure or bi-level positive airway pressure therapy found no significant difference in intubation rates, p=0.119. No significant difference was found between type of NIV therapy used for post extubation patients and the rate of re-intubation for Group 2, p=0.789. In-group analysis of high flow cannula setting (FiO2 and LPM) found that there was no significant difference associated with high flow administration and reduced mortality in Group 1 (FiO2 p=0.0988, LPM p=0.502 or Group 2 (FiO2 p=0.194, LPM p=0.449). There was no significant difference in the need for intubation or re-intubation in both Group 1 (FiO2 p=0.992, LPM p=0.716) and Group 2 (FiO2 p=0.746, LPM p=0.592).

Conclusion: This study suggests that high flow nasal cannula therapy performed similarly as continuous positive airway pressure or bi-level positive airway pressure therapy in preventing intubation and re-intubation rates. The group analysis of high flow nasal cannula therapy settings suggests that variation in the setting did not impact intubation or re-intubation rates.

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