Efficacy of high-flow nasal cannula therapy in bedridden patients

Background: A growing number of studies have demonstrated the efficacy of high-flow nasal cannula therapy (HFNC) for treating children with acute respiratory distress. However, it remains unknown whether HFNC is effective in bedridden patients with acute respiratory distress.

Method: We retrospectively reviewed the medical records of bedridden patients with acute respiratory distress who were treated with HFNC using a home ventilator in continuous positive airway pressure mode at our center between March 2014 and August 2016. We assessed heart rate, respiratory rate, oxygen saturation measured using a pulse oximeter, the partial pressure of venous carbon dioxide, or the transcutaneous partial pressure of carbon dioxide, and symptoms of respiratory distress before and after the initiation of HFNC.

Results: During the 2-year-study period, 25 patients were treated with HFNC. The patients' mean heart rate, respiratory rate, oxygen saturation measured using a pulse oximeter, and pressure of venous carbon dioxide/the transcutaneous partial pressure of carbon dioxide values improved significantly (P < 0.05). Symptoms of respiratory distress were considerably ameliorated at 1-3 h after the HFNC initiation, except in two patients. In these two patients, the HFNC was replaced with non-invasive positive pressure ventilation. Non-invasive positive pressure was also required at 16 to 168 h after the initiation of HFNC in five of the 28 episodes in which the patient was initially responsive to HFNC, as the patients' respiratory symptoms gradually deteriorated.

Conclusion: Performing HFNC with a home ventilator in continuous positive airway pressure mode is effective at treating bedridden patients with acute respiratory distress. However, it is essential that the HFNC can be switched to non-invasive positive pressure if needed.