HFNC oxygen therapy success and failure predictors: a portuguese ICU experience

Introduction: High flow nasal cannula oxygen (HFNC) therapy is an alternative in non-invasive ventilatory support for patients (pts) with acute respiratory failure (ARF). The ability to predict HFNC therapy outcome is a key point, allowing prompt endotracheal intubation in pts who are likely to fail. Objects: examine the experience of a portuguese general Intensive Care Unit with HFNC and to identify possible factors associated with success or failure, defined by the need of intubation. Methods: retrospective review of clinical data in a 16-month period comparing pts with 2 outcomes - success versus failure of HFNC therapy - using Mann-Whitney and Chi-square tests. Results: 49 pts were admitted, where success occurred in 18 cases (36,7%) and failure in 31 (63,2%). Baseline characteristics such as age, gender and comorbidities were similar. The main reason for admission was respiratory failure due to pneumonia and both groups had similar severity scoring systems. Despite small sample size, group comparison revealed that HFNC failure was frequent when patients presented cardiovascular failure (p=0,01), which lead to higher mortality (5,6% vs 44,4%; p Conclusions: Cardiovascular failure and absence of improvement in oxygenation 24h and 48h of HFNC therapy may be considered as future predictors of HNFC failure, and can be useful to avoid intubation delay and increased mortality on patients who most likely will benefit from mechanical invasive ventilation.