1. High-Flow Nasal Oxygen in the Adult Emergency Department
Ammara Doolabh
James Hughes
Princess Alexandra Hospital Emergency Department

2. High-Flow Nasal Oxygen
“High-flow”, “Airvo”, “Optiflow”, “HFNO”
Widely used and studied in paediatric populations
Recently introduced into adult populations
Limited literature on use in adult populations
Particularly ED Setting (single study on management of hypoxemic respiratory failure)
Focus on hypoxemic respiratory failure

3. High-Flow Nasal Oxygen
Able to generate flow dependent positive pressure within the upper airways
Associated increase in end expiratory lung volumes
Nasopharyngeal dead-space washout and oxygen reservoir
Improvements in a number of clinical parameters (Oxygenation, HR, RR, dyspnoea scores, supra- clavicular recession, thoraco-abdominal asynchrony)
Useful for both “stepping-up” and “stepping-down” respiratory support

4. HFNO in the ED Improvements as early as 15 minutes after commencement
Better patient tolerance and adherence (compared to systems requiring a face-mask)
Lower cost per use (compared to NIV)
Acceptable usage for caregivers (set-up and management) within an ED setting

5. To explore the role of HFNO in an adult emergency department
Objectives
To explore the role of HFNO in an adult emergency department
Indications for use
Outcomes of use

6. Our Study Explorative, retrospective study Chart review
Patients 18 years or older
Received HFNO within the PA Hospital Emergency Department
2014 Calendar Year
Ethical Approval from both Metro South Health and University of Queensland School of Medicine Human Research Ethics Committees

7. Results 39 patients identified Male patients: 29 (74.4%)
Age range: years
Mean age: 60 years (SD )

8. Pre-HFNO Oxygenation

9. Indications for HFNO Use
35 patients with pre-HFNO blood gas values available
Patients with normal blood gas analysis:
“Step-up”: 3
“Step-down”: 1

10. Diagnoses

11. Influenza Status
18 Patients with Nasopharyngeal Swab and PCR Analysis for Influenza A and Influenza B

12. Clinical Effects of HFNO

13. Effects of HFNO on Carbon Dioxide Levels
16 patients with both pre-HFNO and post one hour of HFNO Blood Gas Analyses available
6 hypercapnic patients, 10 normocapnic patients

14. Cessation of HFNO and Post-HFNO Oxygenation
HFNO Patients (n=39)
Discharged to Ward on HFNO (n=27)
HFNO Ceased in ED (n=12)
Condition Improved (n=7)
NRB (n= 1)
NP (n=4)
RA(n=2)
Patient Refusal (n=1)
HM (n=1)
Unsatisfactory Progress(n=2)
NRB(n=2)
NIV Commenced (n=2)
CPAP (n=1)
BiPAP (n=1)
HM = Hudson Mask, NRB = Non-Rebreather Mask, NP = Nasal Prongs, RA = Room Air

15. Limitations Small number of patients Retrospective nature of the study
Missing data / data inconsistencies
Lack of comparison or control arm
Causal relationship cannot be established
Results can be attributed to “regression-to-the-mean” or concurrent treatments
Only focused on outcomes within the ED

16. Conclusion HFNO is useful for a number of indications within the PA ED
Associated with improvements in a number of clinical parameters
HFNO may be useful in the ED management of hypercapnic patients
Questions for further research
Role of HFNO in management of hypercapnia
Outcomes of ED HFNO patients beyond the ED

17. Thank You