RESUMEN
INTRODUCTION: To assess the efficacy and safety of high-flow nasal cannula (HFNC) in elderly patients with acute respiratory failure (ARF) not due to COVID-19, refractory to treatment with conventional oxygen therapy and/or intolerant to noninvasive ventilation (NIV) or continuous positive airway pressure (CPAP) and without criteria for admission to intensive care units (ICU). METHODS: Prospective observational study of patients with ARF treated with HFNC who presented clinical and arterial blood gas deterioration after 24 h of medical treatment and oxygenation by conventional systems. The degree of dyspnoea, gas exchange parameters (arterial O2 pressure/inspired O2 fraction ratio (PaO2/FiO2); oxygen saturation measured by oximetry/ inspired fraction of oxygen (Sp02/Fi02), ROX index), degree of patient tolerance and mortality were evaluated. These were measured at discharge from the emergency department (ED), 24 h after treatment with conventional oxygenation and 60, 120 min and 24 h after initiation of HFNC. The results were analyzed for all patients as a whole and for patients with hypercapnia (arterial carbon dioxide tension (PaCO2) < 45 mmHg) separately. RESULTS: 200 patients were included in the study between November 2019 and November 2020, with a mean age of 83 years, predominantly women (61.9%), obese (Body Mass Index (BMI) 31.1), with high comorbidity (Charlson index 4) and mild-moderate degree of dependence (Barthel 60). A number of 128 patients (64%) were hypercapnic. None had respiratory acidosis (pH 7.39). Evaluation at 60 min, 120 min and 24 h showed significant improvement in all patients and in the subgroup of hypercapnic patients with respect to baseline parameters in respiratory rate (RR), dyspnoea, ROX index, PaO2/FiO2, SpO2/FiO2 and patient comfort. No changes in PaCO2 or level of consciousness were observed. HFNC was well tolerated. Ten patients (5%) died due to progression of the disease causing ARF. CONCLUSIONS: HFNC is an effective and safe alternative in elderly patients with ARF not due to COVID-19, refractory to treatment with conventional oxygen therapy and/or intolerant to NIV or CPAP and without criteria for admission to ICU.
RESUMEN
Objetivos: El objetivo es evaluar el perfil clínico y la evolución de los pacientes con edema agudo de pulmón (EAP) tratados con ventilación no invasiva (VNI) en un servicio de urgencias hospitalario (SUMH) y los factores asociados con el fracaso de la técnica y la mortalidad. Método: Estudio observacional y prospectivo que incluyó a todos los pacientes atendidos en el SUMH por con EAP que precisaron VNI. Se analizaron los parámetros clínicos y gasométricos al ingreso y a los 60 minutos, el modo ventilatorio, destino, complicaciones, necesidad de intubación orotraqueal, y tiempo de permanencia en urgencias. Se calcularon el índice de comorbilidad de Charlson y el índice de Barthel (IB). Se evaluó l amortalidad en el SUH, durante el ingreso hospitalario y a los 7 y 21 días tras el alta. Resultados: Se estudió a 133 pacientes, 69 varones (51%), la edad media fue de76,2 ± 10,9 años. En el 60% se utilizó la presión positiva constante en la vía aérea(CPAP) como modo ventilatorio. Los parámetros clínicos y gasométricos mejoraron tras una hora de VNI. El tiempo de tratamiento de VNI fue 4,25 ± 2,54 horas. La sequedad de mucosas y el eritema facial fueron las complicaciones más frecuentes (69 y 50% respectivamente).La técnica fracasó en el 9,8% y la mortalidad en urgencias fue del 3%.No se identificaron factores de riesgo asociados a una mayor mortalidad. La modalidad ventilatoria no influyó en la mejoría clínico-gasométrica, mortalidad ni en el fracaso de la técnica. El 33,8% (45) de los pacientes ingresó en la unidad de corta estancia (UCE),26,3% (35) en cardiología, 18,8% (25) en medicina interna y el 5,2% (7) de cuidados intensivos. (..) (AU)
Objectives: Our aim was to analyze patient characteristics and clinical course in acute cardiogenic pulmonary edema(PE) treated with noninvasive ventilation (NIV) in our hospital emergency department (ED) and to find out factors related to NIV failure and mortality. Patients and methods: Prospective, observational study of all patients with acute CPE requiring NIV in our ED. We analyzed clinical characteristics and blood gas analyses on admission and at 60 minutes, type of ventilation applied, destination on discharge, complications, need for orotracheal intubation, and duration of stay in the ED. Comorbidity was assessed on the Charlson and Barthel indices. Mortality in the emergency department, on the ward, or 7 and 21days after discharge was registered on follow-up. Results: We studied 133 patients; 69 (51%) were men and the mean (SD) age was 76.2 (10.9) years. Continuous positive airway pressure was used in 60% of the cases. Symptoms and results of arterial blood gas analysis improved 1hour after starting NIV. Mean duration of NIV was 4.25 (2.54) hours. Dry mucus membranes (69%) and erythematousfacial sores (50%) were the most common complications. NIV failed in 9,8% of patients. ED mortality was 3%. We do not identify and risk factors associated with increased mortality. Choice of NIV modality was not a factor in clinical or blood gas improvements, mortality, or failure of NIV treatment. Forty-five (33.8%) patients were admitted to the shortstayunit, 35 (26.3%) to the cardiology ward, 25 (18.8%) to the internal medicine ward, and 7 (5.2%) to the intensivecare unit. Conclusions: Early application of NIV to treat acute CPE improves symptoms and blood gases quickly, with few complications and short ED stays. The NIV modality chosen does not affect mortality or failure of the technique. The possibility of using NIV in all hospital ED should be considered (AU)