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Title: Nasal high-flow oxygen therapy in ICU: A before-and-after study.
Austin Authors: Fealy, Nigel G ;Osborne, Clare ;Eastwood, Glenn M ;Glassford, Neil J;Hart, Graeme K ;Bellomo, Rinaldo 
Affiliation: Department of Intensive Care, Austin Health, Heidelberg, Victoria, Australia
School of Nursing and Midwifery, Deakin University, Melbourne, Australia
School of Nursing and Midwifery, Griffith University, Brisbane Australia
Australian and New Zealand Intensive Care Research Centre (ANZICS-RC), School of Preventative Medicine and Public Health, Monash University, Melbourne, Australia
Issue Date: 16-Jun-2015
Publication information: Australian Critical Care 2016; 29(1): 17-22
Abstract: BACKGROUND: Non-intubated intensive care patients commonly receive supplemental oxygen by high-flow face mask (HFFM), simple face mask (FM) and nasal prongs (NP) during their ICU admission. However, high-flow nasal prongs (HFNP) offer considerable performance capabilities that may sufficiently meet all their oxygen therapy requirements. STUDY AIMS: To assess the feasibility, safety and cost-effectiveness of introducing a protocol in which HFNP was the primary oxygen delivery device for non-intubated intensive care patients. METHOD: Prospective 4-week before-and-after study (6 months apart) for all adult patients admitted to a 22-bed tertiary ICU in Melbourne, Australia. RESULTS: 117 patients (57 before, 60 after) were included: 86 (73.5%) received mechanical ventilation. Feasibility revealed a significant reduction in HFFM (52.6-0%, p<.001), FM (35.1-8.3%, p=.002) and NP (75.4-36.7%, p<.001) use and an increase in HFNP use (31.6-81.7%, p<.05) during the after period. Following extubation, there was a significant reduction in HFFM use (65.7% vs. 0%, p<.05) and an increase HFNP use (8.6% vs. 87.5%, p<.05). Costing was in favour of the after period with a consumable cost saving per patient (AUD $32.56 vs. $17.62, p<.05). During the after period, more patients were discharged from ICU with HFNP than during the before period (5 vs. 33 patients, p<.05) and fewer patients (5 vs. 14 patients) used three or more oxygen delivery devices. Safety outcomes demonstrated no significant difference in the number of intubations, re-intubations, readmissions or non-invasive ventilation use between the two time periods. CONCLUSIONS: Using HFNP as the primary oxygen delivery method for non-intubated intensive care patients was feasible, appeared safe, and the oxygen device costs were reduced. The findings of our single-centre study support further multi-centre evaluations of HFNP therapy protocols in non-ventilated intensive care patients.
DOI: 10.1016/j.aucc.2015.05.003
ORCID: 0000-0002-1650-8939
Journal: Australian Critical Care
PubMed URL:
Type: Journal Article
Subjects: Acute nursing care
Critical illness
Intensive care nasal high-flow
Nasal cannulae
Nasal prongs
Oxygen therapy
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