Clinical Application of High-Flow Nasal Cannula Oxygen Therapy for Patients with Blunt Chest Injury: A Prospective Study

Yin-Chi Lee ； Chun-Fu Chang ； Chien-Ho Tsai ； Shih-Chieh Chang ； Hsin-Yi Chang ； Yi-Chun Lai

《胸腔醫學》 37卷1期 (2022/03) Pp. 13-20

摘要

Introduction: Blunt chest injury (BCI) is associated with a high risk of mortality. High-flow nasal cannula (HFNC) oxygen therapy can be used to reduce the risk of respiratory failure due to hypoxemia, and can significantly reduce the need for intubation compared with general oxygen therapy and the use of a non-invasive positive pressure breathing apparatus. However, it is not widely known whether HFNC can be used in trauma-related hypoxemia. Methods: We performed a cross-sectional study of patients with BCI but without hypercapnia, and compared HFNC therapy with standard oxygen therapy (control group). The primary outcome was the ratio of the proportion of patients intubated in each group; secondary outcomes included mortality in the intensive care unit (ICU), duration of hospital and ICU stay, and other complications. Results: A total of 74 patients fulfilled the BCI criteria and were divided into the HFNC and control groups, with 24 and 50 patients, respectively. Findings revealed a lower respiratory failure rate requiring intubation in the HFNC group (4.2% vs. 10%, p=0.657). A trend toward a shorter length of ICU and hospital stay in the HFNC group was noted, as well as lower incidence of pneumonia (25% vs. 40%, p=0.206). Hemodynamic changes in the control group revealed an increased heart rate and respiratory rate 48 hours later, and an increased respiratory rate after 72 hours. Conclusion: This is the first study in Taiwan to investigate initial HFNC use in patients with BCI. Usage of HFNC for 48 hours exhibited beneficial hemodynamic changes with a lower respiratory and heart rate, and a trend toward a lower rate of intubation, less pneumonia risk, a shorter hospital and ICU stay, and a lower 30-day mortality rate.

關鍵字

Blunt chest injury ； chest trauma ； high-flow nasal cannula ； respiratory failure ； ventilation