High-Flow Nasal Cannula Oxygen in Patients with Acute Respiratory Failure and Do-Not-Intubate or Do-Not-Resuscitate Orders: A Systematic Review

Michael E. Wilson, Aniket Mittal, Claudia Caroline Dobler, J. Randall Curtis, Abdul M. Majzoub, Jalal Soleimani, Ognjen Gajic, Patricia J. Erwin, Victor M. Montori, Mohammad Hassan Murad

Research output: Contribution to journalArticleResearchpeer-review

Abstract

BACKGROUND AND OBJECTIVES: High-flow nasal cannula (HFNC) oxygen may provide tailored benefits in patients with preset treatment limitations. The objective of this study was to assess the effectiveness of HFNC oxygen in patients with do-not-intubate (DNI) and/or do-not-resuscitate (DNR) orders.
METHODS: We conducted a systematic review of interventional and observational studies. A search was performed using MEDLINE, EMBASE, CINAHL, Scopus, and Web of Science, from inception to October 15, 2018.
RESULTS: We included six studies evaluating 293 patients. All studies had a high risk of bias. The hospital mortality rates of patients with DNI and/or DNR orders receiving HFNC oxygen were variable and ranged from 40% to 87%. In two before and after studies, the initiation of HFNC oxygen was associated with improved oxygenation and reduced respiratory rates. One comparative study found no difference in dyspnea reduction or morphine doses between patients using HFNC oxygen versus conventional oxygen. No studies evaluated quality of life in survivors or quality of death in nonsurvivors. HFNC was generally well tolerated with few adverse events identified.
CONCLUSIONS: While HFNC oxygen remains a viable treatment option for hospitalized patients who have acute respiratory failure and a DNI and/or DNR order, there is a paucity of high-quality, comparative, effectiveness data to guide the usage of HFNC oxygen compared with other treatments, such as noninvasive ventilation, conventional oxygen, and palliative opioids.
Original languageEnglish
JournalJournal of Hospital Medicine
DOIs
Publication statusE-pub ahead of print - 20 Nov 2019
Externally publishedYes

Fingerprint

Resuscitation Orders
Respiratory Insufficiency
Oxygen
Cannula
Noninvasive Ventilation
Respiratory Rate
Hospital Mortality
MEDLINE
Dyspnea
Morphine
Opioid Analgesics
Observational Studies
Survivors
Therapeutics
Quality of Life

Cite this

Wilson, Michael E. ; Mittal, Aniket ; Dobler, Claudia Caroline ; Curtis, J. Randall ; Majzoub, Abdul M. ; Soleimani, Jalal ; Gajic, Ognjen ; Erwin, Patricia J. ; Montori, Victor M. ; Murad, Mohammad Hassan. / High-Flow Nasal Cannula Oxygen in Patients with Acute Respiratory Failure and Do-Not-Intubate or Do-Not-Resuscitate Orders: A Systematic Review. In: Journal of Hospital Medicine. 2019.
@article{11e5f3f94d6043a6bd36df2d26e460cb,
title = "High-Flow Nasal Cannula Oxygen in Patients with Acute Respiratory Failure and Do-Not-Intubate or Do-Not-Resuscitate Orders: A Systematic Review",
abstract = "BACKGROUND AND OBJECTIVES: High-flow nasal cannula (HFNC) oxygen may provide tailored benefits in patients with preset treatment limitations. The objective of this study was to assess the effectiveness of HFNC oxygen in patients with do-not-intubate (DNI) and/or do-not-resuscitate (DNR) orders.METHODS: We conducted a systematic review of interventional and observational studies. A search was performed using MEDLINE, EMBASE, CINAHL, Scopus, and Web of Science, from inception to October 15, 2018.RESULTS: We included six studies evaluating 293 patients. All studies had a high risk of bias. The hospital mortality rates of patients with DNI and/or DNR orders receiving HFNC oxygen were variable and ranged from 40{\%} to 87{\%}. In two before and after studies, the initiation of HFNC oxygen was associated with improved oxygenation and reduced respiratory rates. One comparative study found no difference in dyspnea reduction or morphine doses between patients using HFNC oxygen versus conventional oxygen. No studies evaluated quality of life in survivors or quality of death in nonsurvivors. HFNC was generally well tolerated with few adverse events identified.CONCLUSIONS: While HFNC oxygen remains a viable treatment option for hospitalized patients who have acute respiratory failure and a DNI and/or DNR order, there is a paucity of high-quality, comparative, effectiveness data to guide the usage of HFNC oxygen compared with other treatments, such as noninvasive ventilation, conventional oxygen, and palliative opioids.",
author = "Wilson, {Michael E.} and Aniket Mittal and Dobler, {Claudia Caroline} and Curtis, {J. Randall} and Majzoub, {Abdul M.} and Jalal Soleimani and Ognjen Gajic and Erwin, {Patricia J.} and Montori, {Victor M.} and Murad, {Mohammad Hassan}",
year = "2019",
month = "11",
day = "20",
doi = "10.12788/jhm.3329",
language = "English",
journal = "Journal of hospital medicine (Online)",
issn = "1553-5592",
publisher = "John Wiley & Sons",

}

High-Flow Nasal Cannula Oxygen in Patients with Acute Respiratory Failure and Do-Not-Intubate or Do-Not-Resuscitate Orders: A Systematic Review. / Wilson, Michael E.; Mittal, Aniket; Dobler, Claudia Caroline; Curtis, J. Randall; Majzoub, Abdul M.; Soleimani, Jalal; Gajic, Ognjen; Erwin, Patricia J.; Montori, Victor M.; Murad, Mohammad Hassan.

In: Journal of Hospital Medicine, 20.11.2019.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - High-Flow Nasal Cannula Oxygen in Patients with Acute Respiratory Failure and Do-Not-Intubate or Do-Not-Resuscitate Orders: A Systematic Review

AU - Wilson, Michael E.

AU - Mittal, Aniket

AU - Dobler, Claudia Caroline

AU - Curtis, J. Randall

AU - Majzoub, Abdul M.

AU - Soleimani, Jalal

AU - Gajic, Ognjen

AU - Erwin, Patricia J.

AU - Montori, Victor M.

AU - Murad, Mohammad Hassan

PY - 2019/11/20

Y1 - 2019/11/20

N2 - BACKGROUND AND OBJECTIVES: High-flow nasal cannula (HFNC) oxygen may provide tailored benefits in patients with preset treatment limitations. The objective of this study was to assess the effectiveness of HFNC oxygen in patients with do-not-intubate (DNI) and/or do-not-resuscitate (DNR) orders.METHODS: We conducted a systematic review of interventional and observational studies. A search was performed using MEDLINE, EMBASE, CINAHL, Scopus, and Web of Science, from inception to October 15, 2018.RESULTS: We included six studies evaluating 293 patients. All studies had a high risk of bias. The hospital mortality rates of patients with DNI and/or DNR orders receiving HFNC oxygen were variable and ranged from 40% to 87%. In two before and after studies, the initiation of HFNC oxygen was associated with improved oxygenation and reduced respiratory rates. One comparative study found no difference in dyspnea reduction or morphine doses between patients using HFNC oxygen versus conventional oxygen. No studies evaluated quality of life in survivors or quality of death in nonsurvivors. HFNC was generally well tolerated with few adverse events identified.CONCLUSIONS: While HFNC oxygen remains a viable treatment option for hospitalized patients who have acute respiratory failure and a DNI and/or DNR order, there is a paucity of high-quality, comparative, effectiveness data to guide the usage of HFNC oxygen compared with other treatments, such as noninvasive ventilation, conventional oxygen, and palliative opioids.

AB - BACKGROUND AND OBJECTIVES: High-flow nasal cannula (HFNC) oxygen may provide tailored benefits in patients with preset treatment limitations. The objective of this study was to assess the effectiveness of HFNC oxygen in patients with do-not-intubate (DNI) and/or do-not-resuscitate (DNR) orders.METHODS: We conducted a systematic review of interventional and observational studies. A search was performed using MEDLINE, EMBASE, CINAHL, Scopus, and Web of Science, from inception to October 15, 2018.RESULTS: We included six studies evaluating 293 patients. All studies had a high risk of bias. The hospital mortality rates of patients with DNI and/or DNR orders receiving HFNC oxygen were variable and ranged from 40% to 87%. In two before and after studies, the initiation of HFNC oxygen was associated with improved oxygenation and reduced respiratory rates. One comparative study found no difference in dyspnea reduction or morphine doses between patients using HFNC oxygen versus conventional oxygen. No studies evaluated quality of life in survivors or quality of death in nonsurvivors. HFNC was generally well tolerated with few adverse events identified.CONCLUSIONS: While HFNC oxygen remains a viable treatment option for hospitalized patients who have acute respiratory failure and a DNI and/or DNR order, there is a paucity of high-quality, comparative, effectiveness data to guide the usage of HFNC oxygen compared with other treatments, such as noninvasive ventilation, conventional oxygen, and palliative opioids.

U2 - 10.12788/jhm.3329

DO - 10.12788/jhm.3329

M3 - Article

JO - Journal of hospital medicine (Online)

JF - Journal of hospital medicine (Online)

SN - 1553-5592

ER -