High-Flow Nasal Cannula Versus Conventional Oxygen Therapy in Relieving Dyspnea in Emergency Palliative Patients With Do-Not-Intubate Status: A Randomized Crossover Study
Palliative patients often visit the emergency department (ED) with respiratory distress during their end-of-life period. The goal of management is alleviating dyspnea and providing comfort. High-flow nasal cannula may be an alternative oxygen-delivering method for palliative patients with do-not-int...
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| Veröffentlicht in: | Annals of emergency medicine 2020-05, Vol.75 (5), p.615-626 |
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| creator | Ruangsomboon, Onlak Dorongthom, Thawonrat Chakorn, Tipa Monsomboon, Apichaya Praphruetkit, Nattakarn Limsuwat, Chok Surabenjawong, Usapan Riyapan, Sattha Nakornchai, Tanyaporn Chaisirin, Wansiri |
| description | Palliative patients often visit the emergency department (ED) with respiratory distress during their end-of-life period. The goal of management is alleviating dyspnea and providing comfort. High-flow nasal cannula may be an alternative oxygen-delivering method for palliative patients with do-not-intubate status. We therefore aim to compare the efficacy of high-flow nasal cannula with conventional oxygen therapy in improving dyspnea of palliative patients with do-not-intubate status who have hypoxemic respiratory failure in the ED.
This randomized, nonblinded, crossover study was conducted with 48 palliative patients aged 18 years or older with do-not-intubate status who presented with hypoxemic respiratory failure to the ED of Siriraj Hospital, Bangkok, Thailand. The participants were randomly allocated to conventional oxygen therapy for 60 minutes, followed by high-flow nasal cannula for 60 minutes (n=24) or vice versa (n=24). The primary outcome was modified Borg scale score. The secondary outcomes were numeric rating scale score of dyspnea and vital signs.
Intention-to-treat analysis included 44 patients, 22 in each group. Baseline mean modified Borg scale score was 7.6 (SD 2.2) (conventional oxygen therapy first) and 8.2 (SD 1.8) (high-flow nasal cannula first). At 60 minutes, mean modified Borg scale score in patients receiving conventional oxygen therapy and high-flow nasal cannula was 4.9 (standard of mean 0.3) and 2.9 (standard of mean 0.3), respectively (mean difference 2.0; 95% confidence interval 1.4 to 2.6). Results for the numeric rating scale score of dyspnea were similar to those for the modified Borg scale score. Respiratory rates were lower with high-flow nasal cannula (mean difference 5.9; 95% confidence interval 3.5 to 8.3), and high-flow nasal cannula was associated with a significantly lower first-hour morphine dose.
High-flow nasal cannula was superior to conventional oxygen therapy in reducing the severity of dyspnea in the first hour of treatment in patients with do-not-intubate status and hypoxemic respiratory failure. |
| doi_str_mv | 10.1016/j.annemergmed.2019.09.009 |
| format | Article |
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This randomized, nonblinded, crossover study was conducted with 48 palliative patients aged 18 years or older with do-not-intubate status who presented with hypoxemic respiratory failure to the ED of Siriraj Hospital, Bangkok, Thailand. The participants were randomly allocated to conventional oxygen therapy for 60 minutes, followed by high-flow nasal cannula for 60 minutes (n=24) or vice versa (n=24). The primary outcome was modified Borg scale score. The secondary outcomes were numeric rating scale score of dyspnea and vital signs.
Intention-to-treat analysis included 44 patients, 22 in each group. Baseline mean modified Borg scale score was 7.6 (SD 2.2) (conventional oxygen therapy first) and 8.2 (SD 1.8) (high-flow nasal cannula first). At 60 minutes, mean modified Borg scale score in patients receiving conventional oxygen therapy and high-flow nasal cannula was 4.9 (standard of mean 0.3) and 2.9 (standard of mean 0.3), respectively (mean difference 2.0; 95% confidence interval 1.4 to 2.6). Results for the numeric rating scale score of dyspnea were similar to those for the modified Borg scale score. Respiratory rates were lower with high-flow nasal cannula (mean difference 5.9; 95% confidence interval 3.5 to 8.3), and high-flow nasal cannula was associated with a significantly lower first-hour morphine dose.
High-flow nasal cannula was superior to conventional oxygen therapy in reducing the severity of dyspnea in the first hour of treatment in patients with do-not-intubate status and hypoxemic respiratory failure.</description><identifier>ISSN: 0196-0644</identifier><identifier>EISSN: 1097-6760</identifier><identifier>DOI: 10.1016/j.annemergmed.2019.09.009</identifier><identifier>PMID: 31864728</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Aged ; Cannula ; Cross-Over Studies ; Dyspnea - therapy ; Emergency Service, Hospital ; Female ; Humans ; Male ; Middle Aged ; Oxygen Inhalation Therapy - instrumentation ; Palliative Care - methods ; Terminally Ill ; Thailand ; Treatment Outcome</subject><ispartof>Annals of emergency medicine, 2020-05, Vol.75 (5), p.615-626</ispartof><rights>2019 American College of Emergency Physicians</rights><rights>Copyright © 2019 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c428t-cb0a69c9f72948ca8caa921fd69b8b078327b889c8ea310c6f165a10f9d3d7723</citedby><cites>FETCH-LOGICAL-c428t-cb0a69c9f72948ca8caa921fd69b8b078327b889c8ea310c6f165a10f9d3d7723</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0196064419312272$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,776,780,3536,27903,27904,65309</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31864728$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ruangsomboon, Onlak</creatorcontrib><creatorcontrib>Dorongthom, Thawonrat</creatorcontrib><creatorcontrib>Chakorn, Tipa</creatorcontrib><creatorcontrib>Monsomboon, Apichaya</creatorcontrib><creatorcontrib>Praphruetkit, Nattakarn</creatorcontrib><creatorcontrib>Limsuwat, Chok</creatorcontrib><creatorcontrib>Surabenjawong, Usapan</creatorcontrib><creatorcontrib>Riyapan, Sattha</creatorcontrib><creatorcontrib>Nakornchai, Tanyaporn</creatorcontrib><creatorcontrib>Chaisirin, Wansiri</creatorcontrib><title>High-Flow Nasal Cannula Versus Conventional Oxygen Therapy in Relieving Dyspnea in Emergency Palliative Patients With Do-Not-Intubate Status: A Randomized Crossover Study</title><title>Annals of emergency medicine</title><addtitle>Ann Emerg Med</addtitle><description>Palliative patients often visit the emergency department (ED) with respiratory distress during their end-of-life period. The goal of management is alleviating dyspnea and providing comfort. High-flow nasal cannula may be an alternative oxygen-delivering method for palliative patients with do-not-intubate status. We therefore aim to compare the efficacy of high-flow nasal cannula with conventional oxygen therapy in improving dyspnea of palliative patients with do-not-intubate status who have hypoxemic respiratory failure in the ED.
This randomized, nonblinded, crossover study was conducted with 48 palliative patients aged 18 years or older with do-not-intubate status who presented with hypoxemic respiratory failure to the ED of Siriraj Hospital, Bangkok, Thailand. The participants were randomly allocated to conventional oxygen therapy for 60 minutes, followed by high-flow nasal cannula for 60 minutes (n=24) or vice versa (n=24). The primary outcome was modified Borg scale score. The secondary outcomes were numeric rating scale score of dyspnea and vital signs.
Intention-to-treat analysis included 44 patients, 22 in each group. Baseline mean modified Borg scale score was 7.6 (SD 2.2) (conventional oxygen therapy first) and 8.2 (SD 1.8) (high-flow nasal cannula first). At 60 minutes, mean modified Borg scale score in patients receiving conventional oxygen therapy and high-flow nasal cannula was 4.9 (standard of mean 0.3) and 2.9 (standard of mean 0.3), respectively (mean difference 2.0; 95% confidence interval 1.4 to 2.6). Results for the numeric rating scale score of dyspnea were similar to those for the modified Borg scale score. Respiratory rates were lower with high-flow nasal cannula (mean difference 5.9; 95% confidence interval 3.5 to 8.3), and high-flow nasal cannula was associated with a significantly lower first-hour morphine dose.
High-flow nasal cannula was superior to conventional oxygen therapy in reducing the severity of dyspnea in the first hour of treatment in patients with do-not-intubate status and hypoxemic respiratory failure.</description><subject>Aged</subject><subject>Cannula</subject><subject>Cross-Over Studies</subject><subject>Dyspnea - therapy</subject><subject>Emergency Service, Hospital</subject><subject>Female</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Oxygen Inhalation Therapy - instrumentation</subject><subject>Palliative Care - methods</subject><subject>Terminally Ill</subject><subject>Thailand</subject><subject>Treatment Outcome</subject><issn>0196-0644</issn><issn>1097-6760</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNUcFu1DAUtBCIbgu_gMyNSxY7Se2YW5W2tFLVolLgaDnOy65Xib3YTiD9JL4SR9tKHJFGsvVm3rxnD0LvKVlTQtnH3VpZCwP4zQDtOidUrEkCES_QihLBM8YZeYlWiWAZYWV5hI5D2JGkKHP6Gh0VtGIlz6sV-nNlNtvssne_8K0Kqsd1sh57hb-DD2PAtbMT2GicTdzd73kDFj9swav9jI3F99AbmIzd4PM57C2opXixbAZWz_iL6nujopkgXaNJRgH_MHGLz11262J2bePYqAj4a1RxDJ_wGb5XtnWDeYQW196F4CbwiR7b-Q161ak-wNun8wR9u7x4qK-ym7vP1_XZTabLvIqZbohiQouO56KstEpQIqddy0RTNYRXRc6bqhK6AlVQollH2amipBNt0XKeFyfow8F3793PEUKUgwka-l5ZcGOQeVEQcioE50kqDlK9rOqhk3tvBuVnSYlcopI7-U9UcolKkgQiUu-7pzFjs3DPnc_ZJEF9EEB67GTAy6DTF2pojQcdZevMf4z5C_bYrk8</recordid><startdate>202005</startdate><enddate>202005</enddate><creator>Ruangsomboon, Onlak</creator><creator>Dorongthom, Thawonrat</creator><creator>Chakorn, Tipa</creator><creator>Monsomboon, Apichaya</creator><creator>Praphruetkit, Nattakarn</creator><creator>Limsuwat, Chok</creator><creator>Surabenjawong, Usapan</creator><creator>Riyapan, Sattha</creator><creator>Nakornchai, Tanyaporn</creator><creator>Chaisirin, Wansiri</creator><general>Elsevier Inc</general><scope>6I.</scope><scope>AAFTH</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>202005</creationdate><title>High-Flow Nasal Cannula Versus Conventional Oxygen Therapy in Relieving Dyspnea in Emergency Palliative Patients With Do-Not-Intubate Status: A Randomized Crossover Study</title><author>Ruangsomboon, Onlak ; 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The goal of management is alleviating dyspnea and providing comfort. High-flow nasal cannula may be an alternative oxygen-delivering method for palliative patients with do-not-intubate status. We therefore aim to compare the efficacy of high-flow nasal cannula with conventional oxygen therapy in improving dyspnea of palliative patients with do-not-intubate status who have hypoxemic respiratory failure in the ED.
This randomized, nonblinded, crossover study was conducted with 48 palliative patients aged 18 years or older with do-not-intubate status who presented with hypoxemic respiratory failure to the ED of Siriraj Hospital, Bangkok, Thailand. The participants were randomly allocated to conventional oxygen therapy for 60 minutes, followed by high-flow nasal cannula for 60 minutes (n=24) or vice versa (n=24). The primary outcome was modified Borg scale score. The secondary outcomes were numeric rating scale score of dyspnea and vital signs.
Intention-to-treat analysis included 44 patients, 22 in each group. Baseline mean modified Borg scale score was 7.6 (SD 2.2) (conventional oxygen therapy first) and 8.2 (SD 1.8) (high-flow nasal cannula first). At 60 minutes, mean modified Borg scale score in patients receiving conventional oxygen therapy and high-flow nasal cannula was 4.9 (standard of mean 0.3) and 2.9 (standard of mean 0.3), respectively (mean difference 2.0; 95% confidence interval 1.4 to 2.6). Results for the numeric rating scale score of dyspnea were similar to those for the modified Borg scale score. Respiratory rates were lower with high-flow nasal cannula (mean difference 5.9; 95% confidence interval 3.5 to 8.3), and high-flow nasal cannula was associated with a significantly lower first-hour morphine dose.
High-flow nasal cannula was superior to conventional oxygen therapy in reducing the severity of dyspnea in the first hour of treatment in patients with do-not-intubate status and hypoxemic respiratory failure.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>31864728</pmid><doi>10.1016/j.annemergmed.2019.09.009</doi><tpages>12</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Aged Cannula Cross-Over Studies Dyspnea - therapy Emergency Service, Hospital Female Humans Male Middle Aged Oxygen Inhalation Therapy - instrumentation Palliative Care - methods Terminally Ill Thailand Treatment Outcome |
| title | High-Flow Nasal Cannula Versus Conventional Oxygen Therapy in Relieving Dyspnea in Emergency Palliative Patients With Do-Not-Intubate Status: A Randomized Crossover Study |
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