Clinical Outcomes of High-Flow Nasal Oxygen Therapy in Acute Respiratory Failure in the Emergency Department: A Retrospective Observational Study.

Original Article

Abstract

Background: High-flow nasal oxygen (HFNO) is an effective respiratory support modality for patients with acute respiratory failure in the emergency department. It improves oxygenation, reduces the work of breathing, and may decrease the need for invasive mechanical ventilation.

Objective: To determine both the effectiveness and various clinical outcomes achieved through high-flow nasal oxygen therapy when treating patients with acute respiratory failure in emergency departments.

 Methods: Adults aged ≥18 years who received high-flow nasal oxygen (HFNO) for acute respiratory failure were eligible. Investigators abstracted demographics, baseline clinical measures (vital signs, arterial blood gas, SpO₂/FiO₂), HFNO settings, and clinical response, and recorded outcomes of endotracheal intubation, ICU admission, and in-hospital mortality.

Results: Among 100 patients, the mean (SD) age was 64.7 (13.2) years, and 58% were male (n=58). Pneumonia was the leading etiology of acute respiratory failure (34%), followed by COPD exacerbation (22%) and pulmonary edema (19%), and within 2 hours of HFNO initiation, oxygenation and respiratory rate improved (SpO₂ from 85.2% ± 5.4% to 94.7% ± 3.8%; p<0.001). During hospitalization, 18% required endotracheal intubation and 37% were admitted to the ICU; overall in-hospital mortality was 13%.

Conclusion: High-flow nasal oxygen therapy is a safe and effective modality for managing acute respiratory failure in the emergency department. It significantly improves oxygenation, reduces respiratory distress, and may decrease the need for invasive mechanical ventilation and escalation to intensive care in appropriately selected patients.