Implementing high-flow nasal cannula therapy in the emergency department

Abstract

Patients with respiratory distress present to the Emergency Department (ED) primarily due to hypoxia, hypoxemia and hypercapnea. These critically ill patients are commonly managed using non-invasive ventilation therapy (NIV), which is comprised of Continuous Positive Airway Pressure (CPAP) and Bilevel Positive Airway Pressure (BiPAP). In our organization, patients requiring NIV therapy are admitted to the intensive care unit (ICU) or step-down area because of frequent monitoring. In addition, CPAP and BiPAP are considered ventilators, which require orders from providers who are credentialed with ventilator privileges. In analyzing the cost effectiveness of NIV therapy through retrospective chart review, it was identified that there were total of 94 ED patients placed on NIV, who were admitted to ICU in CY2017. The higher level of care was necessitated because of the need for a provider with ventilator privileges. This led the respiratory therapy (RT) and ED nursing teams to implement the use of high-flow nasal cannula therapy that addresses hypoxemia and hypercapnea as effectively as CPAP and BiPAP, but does not require ventilator-privileged provider orders. The purpose of this study is to examine the effect of implementing high-flow nasal cannula therapy on ICU admission of adult patients presenting in ED with respiratory distress/failure.