{
  "abstract": "Introduction High flow nasal oxygen (HFNO) is often deployed in patients with severe respiratory failure. It can deliver oxygen at rates of up to 60 litres per minute. It also provides some positive pressure which prevents the alveoli from collapsing. Studies have shown that it is comfortable, effective and may reduce the need for invasive ventilation in some patients. 1 We are looking to identify patients that are most likely to benefit from this intervention.Methods We retrospectively reviewed the case notes of patients requiring HFNO in our hospital over a 3 month period. Data such as demographics, diagnosis, co-morbidities, care escalation status and outcomes including death were collected.Results 63 patients were identified. Median age was 77 years. 34 (54.0%) had an underlying respiratory co-morbidity. 59 (93.7%) received HFNO in a ward (level 1) environment, the remainder in intensive care (level 2–3). Overall mortality was 39.7%.Aspiration pneumonia (22.2%) and community-acquired pneumonia (20.6%) were the most common diagnoses. Mortality rates were lower in patients with aspiration pneumonia (35.7%), community acquired pneumonia (30.8%), viral pneumonia (0%) and exacerbation of chronic airways disease (20.0%).Higher mortality rates were observed in patients with hospital acquired pneumonia (75.0%), interstitial lung disease (50.0%) and pulmonary embolism (100%).24 patients (38.1%) were for escalation to ICU level care. Of these, 20 (83.3%) survived to discharge without requiring ICU admission and 3 (12.5%) were admitted to ICU but did not require invasive ventilation. 1 (4.2%) patient declined invasive ventilation and died.There were no complications associated with starting HFNO in a ward setting.Conclusion High flow nasal oxygen is an effective, non-invasive method of providing respiratory support in patients with severe respiratory failure. It should be considered in all patients with community acquired pneumonia, aspiration pneumonia and exacerbation of COPD. It is likely to prevent the need for intubation and ventilation in these patients. It seems less effective in conditions such as hospital acquired pneumonia, interstitial lung disease and pulmonary embolism.References Nishimura M. High-flow nasal cannula oxygen therapy in adults: physiological benefits, indication, clinical benefits, and adverse effects . Respiratory Care April 2016;61(4):529–41.",
  "authors": [
    {
      "affiliations": [
        "Calderdale and Huddersfield NHS Foundation Trust, Halifax, UK"
      ],
      "name": "T Woodhead"
    },
    {
      "affiliations": [
        "Calderdale and Huddersfield NHS Foundation Trust, Halifax, UK"
      ],
      "name": "B Afzal"
    },
    {
      "affiliations": [
        "Calderdale and Huddersfield NHS Foundation Trust, Halifax, UK"
      ],
      "name": "M Nayyar"
    }
  ],
  "title": "P231 High flow nasal oxygen: is it suitable for everyone with respiratory failure?",
  "uid": "124f73b7-5e72-57d1-84ea-46b080d14f13"
}