Exploring the effectiveness of high-flow nasal cannula in the neurointensive care unit: a prospective observational study.

Background: Acute respiratory failure is common occurrence in critical care, with varying causes, depending on case mix of the ICU. High flow nasal cannula (HFNC) is commonly utilized in both adult and pediatric population. However, traditionally, neurologically ill patients have been considered unsuitable for HFNC due to poor sensorium and risk of aspiration. Therefore, we conducted a study to assess the effectiveness of HFNC in Neuro ICU.

Methodology: We did a prospective observational study on all adult patients requiring HFNC during their stay in Neuro ICU. Primary aim of the study was to find common indications for use of HFNC in neuro ICU. The secondary objective was to observe if HFNC could prevent re-intubation. The various other factors studied included age, gender, diagnosis (traumatic brain injury, postoperative neurosurgical condition or other neurological conditions), GCS score, HFNC settings, duration and cost of HFNC therapy.

Results: During the period from January 1, 2021- 23, out of 1825 patients admitted to neuro ICU, 98 required HFNC therapy. Mean age was 43.3 years (range 18-85), 75.5% of which were males. Utilization rate of HFNC was 5.3%. HFNC was more commonly used for non-trauma patients, most often to reduce work of breathing following extubation (85%). HFNC helped prevent the need for re-intubation in 76.5% of patients with a failure rate of 23.5% across all subgroups of patients in neuro ICU. Requirements for higher flow rate and FiO₂ were significant predictors of HFNC failure. The mean cost of HFNC usage accounted for only 5.6% of the total inpatient bill.

Conclusion: In neurocritical care, the causes of extubation failures and hypoxemia, differ significantly from other ICUs. In our study, HFNC was used most often to reduce work of breathing following extubation and was useful in preventing re-intubation. The use of HFNC did not significantly increase the cost of healthcare.