Comparison of the effectiveness of high-flow and conventional nasal cannula oxygen therapy in pulmonary embolism patients with acute hypoxemic respiratory failure.

Introduction: The leading cause of mortality in pulmonary embolism (PE) is hypoxemic respiratory failure. The aim of this study was to compare the efficacy of high-flow nasal cannula (HFNC) and conventional nasal cannula (CNC) oxygen therapy in PE patients with hypoxemia.

Materials and methods: Fifty-eight patients with a PaO2/FIO2 ratio below 300 who were admitted to the emergency department with acute respiratory distress and followed up in our intensive care unit due to PE between March and October 2019 were included in the study. One group (n= 29) received HFNC oxygen therapy and the other group (n= 29) received CNC oxygen therapy.

Result: Arterial blood gas analysis showed no significant differences in baseline SpO2 and PaO2 between the HFNC and CNC groups, whereas both values were significantly higher in the HFNC group starting at 1 hour (PaO2: p= .01, p= .001, p= .001; SpO2: p= .009, p= .005, p= .002). Among massive PE patients with contraindications for thrombolytic therapy, there was no significant difference between the HFNC and CNC groups in baseline SpO2, PaO2, or respiratory rate, but those who received HFNC therapy had significant higher SpO2 starting at 15 minutes (p= .004 for all), significantly higher PaO2 starting at 1 hour (p= .01, p= .001, p= .001), and significantly lower respiratory rate starting at 30 minutes (p= .003, p= .001, p= .001, p= .002, p= .002).

Conclusions: In patients presenting with PE and hypoxemic respiratory failure, HFNC oxygen therapy was more effective on both vital signs and arterial blood gas parameters compared to conventional oxygen therapy and can be used safely as primary treatment.