Clinical utility of high-flow nasal cannula oxygen therapy for acute respiratory failure in patients with hematological disease

Kaito Harada, Shuhei Kurosawa, Yutaro Hino, Keita Yamamoto, Masahiro Sakaguchi, Shuntaro Ikegawa, Keiichro Hattori, Aiko Igarashi, Kyoko Watakabe, Yasushi Senoo, Yuho Najima, Takeshi Hagino, Noriko Doki, Takeshi Kobayashi, Kazuhiko Kakihana, Toshihiro Iino, Hisashi Sakamaki, Kazuteru Ohashi

A high-flow nasal cannula (HFNC) is a newly developed device that enables high-flow oxygen therapy for patients with serious cardiopulmonary problems, but there are few data regarding its use in patients with hematological disease. The efficacy and tolerability of HFNCs for patients who developed ARF during the treatment of various hematological diseases was evaluated. Fifty-six patients underwent HFNC therapy during the last 2 years, and the causes of ARF were mainly pneumonia (n = 37) or acute congestive heart failure (n = 7). Only 11 patients (20 %) showed a good response to HFNC therapy, and remaining 45 patients (80 %) failed to respond to the initial HFNC therapy and, therefore, underwent second-line therapy including endotracheal intubation with mechanical ventilation (n = 15), non-invasive positive pressure ventilation (n = 1), or narcotic palliation alone (n = 29). Thus, HFNC appear not to be a viable treatment option in 4 out of 5 patients in this cohort of patients with hematological disease, but it was well tolerated in most patients (96 %); no major complications except for nasal soreness (n = 2) were observed. Multivariate analysis showed that the cause of ARF (pneumonia, odds ratio 11.2, 95 % CI 1.76-71.5, p = 0.01) was the only risk factor for treatment failure.