Randomized Controlled Trial of Humidified High-Flow Nasal Oxygen for Acute Respiratory Distress in the Emergency Department: The HOT-ER Study.

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dc.contributor.author Jones, Peter en
dc.contributor.author Kamona, Sinan en
dc.contributor.author Doran, Owen en
dc.contributor.author Sawtell, Frann en
dc.contributor.author Wilsher, Margaret en
dc.date.accessioned 2018-10-02T02:49:04Z en
dc.date.issued 2016-03 en
dc.identifier.issn 0020-1324 en
dc.identifier.uri http://hdl.handle.net/2292/38189 en
dc.description.abstract Humidified high-flow nasal cannula (HFNC) is a novel method of oxygen delivery with increasing use in emergency departments and intensive care settings despite little evidence showing benefit over standard oxygen delivery methods (standard O2). The aim of this study was to determine whether HFNC compared with standard O2 given to subjects in acute respiratory distress would reduce the need for noninvasive ventilation or invasive ventilation.This was a pragmatic open randomized controlled trial in adult subjects with hypoxia and tachypnea presenting to a tertiary academic hospital emergency department. The primary outcome was the need for mechanical ventilation in the emergency department.We screened 1,287 patients, 322 met entry criteria and 19 were excluded from analysis. Of these, 165 randomized to HFNC and 138 to standard O2 were analyzed. Baseline characteristics were similar. In the HFNC group, 3.6% (95% CI 1.5-7.9%) versus 7.2% (95% CI 3.8-13%) in the standard O2 group required mechanical ventilation in the emergency department (P = .16), and 5.5% (95% CI 2.8-10.2%) in HFNC versus 11.6% (95% CI 7.2-18.1%) in the standard O2 group required mechanical ventilation within 24 h of admission (P = .053). There was no difference in mortality or stay. Adverse effects were infrequent; however, fewer subjects in the HFNC group had a fall in Glasgow coma score due to CO2 retention, 0% (95% CI 0-3%) versus 2.2% (95% CI 0.4-6%). One in 12 subjects did not tolerate HFNC.HFNC was not shown to reduce the need for mechanical ventilation in the emergency department for subjects with acute respiratory distress compared with standard O2, although it was safe and may reduce the need for escalation of oxygen therapy within the first 24 h of admission. en
dc.format.medium Print-Electronic en
dc.language eng en
dc.relation.ispartofseries Respiratory care en
dc.rights Items in ResearchSpace are protected by copyright, with all rights reserved, unless otherwise indicated. Previously published items are made available in accordance with the copyright policy of the publisher. en
dc.rights.uri https://researchspace.auckland.ac.nz/docs/uoa-docs/rights.htm en
dc.subject Humans en
dc.subject Respiratory Distress Syndrome, Adult en
dc.subject Dyspnea en
dc.subject Treatment Outcome en
dc.subject Oxygen Inhalation Therapy en
dc.subject Humidity en
dc.subject Adult en
dc.subject Aged en
dc.subject Aged, 80 and over en
dc.subject Middle Aged en
dc.subject Emergency Service, Hospital en
dc.subject Emergency Medical Services en
dc.subject Female en
dc.subject Male en
dc.subject Hypoxia en
dc.subject Cannula en
dc.title Randomized Controlled Trial of Humidified High-Flow Nasal Oxygen for Acute Respiratory Distress in the Emergency Department: The HOT-ER Study. en
dc.type Journal Article en
dc.identifier.doi 10.4187/respcare.04252 en
pubs.issue 3 en
pubs.begin-page 291 en
pubs.volume 61 en
dc.rights.holder Copyright: The author en
pubs.end-page 299 en
pubs.publication-status Published en
dc.rights.accessrights http://purl.org/eprint/accessRights/RestrictedAccess en
pubs.subtype Research Support, Non-U.S. Gov't en
pubs.subtype Randomized Controlled Trial en
pubs.subtype Pragmatic Clinical Trial en
pubs.subtype Journal Article en
pubs.elements-id 684976 en
pubs.org-id Medical and Health Sciences en
pubs.org-id School of Medicine en
pubs.org-id Surgery Department en
dc.identifier.eissn 1943-3654 en
pubs.record-created-at-source-date 2016-02-28 en
pubs.dimensions-id 26577199 en


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