Sunday, September 15, 2019

High Flow Nasal Cannula in the Emergency Department: Can it avoid intubations?

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

This study was the first randomized control trial looking at whether high-flow nasal cannula decreases the need for mechanical ventilation in the emergency department. In addition they looked at emergency department and hospital lengths of stays, 90 day mortality, adverse effects in the hospital, and patient experience. I sympathize for the authors of this study because their abstract shows results that my not in fact be true. I state this because, although the study took over two years to complete, they did not collect sufficient patients to demonstrate an effect on their primary outcome which was a need for mechanical ventilation. Unfortunately, they needed 900 based on post-hoc analysis and obtained 322 patients. It would have taken them approximately 6 years to get this trial done. Sigh. The other caveat to this trial is that the sickest patients were plucked out by the physicians after recruitment because they wanted to proceed with NIV/BiPAP before even trying HFNC. I can't say I blame them. I treat patients and trials be damned if my clinical judgement is telling me to do something. That's another reason why I am not in academics nor do I do research. Patients also just weren't that sick. If you're an ER doctor, could you imagine the acuity if you just intubate 7.2% of patients in respiratory failure on standard oxygen therapy? That means these patients weren't that sick. I mean, the intubation rates for all comers in patients who are on HFNC in subsequent studies flirts with 30%. Please don't quote me on that number but I believe it to be accurate based on my prior research. I can just imagine how many clinicians would irresponsibly read through the abstract and say, HFNC is not good and just throw away the technology ignoring the benefits. Then you have to fight against their cognitive dissonance to make them change their practice. That's enough for today on this study. Thanks for checking it out.
A 🎩 tip to the authors


Jones PG, Kamona S, Doran O, Sawtell F, Wilsher M. Randomized controlled trial of humidified high-flow nasal oxygen for acute respiratory distress in the emergency department: the HOT-ER Study. Respir Care 2016;61:291–299.

Link to Abstract

Link to FREE PDF

Although great care has been taken to ensure that the information in this post is accurate, eddyjoemd, LLC shall not be held responsible or in any way liable for the continued accuracy of the information, or for any errors, omissions or inaccuracies, or for any consequences arising therefrom.

The primary source of compensation I receive for this page and Instagram work is via Amazon Affiliates. All this free education you receive is much out of the kindness of my heart but I also like to receive a check every month from Affiliate Marketing. No one likes to work for free. The best part is that it's of no cost to you. Here's how it works. 

You click on the link for Will Owens' awesome ventilator book here: and whether or not you purchase the book I receive a small commission for whatever you buy on Amazon for the next 24 hours at no cost to you. For every copy of the Ventilator book people have bought off of my affiliate links, for example, I have earned $0.85. I know it's not big money but it helps motivate me to keep on plugging along doing this heavy lifting in Critical Care. Thank you for supporting my work! 

My Amazon Store

No comments:

Post a Comment