Role of High flow nasal cannula in managing Type I respiratory failure in patients with neuromuscular disorders

Management of acute Type I respiratory failure (RF) in patients with neuromuscular disorders (NMD) and myopathies poses a clinical challenge in the acute care setting. There is a lack of studies which looked into the effectiveness of High flow nasal cannula (HFNC) in acutely ill NMD patients with Type I RF. This single centre, retrospective case-series study was conducted at the RICU of a tertiary care institute in the state of Rajasthan, India, between 1 January 2020 and 31 March 2025 .All patients with a diagnosis of NMD who were admitted in RICU with Type I respiratory failure were sequentially enrolled in the study. Along with demographic and clinical data of patients, arterial blood gas analysis, routine blood and radiological investigations were incorporated in the study. Patient data was traced till the patient was discharged from the hospital or expired. Risk factors for HFNC failure were evaluated. The patient data was analysed using R version 4.5.0. Risk factors found statistically significant on univariate analyses underwent logistic regression .Odds ratio was calculated for those factors which were significant on logistic regression. p value < 0.05 was taken to be significant. In the study period, 42 patients were enrolled, out of whom, 29 (69%) patients could be successfully managed on HFNC, while 13 (31%) patients had HFNC failure. On multiple logistic regression, exacerbation of restrictive lung disease in patients with kyphoscoliosis, serum albumin and Simplified Acute Physiology Score (SAPS) 3 scores were found to be independent risk factors for HFNC failure with Odds ratio (95% CI) of 4.1(2.1-6.1), 6.9(5.2-8.6) and 5.1(3.2-7) respectively. ROX > 4.88 at 12 h had a sensitivity of 80.3% and specificity of 69.23% and an accuracy of 76.2% of predicting HFNC success. This retrospective study shows that HFNC can be an essential adjunct in managing Type I respiratory failure in patients with neuromuscular disorders.