High flow nasal cannula in the emergency department’s resuscitation room: a prospective monocenter descriptive study

High-flow nasal cannula (HFNC) therapy is commonly used in emergency departments (EDs) to treat acute respiratory failure (ARF). However, its utilization patterns in the resuscitation room (RR) are not well documented. The aim of this study was to describe patient characteristics, management, and in-hospital trajectories according to HFNC use. We conducted a prospective, monocenter, cohort study of consecutive adults admitted to the RR with ARF requiring ≥ 9 L/min of oxygen. We recorded demographic data, comorbidities, clinical and biological parameters, imaging results, treatments, and final ED diagnoses. Patients were classified according to HFNC initiation in the RR. We described clinical pathways through a structured flow diagram that included ICU admission, escalation of respiratory support and in-hospital mortality. Among 165 patients, 57 (35%) received HFNC and 108 (65%) did not. Patients receiving HFNC were younger (73 [59; 86] vs. 77 [70;87] years old) and had a lower Charlson index (5 [3; 7] vs. 7 [5; 9]). Median NEWS2 score at admission was 8 [6; 9] in both groups. Infectious pneumonia was the primary ED diagnosis in 84% of HFNC patients (48/57) and 53% of non-HFNC patients (57/108). Cardiogenic pulmonary oedema accounted for 5% (3/57) vs. 21% (23/108), respectively. ICU admission occurred in 39 (68%) of HFNC patients and 40 (37%) of non-HFNC patients. Intubation was performed in 3 (5.3%) vs. 10 (9.3%). In-hospital mortality was 12/57 (21%) in the HFNC group and 35/108 (33%) in the non-HFNC group. Patients who receive HFNC therapy in the RR are younger and healthier than those who do not, regardless of the initial severity of acute respiratory failure ARF. The probability of receiving HFNC seems to be linked to the patient’s burden of comorbidities. Further study should explore its impact on patient outcomes. None.