ICU Cases · Oxygen & gas exchange
Acute hypoxaemic respiratory failure — from HFNC to intubation
A long case on acute hypoxaemic respiratory failure — the HFNC first (FLORALI), the recognition of the HFNC failure (the rising work of breathing), the intubation decision, and the conservative oxygen target throughout (Chu 2018).
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Presentation
A 58-year-old man is admitted with a 48-hour history of a productive cough, fever and progressive dyspnoea. On a high-flow face mask at 15 L/min, his oxygen saturation is 88 per cent, his respiratory rate is 32, he has bilateral crackles and a chest X-ray showing bilateral consolidation. The blood gas shows a PaO2 of 65 mmHg (FiO2 ~0.6), a PaCO2 of 34, a pH of 7.45, and the PaO2/FiO2 is approximately 108 — moderate ARDS from the pneumonia. He is alert but working hard, using his accessory muscles.
[1]References4ShowHide
- [1]Frat JP, Thille AW, Mercat A, et al. High-flow oxygen through nasal cannula in acute hypoxemic respiratory failure (FLORALI). New England Journal of Medicine, 2015.PMID 25981908
- [2]Chu DK, Kim LH, Young PJ, et al. Mortality and morbidity in acutely ill adults treated with liberal versus conservative oxygen therapy. Lancet, 2018.PMID 29726345
- [3]Bersten AD, Soni N (eds) Oh's Intensive Care Manual. 8th edition, Elsevier, 2018.
- [4]Marino PL The ICU Book. 4th edition, Lippincott Williams & Wilkins, 2014.