Prognostic impact of high-flow nasal cannula oxygen supply in an ICU patient with pulmonary fibrosis complicated by acute respiratory failure.

摘要

Pulmonary nbrosis (PF) complicated by acute respiratory failure (ARF) requiring ventilatory support has a poor prognosis, challenging the opportunity for intensive care unit (ICU) admission [1]. A new device called a high-flow nasal cannula (HFNC) is used increasingly in hyp-oxemic ARF [2]. We report the case of a patient who was admitted with PF-related ARF and received HFNC oxygen during his ICU stay.A 73-year-old man was admitted to the emergency department with sub-febrile ARF in the context of chronic ischemic and valvular myocardiopa-thy treated routinely with trinitrine, spironolactone, bisoprolol and lisino-pril. Amiodarone had been introduced 1 month previously. Oxygen therapy (10 1/min) with a reservoir mask was started, and transthoracic echocardi-ography rapidly eliminated a cardiac origin of the diffuse alveolo-intersti-tial infiltrate. Antibiotic treatment was introduced, but he was transferred to the ICU after deterioration of his respiratory status. His respiratory rate fluctuated between 25 and 30 breaths/min despite 15 1/min oxygen therapy. Arterial blood gas analysis revealed a PaC<2 of 55 mmHg without respiratory acido-sis. HFNC (OptiflowTM system; Fisher and Paykel Healthcare Ltd., Auckland, New Zealand) was introduced with an air/oxygen blender at 40 1/min and 80% FiO_2.