The Breathe Easy Early Study: BEES

Investigate the efficacy of early intervention of Humidified High Flow Therapy versus standard practice in patients that present to the Emergency Department with breathlessness.

Grant ID: EMPJ-306R23-2015

Project Summary

Shortness of breath is one of the most common reasons for presentation to Australian Emergency Departments, with millions of presentations each year.

A new patient, unable to speak properly because they cannot breathe present difficulties in immediate diagnosis and therefore treatment, to emergency doctors and nurses. Immediate management involves the application of oxygen via a face-mask in addition to drug therapy and investigations including x-rays and blood tests. If breathlessness gets worse, the patient may need invasive support for breathing; a process that involves more staff, expensive machines, and resultant considerable cost to the health care system.

A simpler support device that provides non-invasive humidified high flow nasal cannula is one alternative to the provision of oxygen and is currently utilised safely in adult and paediatric patients. The “high flow” delivery of humidified oxygen and air provides moderate support, which reduces the work that the exhausted patient does while breathing in and to help splint the airways open. This support is a driving pressure, which is not present during simple mask oxygen therapy. If we treat patients early with high flow therapy rather than standard facemask, we may be able to relieve symptoms of breathlessness sooner and avoid worsening of breathing difficulties.

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Outcomes

Due to difficulties with the study design and patient recruitment, the trial was closed early.

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IMPACT

Ipswich Hospital Emergency Department staff now frequently used nasal high-flow in adults for a range of respiratory-related conditions. In addition, two inpatient medical wards at the hospital now allow patients to be admitted with high flow rates.

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Dissemination

Baker, K., Greaves, T. and Fraser, J.F., 2019. How to use humidified high‐flow nasal cannula in breathless adults in the emergency department. Emergency Medicine Australasia, 31(5), pp.863-868.

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