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.
Due to difficulties with the study design and patient recruitment, the trial was closed early.
Baker K., Greaves T., Fraser J.F., “How to use humidified high-flow nasal cannula in breathless adults in the emergency department”, Emerg Med Australas, 2019 Oct;31(5):863-868. doi: 10.1111/1742-6723.13372. [Epub 2019 Aug 6]
Dr Kylie Baker
Prof John Fraser
A/Prof Andreas Schibler
Ms Kelly Foster
Ms Sara Diab
Prof Louise Cullen
Ms Tanya Greaves