Does High Flow Nasal Cannula avoid intubation and improve the mortality of adult patients in acute respiratory failure in the intensive care setting, when compared to others methods as Conventional Oxygen Therapy or Non-Invasive Ventilation? A narrative review

High-flow oxygen therapy via nasal cannula (HFNC) has been used for many years to oxygenate patients in respiratory failure. However, scientific data in literature are divergent about its value to prevent invasive mechanical ventilation and mortality. The use of HFNC has increased following the COVID-19 pandemic. Our review considers the impact of HFNC on intubation rates and mortality compared with conventional oxygen therapy (COT) and noninvasive ventilation (NIV). HFNC would decrease the use of invasive mechanical ventilation compared to COT and would be equivalent to NIV. Combination of NIV and HFNC would have a benefit compared to NIV alone. Some etiologies of respiratory failure would benefit more from this technique as post-extubation critical ill patient or COVID-19 pneumonia. HFNC seems to reduce mortality in COVID-19 patients compared to NIV. Several clinical studies are needed to refine the indications of this technique.

B-PO04-177 REMOTE-CONTROL INTERROGATION, TESTING AND REPROGRAMMING OF CARDIAC DEVICES WITH TELEHEALTH PROTOCOL FOR THE MANAGEMENT OF PATIENTS AT HOME

Background: The use of remote-control (RC) to manage cardiac devices has been tested before as safe and effective in the MRI space. We thought evaluating the use of RC application in patients at home. Objective: Remote-Control management of cardiac devices in patients at home is safe, effective with patients’ acceptance. Methods: Patients (pts) with pacemakers and defibrillators using CareLink network were offered to participate on up to two home RC sessions. A technician visited the patient’s home and set up a telehealth tablet and a dedicated programmer with modem card and RC software. These devices were connected via a cellular hot spot to the internet. The investigator had a videoconference interview with the pt and instructed the technician to input a randomized session key number to enable the programmer encrypted communication via a third-party host. At this point the investigator had remote-control of the programmer for usual full device function testing and data assessment. Parameters reprogramming was performed as clinically deemed necessary. In all cases a legend regarding the RC session was programmed in the device information field. A patients’ feedback questionnaire was recorded. Results: A total of 58 pts were evaluated for a total of 78 RC sessions. Pacemakers: 45 and 14 ICDs (one pt had 2 devices). There were no complications or communication interruptions once proven stable after the first minute. In 13 sessions the initial interrogation communication was interrupted upon device interrogation requiring to be re-established (sometimes resourcing to an alternative cellular carrier). Clinically driven parameters reprogramming was performed in 22 sessions. Programming of notations regarding RC session were performed in all of them. The average RC session duration was 11 +/- 3 minutes. Pts’ satisfaction scored 4.5/5. Conclusion: Remote-Control management of cardiac devices at pts’ home can be performed safely and effectively, with high patient satisfaction and expansive convenience particularly in times of COVID pandemic and patients with limited transportation. Eventual advancements in the programmer interface, becoming patient self-driven, will facilitate the use of this feature.