Application of high-flow nasal cannula in hypoxemic patients with COVID-19: a retrospective cohort study

Hu, Ming; Zhou, Qiang; Zheng, Ruiqiang; Li, Xuyan; Ling, Jianmin; Chen, Yumei; Jia, Jing; Xie, Cuihong

doi:10.21203/rs.3.rs-34561/v1

Cited by 22 publications

(51 citation statements)

References 23 publications

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“…18 Similarly, in a retrospective study conducted on 105 patients, median (IQR) PaO2/FiO2 ratio was 116.0 (102.1-132.0) with lower HFNOT failure rate 38%. 13 Our HFNOT failure rate is comparable to previously reported HFNOT failure rates (32-53%). 18,19 Significant predictors of HFNOT failure in our study, which were obtained using multivariate and ROC analysis, were older age (>65 years), higher APACHE II and SOFA scores, lower P/F ratio (<100), higher IL-6 (>40 pg/mL), D dimer (>2 mg/L) values and hyperglycaemia (RBS>250 mg/dL).…”

Section: Discussionsupporting

confidence: 87%

“…Similarly, two recent investigations noted lower ROX score at 6 hours was highly predictive of HFNOT failure. 13,18 In our study, about 36% of patients followed proning, the frequency of which was greater in the HFNOT success group. Failure to prone was found to be a significant predictor of HFNOT failure on univariate analysis (OR 3.42, CI 1.28-9.19; p<0.05).…”

Section: Discussionmentioning

confidence: 47%

“…16 Profound hypoxemia before HFNOT application recorded in our study is comparable to that reported in two studies conducted in COVID-19 patients. 13,17 In a prospective study conducted in 293 enrolled patients at two tertiary hospitals in Cape Town, South Africa, the median (IQR) PaO2/FiO2 ratio was 68 (54-92) with more than half of the patients failed to continue on HFNOT. 18 Similarly, in a retrospective study conducted on 105 patients, median (IQR) PaO2/FiO2 ratio was 116.0 (102.1-132.0) with lower HFNOT failure rate 38%.…”

Section: Discussionmentioning

confidence: 99%

“…Limited number of studies exploring the impact of HFNOT in COVID-19 pneumonia has been performed, albeit with small sample sizes. [13][14][15] Therefore, we planned this study with aim to determine the impact of HFNOT on the oxygenation level in COVID-19 critically ill patients presenting with acute hypoxemic respiratory failure (AHRF). Primary objective was to record the change in PaO 2 /FiO 2 ratio from baseline to various time points (1-hr, 6-hr, 7-day and 14 day) after initiation of HFNOT.…”

mentioning

confidence: 99%

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High flow nasal oxygen therapy in COVID-19 critically ill patients with acute hypoxemic respiratory failure: A prospective observational cohort study

Khan

Prakash

Banerjee

et al. 2021

Preprint

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Background: Acute hypoxemic respiratory failure (AHRF) is common in COVID-19. Tracheal intubation in such patients is fraught with higher mortality, therefore, high flow nasal oxygen therapy (HFNOT) is being used in AHRF. In this study, we aimed to determine the impact of HFNOT on oxygenation status and also various predictors of HFNOT failure. Methods: A prospective observational cohort study was conducted in COVID-positive critically ill adult patients (aged>18 years) with AHRF, who were unable to maintain SpO2>90% on a non-rebreathing face mask at an oxygen flow ≥15 litres/minute. Respiratory variables (PaO2/FiO2, SpO2, and RR) before HFNOT (baseline), then at 1-hour, 6-hour, 7-day, and 14-day after HFNOT application, were recorded. Borg CR10 scale and visual analog scale were used to evaluate the subjective sensation of dyspnoea and comfort level respectively. Student’s t, Mann–Whitney U or Wilcoxon signed-rank tests were used as applicable. Multivariate logistic regression and Receiver-Operating Characteristic (ROC) analyses were performed to determine factors associated with HFNOT failure. Results: 114 patients were included with HFNOT failure rate of 29%. The Median PaO2/FiO2 ratio at baseline (before initiation of HFNOT) was 99.5 (80-110) which significantly increased at various time points (1-hour, 6-hour, 7-days, and 14-day) after HFNOT initiation in the successful group. Patients reported significant improvement in sensation of breathlessness (9 [8-10], 3 [2-4]; p<0.001) as well as in comfort level (2 [1-2], 8 [4-9]; p<0.001). Multivariate logistic regression analysis, SOFA>7, APACHE II>20, admission P/F ratio<100, D-dimer>2mg/L, IL-6>40 pg/mL, Random Blood Sugar (RBS)>250 mg/dL, 6-hour ROX Index<3.5, were independent prognostic factors of HFNOT failure. Conclusion: In COVID-19 patients with AHRF, the use of HFNOT significantly improved oxygenation levels at various time points after HFNOT initiation. Age, SOFA, APACHE II, and ROX scores, admission P/F ratio, IL-6, D-dimer, and RBS were independent prognostic factors of HFNOT failure in this cohort.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 47%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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High flow nasal oxygen therapy in COVID-19 critically ill patients with acute hypoxemic respiratory failure: A prospective observational cohort study

Khan

Prakash

Banerjee

et al. 2021

Preprint

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“…of severe COVID-19 patients. The respiratory rate-oxygenation index (ROX index SpO2/FiO2 × RR) > 6.10 at 24 h after starting HFNC was a good predictor for positive outcome [ 26 •].…”

Section: Introductionmentioning

confidence: 99%

High-Flow Nasal Cannula, a Boon or a Bane for COVID-19 Patients? An Evidence-Based Review

Singh

Khanna

Sarkar

2021

Curr Anesthesiol Rep

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Purpose of Review This review instantiates the efficacy and safety of HFNC in the context of COVID-19 pandemic. Recent Findings Globally, the healthcare system is facing an unprecedented crisis of resources due to the 2019 novel coronavirus disease (COVID-19) pandemic. Fever, cough, dyspnea, myalgia, fatigue, and pneumonia are the most common symptoms associated with it. The incidence of invasive mechanical ventilation in ICU patients ranges from 29.1 to 89.9%. Supplemental oxygen therapy is the main stay treatment for managing hypoxemic respiratory failure. The high-flow nasal cannula (HFNC) is a novel non-invasive strategy for better oxygenation and ventilation in critically ill patients. In this grim scenario, a reduction in mechanical ventilation by means of HFNC is of prime interest Summary HFNC is considered an aerosol-generating intervention with the risk of viral aerosolization with a concern of potential nosocomial transmission of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2). However, there is no consensus regarding the use of HFNC in novel coronavirus-infected pneumonia (NCIP). HFNC seems to be an effective and safe treatment modality in acute respiratory failure with optimal settings and selection of ideal patients.

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Delayed mechanical ventilation with prolonged high-flow nasal cannula exposure time as a risk factor for mortality in acute respiratory distress syndrome due to SARS-CoV-2

et al. 2023

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In a high proportion of patients, infection by COVID-19 progresses to acute respiratory distress syndrome (ARDS), requiring invasive mechanical ventilation (IMV) and admission to an intensive care unit (ICU). Other devices, such as a high-flow nasal cannula (HFNC), have been alternatives to IMV in settings with limited resources. This study evaluates whether HFNC exposure time prior to IMV is associated with mortality. This observational, analytical study was conducted on a historical cohort of adults with ARDS due to SARS-CoV-2 who were exposed to HFNC and subsequently underwent IMV. Univariate and multivariate logistic regression was used to analyze the impact of HFNC exposure time on mortality, controlling for multiple potential confounders. Of 325 patients with ARDS, 41 received treatment with HFNC for more than 48 h before IMV initiation. These patients had a higher mortality rate (43.9% vs. 27.1%, p: 0.027) than those using HFNC < 48 h. Univariate analysis evidenced an association between mortality and HFNC ≥ 48 h (OR 2.16. 95% CI 1.087–4.287. p: 0.028). Such an association persisted in the multivariable analysis (OR 2.21. 95% CI 1.013–4.808. p: 0.046) after controlling for age, sex, comorbidities, basal severity of infection, and complications. This study also identified a significant increase in mortality after 36 h in HFNC (46.3%, p: 0.003). In patients with ARDS due to COVID-19, HFNC exposure ≥ 48 h prior to IMV is a factor associated with mortality after controlling multiple confounders. Physiological mechanisms for such an association are need to be defined.

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Application of high-flow nasal cannula in hypoxemic patients with COVID-19: a retrospective cohort study

Cited by 22 publications

References 23 publications

High flow nasal oxygen therapy in COVID-19 critically ill patients with acute hypoxemic respiratory failure: A prospective observational cohort study

High flow nasal oxygen therapy in COVID-19 critically ill patients with acute hypoxemic respiratory failure: A prospective observational cohort study

High-Flow Nasal Cannula, a Boon or a Bane for COVID-19 Patients? An Evidence-Based Review

Delayed mechanical ventilation with prolonged high-flow nasal cannula exposure time as a risk factor for mortality in acute respiratory distress syndrome due to SARS-CoV-2

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