Factors associated with mechanical ventilation in SARS‐CoV‐2 patients treated with high‐flow nasal cannula oxygen and outcomes

Abstract

Five percent of patients infected with SARS-CoV-2 require advanced respiratory support. The high-flow nasal cannula oxygenotherapy (HFNCO) appears to be effective and safe to reduce the need for mechanical ventilation. However, the factors associated with HFNCO failure as well as the outcomes of patients receiving this noninvasive respiratory strategy remain unclear. Thus, we performed this study to determine factors leading to intubation of SARS-CoV-2 patients treated with HFNCO and patients' outcomes. We retrospectively analyzed the medical charts of patients admitted in our ICU center for acute respiratory failure due to SARS-CoV-2 infection and who initially benefited from HFNCO, between September 1, 2020, and March 1, 2021. We included all adults patients who received HFNCO and compared two groups: those treated with HFNCO alone and those who failed HFNCO. Patients treated with HFNCO and secondarily limited to the use of mechanical ventilation were excluded from the analysis. Sixty-nine patients were included, 33 were treated with HFNCO alone and 36 failed HFNCO. We found more patients with shock in the HFNCO failure group (p = 0.001). The mean IGSII score was higher in the HFNCO failure group (p < 0.001). The minimum PaO 2 /FiO 2 was lower in the HFNCO failure group (p = 0.024). The length of stay in ICU was higher in the HFNCO failure group (p < 0.001). The mean duration of HFNCO before intubation was 1.77 days. Six-week mortality was higher in the HFNCO failure group (p = 0.034). Ten patients had a complication during intubation. The HFNCO leads to reduce the intubation rate, the length of stay in ICU, and the mortality. Determining the factors associated with HFNCO failure is important to avoid complications following late intubation.

Sysmex‐derived COVID‐19 prognostic score as an early prognostic marker for severity of the COVID‐19 disease

“…Other therapy management was performed according to valid recommendations 25–29 . Consistent with some other studies, patients requiring high‐flow oxygen deteriorated to requiring ventilatory support usually within 24–48 h 30–32 …”

Risk factors for intubation and mortality in patients treated with high flow nasal cannula due to COVID-19 infection. Survival Analysis Study in a Northern Mexican Population

“…Leroux et al reported in their study that in 47.8% of cases, HFNO prevented the need for intubation [2]. Additional studies have found that HFNO may enhance the prognosis and decrease mortality [2,12].…”

“…The World Health Organization (WHO) advised regular monitoring of oxygenation in severe patients to determine the need for oxygen therapy [1]. About fourteen percent of individuals develop hypoxemic respiratory failure and require oxygen therapy, while five percent require even more intensive breathing assistance [2]. The spread of the virus exceeded hospitals' capacity for moderate and severe patients by mid-2020, resulting in a global shortage of mechanical ventilators.…”

“…Multiple studies have reported the benefits of HFNO in reducing the need for mechanical ventilation, as evidenced by lower intubation rates [2,10,11]. Leroux et al reported in their study that in 47.8% of cases, HFNO prevented the need for intubation [2]. Additional studies have found that HFNO may enhance the prognosis and decrease mortality [2,12].…”