High-flow nasal cannula oxygen therapy to treat patients with hypoxemic acute respiratory failure consequent to SARS-CoV-2 infection

Vianello, Andrea; Arcaro, Giovanna; Molena, Béatrice; Turato, Cristian; Sukthi, Andi; Guarnieri, Gabriella; Lugato, Francesca; Senna, Gianenrico; Navalesi, Paolo

doi:10.1136/thoraxjnl-2020-214993

Cited by 95 publications

(100 citation statements)

References 7 publications

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“…The study by Wang et al 14 showed that none of the patients with PaO 2 /FiO 2 > 200 mm Hg had HFNC failure compared to 63% failure in patients with low PaO 2 /FiO 2 (≤ 200 mm Hg). Additionally, the RR was found to decrease signi cantly after 1-2 hours of HFNC in the successful cases [13].…”

Section: Discussionmentioning

confidence: 90%

“…Our study adds to the existing knowledge by showing the potential utility of the previously established cutoff of ROX index for monitoring HFNC treatment in COVID-19-related AHRF. Another study showed that PaO 2 /FiO 2 ≤ 100 mm Hg at ICU admission was a signi cant predictor of HFNC failure [13]. The study by Wang et al 14 showed that none of the patients with PaO 2 /FiO 2 > 200 mm Hg had HFNC failure compared to 63% failure in patients with low PaO 2 /FiO 2 (≤ 200 mm Hg).…”

Section: Discussionmentioning

confidence: 98%

“…Very few observational studies have looked at HFNC use in COVID-19 patients. Retrospective observational studies report a HFNC failure rate to range between 32-72% [13][14][15][16]20]. The high variability in the reported HFNC failure rates might be attributed to several possible explanations.…”

Section: Discussionmentioning

confidence: 99%

“…Few observational studies have shown the advantage of HFNC in avoiding EI and reversing hypoxemia in patients with COVID-19-related AHRF [13][14][15][16]. Nevertheless, conclusive evidence is still limited, and the role of HFNC remains controversial in the management of COVID-19-related AHRF.…”

Section: Introductionmentioning

confidence: 99%

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High-Flow Nasal Cannula Treatment in Patients with COVID-19 Acute Hypoxemic Respiratory Failure

Alshahrani¹,

Alshaqaq²,

AlHumaid³

et al. 2020

Preprint

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BackgroundThe increasing burden of coronavirus disease 2019 (COVID-19)-related acute hypoxemic respiratory failure (AHRF) is straining intensive care unit (ICU) resources globally. Early use of high-flow nasal cannula (HFNC) decreases the need for endotracheal intubation (EI) in different causes of respiratory failure. While HFNC is used in COVID-19-related AHRF, its efficacy remains to be investigated. We aimed to examine whether the use of high-flow nasal oxygen therapy (HFNO) prevents the need for intubation in COVID-19 with (AHRF).MethodsThis is a single-center prospective observational study that was conducted at a tertiary teaching hospital in Saudi Arabia the period from April, 2020 to August, 2020. Adults patients admitted to the ICU with AHRF secondary to COVID-19 pneumonia and managed with HFNC were included. We excluded hemodynamically unstable patients and those who were intubated or managed with non-invasive ventilation. Patients’ data and clinical outcomes were pre-defined. The primary outcome was to determine the rate of EI among patients who were treated with HFNC. Secondary outcomes included predictors of HFNC success/failure, mortality, and hospital length of stay. ResultsWe consecutively screened 111 hospitalized COVID-19 patients with AHRF,. Out of those, 44 (40%) patients received HFNC with a median duration of three days (IQR, 1–5). The median age was 57 years (interquartile range [IQR], 46–64), and 82% were men. HFNC failure and EI occurred in 29 (66%) patients. Patients who failed HFNC treatment had higher risk of death compared to those who did not (52% vs. 0%; p=0.001). At baseline, the prevalence of hypertension, chronic kidney disease, and asthma was higher in the HFNC failure group. After adjustment for possible confounders, a high Sequential Organ Failure Assessment (SOFA) score and a low ROX index were significantly associated with HFNC failure (hazard ratio [HR], 1.42; 95% confidence interval [CI], 1.04–1.93; p=0.025; and HR, 0.61; 95% CI, 0.42–0.88; p=0.008, respectively). ConclusionsIn this prospective study, one-third of hypoxemic COVID-19 patients who received HFNC did not require intubation. High SOFA score and low ROX index were associated with HFNC failure.

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Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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High-Flow Nasal Cannula Treatment in Patients with COVID-19 Acute Hypoxemic Respiratory Failure

Alshahrani¹,

Alshaqaq²,

AlHumaid³

et al. 2020

Preprint

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“…Das Therapieversagen unter nicht-invasiver Behandlungsstrategie bei COVID-19 schwankt erheblich. Für High-Flow werden Versagerquoten von 32,2 % [65]…”

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S2k-Leitlinie – Empfehlungen zur stationären Therapie von Patienten mit COVID-19

et al. 2021

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ZusammenfassungSeit Dezember 2019 verbreitet sich das neuartige Coronavirus SARS-CoV-2 (Severe Acute Respiratory Syndrome – Corona Virus-2) rasch im Sinne einer weltweiten Pandemie. Dies stellt Kliniker und Krankenhäuser vor große Herausforderungen und belastet die Gesundheitssysteme vieler Länder in einem nie dagewesenen Ausmaß. Die Mehrheit der Patienten mit Coronavirus Disease 2019 (COVID-19) zeigt lediglich milde Symptome wie Husten und Fieber. Allerdings benötigen etwa 8 % eine stationäre Behandlung. Der frühzeitigen Klärung, ob eine stationäre und ggfs. intensivmedizinische Behandlung medizinisch sinnvoll und vom Patienten gewollt ist, kommt in der Pandemie eine besondere Bedeutung zu. Die akute hypoxämische respiratorische Insuffizienz mit Dyspnoe und hoher Atemfrequenz (> 30/min) führt i. d. R. zur Aufnahme auf die Intensivstation. Oft finden sich dann bereits bilaterale pulmonale Infiltrate/Konsolidierungen oder auch Lungenembolien in der Bildgebung. Im weiteren Verlauf entwickeln einige dieser Patienten ein akutes Lungenversagen (Acute Respiratory Distress Syndrome; ARDS). Eine Sterblichkeitsreduktion einer verfügbaren medikamentösen Therapie bei schwerer COVID-19-Erkrankung ist bisher lediglich für Dexamethason in randomisiert, kontrollierten Studien nachgewiesen. Das Hauptziel der supportiven Therapie besteht in der Sicherstellung einer ausreichenden Oxygenierung. Die invasive Beatmung und wiederholte Bauchlagerung sind dabei wichtige Elemente in der Behandlung von schwer hypoxämischen COVID-19-Patienten. Die strikte Einhaltung der Basishygiene, einschließlich der Händehygiene, sowie das korrekte Tragen von adäquater persönlicher Schutzausrüstung sind im Umgang mit den Patienten unabdingbar. Medizinisch notwendige Handlungen am Patienten, die zur Aerosolbildung führen könnten, sollten mit äußerster Sorgfalt und Vorbereitung durchgeführt werden.

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A case report of pneumomediastinum in a COVID‐19 patient treated with high‐flow nasal cannula and review of the literature: Is this a “spontaneous” complication?

Cancelliere

Procopio

Mazzitelli

et al. 2021

Clinical Case Reports

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High-flow nasal cannula oxygen therapy to treat patients with hypoxemic acute respiratory failure consequent to SARS-CoV-2 infection

Cited by 95 publications

References 7 publications

High-Flow Nasal Cannula Treatment in Patients with COVID-19 Acute Hypoxemic Respiratory Failure

High-Flow Nasal Cannula Treatment in Patients with COVID-19 Acute Hypoxemic Respiratory Failure

S2k-Leitlinie – Empfehlungen zur stationären Therapie von Patienten mit COVID-19

A case report of pneumomediastinum in a COVID‐19 patient treated with high‐flow nasal cannula and review of the literature: Is this a “spontaneous” complication?

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