Monitoring of high-flow nasal cannula for SARS-CoV-2 severe pneumonia: less is more, better look at respiratory rate

Blez, Damien; Soulier, A.; Bonnet, Francis; Gayat, Étienne; Garnier, Marc

doi:10.1007/s00134-020-06199-9

Cited by 47 publications

(60 citation statements)

References 7 publications

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“…When you reach FiO2 of 40%, decrease flow until weaning. 40 However an ideal weaning protocol remains to be established. A current RCT 41 is studying 3 different protocols: 1) gradually wean flow by 10 L/min/h.…”

Section: Criteria Of Hfnc Weaningmentioning

confidence: 99%

Non-invasive respiratory support paths in hospitalized patients with COVID-19: proposal of an algorithm

Scala

2021

Pulmonology

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Section: Criteria Of Hfnc Weaningmentioning

confidence: 99%

Non-invasive respiratory support paths in hospitalized patients with COVID-19: proposal of an algorithm

Scala

2021

Pulmonology

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“…Respiratory rate-oxygenation (ROX) was defined as the ratio of SpO 2 /FIO 2 to respiratory rate (18,23). HFNC therapy failure was defined as need for MV within 7 days of HFNC initiation (24). The criteria for typical HFNC failures include failures to maintain SpO 2 >90%, hypercapnic respiratory failures with pH <7.2 or PaCO 2 of arterial blood >55 mm Hg, worsening respiratory distress, or need for airway protection due to altered mental state or aspiration (10,14,15,18,19).…”

Section: Definitionsmentioning

confidence: 99%

“…At HFNC initiation, compared with patients in the HFNC success group, the HFNC failure group had a higher level of D-dimer [ (20)(21)(22)(23)(24) vs. 23 (22)(23)(24)(25); p < 0.001] ( Table 2), but no differences in systolic arterial pressure were observed between the two groups. The RR alone had an AUC of 0.65 (0.59-0.71).…”

Section: Demographic Data and Clinical Parameters Of Included Patientsmentioning

confidence: 99%

“…For all patients allocated into training cohort, 55 patients were deceased on HFNC therapy due to do-not-intubate (excluded 22 [21][22][23][24] 22 [20][21][22][23][24] 23 [22][23][24][25] <0.001 from the further analysis); 142 (60.5%) patients required MV. The HFNC success probability (84.2%) for the patients who were divided into low-risk groups following the models was 9.84 times that in the high-risk group (34.8%) in hospital ( Figure 3A).…”

Section: Risk-stratification Models Of Hfnc Therapy In Covid-19 Patientsmentioning

confidence: 99%

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A Novel Risk-Stratification Models of the High-Flow Nasal Cannula Therapy in COVID-19 Patients With Hypoxemic Respiratory Failure

Yang

Huang

et al. 2020

Front. Med.

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Background: High-flow nasal cannula (HFNC) has been recommended as a suitable choice for the management of coronavirus disease 2019 (COVID-19) patients with acute hypoxemic respiratory failure before mechanical ventilation (MV); however, delaying MV with HFNC therapy is still a dilemma between the technique and clinical management during the ongoing pandemic.Methods: Retrospective analysis of COVID-19 patients treated with HFNC therapy from four hospitals of Wuhan, China. Demographic information and clinical variables before, at, and shortly after HFNC initiation were collected and analyzed. A risk-stratification model of HFNC failure (the need for MV) was developed with the 324 patients of Jin Yin-tan Hospital and validated its accuracy with 69 patients of other hospitals.Results: Among the training cohort, the median duration of HFNC therapy was 6 (range, 3–11), and 147 experienced HFNC failure within 7 days of HFNC initiation. Early predictors of HFNC failure on the basis of a multivariate regression analysis included age older than 60 years [odds ratio (OR), 1.93; 95% confidence interval (CI), 1.08–3.44; p = 0.027; 2 points], respiratory rate-oxygenation index (ROX) <5.31 (OR, 5.22; 95% CI, 2.96–9.20; p < 0.001; 5 points) within the first 4 h of HFNC initiation, platelets < 125 × 109/L (OR, 3.04; 95% CI, 1.46–6.35; p = 0.003; 3 points), and interleukin 6 (IL-6) >7.0 pg/mL (OR, 3.34; 95% CI, 1.79–6.23; p < 0.001; 3 points) at HFNC initiation. A weighted risk-stratification model of these predictors showed sensitivity of 80.3%, specificity of 71.2% and a better predictive ability than ROX index alone [area under the curve (AUC) = 0.807 vs. 0.779, p < 0.001]. Six points were used as a cutoff value for the risk of HFNC failure stratification. The HFNC success probability of patients in low-risk group (84.2%) was 9.84 times that in the high-risk group (34.8%). In the subsequent validation cohort, the AUC of the model was 0.815 (0.71–0.92).Conclusions: Aged patients with lower ROX index, thrombocytopenia, and elevated IL-6 values are at increased risk of HFNC failure. The risk-stratification models accurately predicted the HFNC failure and early stratified COVID-19 patients with HFNC therapy into relevant risk categories.

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“…The accuracy of multiple monitoring parameters in predicting HFNC failure in COVID-19-related AHRF was assessed in one study, where RR ≥ 26/min after half an hour of HFNC application was associated with a higher risk of HFNC failure. However, the study was limited by small sample size (32 patients) and high SpO 2 (100%) observed in a third of their cohort, which could participate in decreasing the contribution of SpO 2 /FiO 2 in the diagnostic accuracy of ROX [21].…”

Section: Discussionmentioning

confidence: 96%

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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Monitoring of high-flow nasal cannula for SARS-CoV-2 severe pneumonia: less is more, better look at respiratory rate

Cited by 47 publications

References 7 publications

Non-invasive respiratory support paths in hospitalized patients with COVID-19: proposal of an algorithm

Non-invasive respiratory support paths in hospitalized patients with COVID-19: proposal of an algorithm

A Novel Risk-Stratification Models of the High-Flow Nasal Cannula Therapy in COVID-19 Patients With Hypoxemic Respiratory Failure

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

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