Use of high-flow nasal cannula and noninvasive ventilation in patients with COVID-19: A multicenter observational study

Duan, Jun; Chen, Baixu; Liu, Xiaoyi; Shu, Weiwei; Zhao, Wei; Li, Ji; Li, Yishi; Hong, Yueling; Pan, Ling Yen; Wang, Ke

doi:10.1016/j.ajem.2020.07.071

Cited by 54 publications

(80 citation statements)

References 26 publications

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“…The average rates of endotracheal intubation with invasive mechanical ventilation for patients who received HFNCO and NIV were 10.8% and 11.5% respectively. Our results are in accordance with the results of another study [11] which showed an average rate of endotracheal intubation for COVID-19 patients treated with HFNCO of 17%, and 15% for those treated with NIV; the average duration of therapy in this study [11] was 5.1 days for HFNCO and 6.8 days for NIV [11].…”

Section: Discussionsupporting

confidence: 92%

High flow nasal cannula oxygen and non-invasive mechanical ventilation in management of COVID-19 patients with acute respiratory failure: a retrospective observational study

Shoukri

2021

Egypt J Bronchol

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Background High flow nasal cannula oxygen (HFNCO) is a relatively new technique used to deliver oxygen in respiratory failure patients. This retrospective study is aiming to assess the role and benefits of using HFNCO compared to non-invasive ventilation (NIV) in management of patients with acute hypoxemic respiratory failure associated with coronavirus disease 2019 (COVID-19). Results A retrospective analysis of the files of 63 patients with COVID-19 and acute hypoxemic respiratory failure admitted to the intensive care unit (ICU), 37 patients received HFNCO as initial therapy, and 26 patients were primarily treated with NIV. There was no significant difference between the 2 groups in terms of baseline characteristics, laboratory tests, arterial blood gases, PaO2/FiO2 values, and vital signs. Re-assessment after 24 h of starting treatment with either HFNCO or NIV showed significant improvement (P<0.01) in the respiratory rate, heart rate, and oxygenation parameters. The magnitude of improvement of the vital signs and oxygenation was not significantly different between patients using HFNCO or NIV. Success rate of HFNCO was 86.4%, endotracheal intubation with invasive mechanical ventilation was required in 10.81% of patients, and mortality rate was 2.7%. Success rate of NIV was 84.6%, endotracheal intubation rate was 11.53%, and mortality rate was 3.8%. No significant difference (P>0.05) between the 2 groups as regards the duration of treatment, rate of endotracheal intubation with invasive mechanical ventilation, and mortality rate. Conclusion High flow nasal cannula oxygen (HFNCO) is effective in the management of acute hypoxemic respiratory failure associated with COVID-19. Its efficacy is similar to NIV, with no difference in the duration of treatment, endotracheal intubation rate, or mortality rate.

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Section: Discussionsupporting

confidence: 92%

High flow nasal cannula oxygen and non-invasive mechanical ventilation in management of COVID-19 patients with acute respiratory failure: a retrospective observational study

Shoukri

2021

Egypt J Bronchol

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“…rr=respiratory rate, PeeP=positive end expiratory pressure, r/i=recruitment/inflation ratio, CoPD=chronic obstructive pulmonary disease, CHF=congestive heart failure, HFnC=high flow nasal cannula, Wob=work of breathing, P/F=Pao2/Fio2 ratio, MaP=mean arterial pressure, niv=non-invasive ventilation doi: 10.1136/bmj.n436 | BMJ 2021;372:n436 | the bmj series. [93][94][95][96][97][98][99][100][101][102] It attests to the feasibility of utilizing HFNC in this setting; however, firm conclusions regarding efficacy are difficult to draw because of the lack of control groups. Table 1 shows large case series in the English language and provides detailed patient information and outcomes.…”

Section: Respiratory Care For Severe Covid-19 Pneumoniamentioning

confidence: 99%

“…Evidence on the use of HFNC for covid-19 pneumonia consists of case reports and case series 93949596979899100101102. It attests to the feasibility of utilizing HFNC in this setting; however, firm conclusions regarding efficacy are difficult to draw because of the lack of control groups.…”

Section: Respiratory Care For Severe Covid-19 Pneumoniamentioning

confidence: 99%

“…The studies that report detailed patient characteristics and outcomes for the use of NIV in covid-19 pneumonia (table 1) are limited to case series 100121123125126127128129. Owing to the observational nature of the studies, NIV management is not driven by protocol and no specific guidance is provided on titration of support or when to intubate.…”

Section: Respiratory Care For Severe Covid-19 Pneumoniamentioning

confidence: 99%

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Severe covid-19 pneumonia: pathogenesis and clinical management

Attaway

Scheraga

Bhimraj

et al. 2021

BMJ

323

248

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Severe covid-19 pneumonia has posed critical challenges for the research and medical communities. Older age, male sex, and comorbidities increase the risk for severe disease. For people hospitalized with covid-19, 15-30% will go on to develop covid-19 associated acute respiratory distress syndrome (CARDS). Autopsy studies of patients who died of severe SARS CoV-2 infection reveal presence of diffuse alveolar damage consistent with ARDS but with a higher thrombus burden in pulmonary capillaries. When used appropriately, high flow nasal cannula (HFNC) may allow CARDS patients to avoid intubation, and does not increase risk for disease transmission. During invasive mechanical ventilation, low tidal volume ventilation and positive end expiratory pressure (PEEP) titration to optimize oxygenation are recommended. Dexamethasone treatment improves mortality for the treatment of severe and critical covid-19, while remdesivir may have modest benefit in time to recovery in patients with severe disease but shows no statistically significant benefit in mortality or other clinical outcomes. Covid-19 survivors, especially patients with ARDS, are at high risk for long term physical and mental impairments, and an interdisciplinary approach is essential for critical illness recovery.

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“…HFNC can improve oxygenation and reduce the respiratory rate [ 22 , 23 ]. In an observational study with a small sample size of critically ill patients with COVID-19 who used HFNC and NIV as first-line therapy, the duration of HFNC + NIV, intubation rate, and mortality did not differ between two groups [ 24 ].…”

Section: Introductionmentioning

confidence: 99%

Ten things you need to know about intensive care unit management of mechanically ventilated patients with COVID-19

Robba

Battaglini

Ball

et al. 2021

Expert Review of Respiratory Medicine

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Introduction: The ongoing pandemic caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has posed important challenges for clinicians and health-care systems worldwide. Areas covered: The aim of this manuscript is to provide brief guidance for intensive care unit management of mechanically ventilated patients with COVID-19 based on the literature and our direct experience with this population. PubMed, EBSCO, and the Cochrane Library were searched up until 15th of January 2021 for relevant literature. Expert opinion: Initially, the respiratory management of COVID-19 relied on the general therapeutic principles for acute respiratory distress syndrome; however, recent findings have suggested that the pathophysiology of hypoxemia in patients with COVID-19 presents specific features and changes over time. Several therapies, including antiviral and anti-inflammatory agents, have been proposed recently. The optimal intensive care unit management of patients with COVID-19 remains unclear; therefore, ongoing and future clinical trials are warranted to clarify the optimal strategies to adopt in this cohort of patients.

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Use of high-flow nasal cannula and noninvasive ventilation in patients with COVID-19: A multicenter observational study

Cited by 54 publications

References 26 publications

High flow nasal cannula oxygen and non-invasive mechanical ventilation in management of COVID-19 patients with acute respiratory failure: a retrospective observational study

High flow nasal cannula oxygen and non-invasive mechanical ventilation in management of COVID-19 patients with acute respiratory failure: a retrospective observational study

Severe covid-19 pneumonia: pathogenesis and clinical management

Ten things you need to know about intensive care unit management of mechanically ventilated patients with COVID-19

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