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

Xu, Jiqian; Yang, Xiaobo; Huang, Chaolin; Zou, Xiaojing; Zhou, Ting; Pan, Shangwen; Yang, Lijing; Wu, Yongran; Ouyang, Yaqi; Wang, Yaxin; Xu, Dan; Zhao, Xin; Shu, Huaqing; Jiang, Yongxiang; Xiong, Wei; Ren, Lehao; Liu, Hong; Yuan, Yin; Qi, Hong; Fu, Shouzhi; Chen, Dechang; Zhang, Dingyu; Yuan, Shiying; Shang, You

doi:10.3389/fmed.2020.607821

Cited by 32 publications

(55 citation statements)

References 40 publications

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“…Several studies have reported the use of HFNC in COVID-19 patients (Geng et al, 2020;Wang et al, 2020;Chandel et al, 2020;Hu et al, 2020;Xu et al, 2020a). These studies showed that the rates of HFNC failure were between 38 and 45%, which agreed with the failure rate in our study (44%).…”

Section: Discussionsupporting

confidence: 91%

“…As the variables required to calculate the ROX index are easy to obtain, even in the resourcelimited area, it may be helpful for the physicians to early identify patients with a high likelihood of success and those who will require escalation therapy. Apart from the ROX index, the advanced age, increased SOFA score, and decreased platelets were also reported to be associated with increased HFNC failure (Hu et al, 2020;Xu et al, 2020a). As such, the combined use of these variables and the ROX index might help improve the predictive accuracy.…”

Section: Discussionmentioning

confidence: 99%

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High-Flow Nasal Cannula for COVID-19 Patients: A Multicenter Retrospective Study in China

Duan

Zeng

Deng

et al. 2021

Front. Mol. Biosci.

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Background: High-flow nasal cannula (HFNC) may help avoid intubation of hypoxemic patients suffering from COVID-19; however, it may also contribute to delaying intubation, which may increase mortality. Here, we aimed to identify the predictors of HFNC failure among patients with COVID-19.Methods: We performed a multicenter retrospective study in China from January 15 to March 31, 2020. Two centers in Wuhan (resource-limited centers) enrolled 32 patients, and four centers outside Wuhan enrolled 34 cases. HFNC failure was defined as the requirement of escalation therapy (NIV or intubation). The ROX index (the ratio of SpO2/FiO2 to the respiratory rate) was calculated.Results: Among the 66 patients, 29 (44%) cases experienced HFNC failure. The ROX index was much lower in failing patients than in successful ones after 1, 2, 4, 8, 12, and 24 h of HFNC. The ROX index was independently associated with HFNC failure (OR = 0.65; 95% CI: 0.45–0.94) among the variables collected before and 1 h after HFNC. To predict HFNC failure tested by ROX index, the AUC was between 0.73 and 0.79 for the time points of measurement 1–24 h after HFNC initiation. The HFNC failure rate was not different between patients in and outside Wuhan (41% vs. 47%, p = 0.63). However, the time from HFNC initiation to intubation was longer in Wuhan than that outside Wuhan (median 63 vs. 22 h, p = 0.02). Four patients in Wuhan underwent intubation due to cardiac arrest; in contrast, none of the patients outside Wuhan received intubation (13 vs. 0%, p = 0.05). The mortality was higher in Wuhan than that out of Wuhan, but the difference did not reach statistical significance (31 vs. 12%, p = 0.07).Conclusion: The ROX index can be used to predict HFNC failure among COVID-19 patients to avoid delayed intubation, which may occur in the resource-limited area.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

High-Flow Nasal Cannula for COVID-19 Patients: A Multicenter Retrospective Study in China

Duan

Zeng

Deng

et al. 2021

Front. Mol. Biosci.

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“…These side effects are comparable with those under conventional oxygen devices: mask discomfort, nasal, and oral dryness, eye irritation, nasal and eye trauma, bronchoconstriction, and gastric distention [8]. Few studies have focused on the impact of HFNCO in older patients [9][10][11], and, to the best of our knowledge, only one of them studied the impact of HFNCO during SARS-CoV-2 ARF [10]. However, this study was observational with no comparison group.…”

Section: Introductionmentioning

confidence: 84%

High-Flow Nasal Cannula Oxygenation in Older Patients with SARS-CoV-2-Related Acute Respiratory Failure

Hacquin

Perret

Manckoundia

et al. 2021

JCM

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We aimed to compare the mortality and comfort associated with high-flow nasal cannula oxygenation (HFNCO) and high-concentration mask (HCM) in older SARS-CoV-2 infected patients who were hospitalized in non-intensive care units. In this retrospective cohort study, we included all consecutive patients aged 75 years and older who were hospitalized for acute respiratory failure (ARF) in either an acute geriatric unit or an acute pulmonary care unit, and tested positive for SARS-CoV-2. We compared the in-hospital prognosis between patients treated with HFNCO and patients treated with HCM. To account for confounders, we created a propensity score for HFNCO, and stabilizing inverse probability of treatment weighting (SIPTW) was applied. From March 2020 to January 2021, 67 patients (median age 87 years, 41 men) were hospitalized with SARS-CoV-2-related ARF, of whom 41 (61%) received HFNCO and 26 (39%) did not. Age and comorbidities did not significantly differ in the two groups, whereas clinical presentation was more severe in the HFNCO group (NEW2 score: 8 (5–11) vs. 7 (5–8), p = 0.02, and Sp02/Fi02: 88 (98–120) vs. 117 (114–148), p = 0.03). Seven (17%) vs. two (5%) patients survived at 30 days in the HFNCO and HCM group, respectively. Overall, after SIPTW, HFNCO was significantly associated with greater survival (adjusted hazard ratio (AHR) 0.57, 95% CI 0.33–0.99; p = 0.04). HFNCO use was associated with a lower need for morphine (AHR 0.39, 95% CI 0.21–0.71; p = 0.005), but not for midazolam (AHR 0.66, 95% CI 0.37–1.19; p = 0.17). In conclusion, HFNCO use in non-intensive care units may reduce mortality and discomfort in older inpatients with SARS-CoV-2-related ARF.

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“…APACHE II and PSI scores can be used to determine when intubation is needed so that it is not late. 20…”

Section: Discussionmentioning

confidence: 99%

High Flow Nasal Cannula Oxygen Therapy in Long Hauler Covid-19 Patients

Sarinti

Wahyuningsih²

2021

SEANR

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Long Hauler Covid-19 is a condition that describes a person who has recovered from Covid-19 and is declared with a negative PCR smear 2 times but still feels signs and symptoms for a longer period of time, even severe and critical symptoms. Most cases complicate Acute Respiratory Disorder Syndrome (ARDS), which can lead to death. Fulfilment of non-invasive high concentration oxygenation requirements as an intervention modality in this case. The purpose of this case study was to determine the effect of giving oxygen therapy through the High Flow Nasal Cannula (HFNC) on the respiratory function of Covid-19 long haulier patients. The method of nursing care was a case study on 2 respondents with a descriptive approach method. There were 2 cases of Long haulier Covid-19 patients with comorbid smokers, Diabetes Mellitus, experiencing moderate ARDS complications, desaturation, and tachypnea. Patients received oxygen therapy intervention through HFNC while being treated in the critical care room, and after being given HFNC oxygen therapy for 5 days there was a decrease in respiratory frequency, a change in breathing pattern from shortness of breath to shortness of breath, an increase in oxygen saturation, an increase in the ROX Index, an increase in PO2 and blood pH in normal limit. Nursing care that focuses on respiratory management in covid-19 long haulier patients improves patient outcomes in particular, namely decreased respiratory rate, changes in the respiratory pattern of shortness of breath, increased oxygen saturation, increased ROX index, increased PO2 and blood pH within normal limits.

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

Cited by 32 publications

References 40 publications

High-Flow Nasal Cannula for COVID-19 Patients: A Multicenter Retrospective Study in China

High-Flow Nasal Cannula for COVID-19 Patients: A Multicenter Retrospective Study in China

High-Flow Nasal Cannula Oxygenation in Older Patients with SARS-CoV-2-Related Acute Respiratory Failure

High Flow Nasal Cannula Oxygen Therapy in Long Hauler Covid-19 Patients

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