Application of high-flow nasal cannula in hypoxemic patients with COVID-19: a retrospective cohort study

Abstract

Background It had been shown that High-flow nasal cannula (HFNC) is an effective initial support strategy for patients with acute respiratory failure. However, the efficacy of HFNC for patients with COVID-19 has not been established. This study was performed to assess the efficacy of HFNC for patients with COVID-19 and describe early predictors of HFNC treatment success in order to develop a prediction tool that accurately identifies the need for upgrade respiratory support therapy. Methods We retrospectively reviewed the medical records of patients with COVID-19 treated by HFNC in respiratory wards of 2 hospitals in Wuhan between 1 January and 1 March 2020. Overall clinical outcomes, the success rate of HFNC strategy and related respiratory variables were evaluated. Results A total of 105 patients were analyzed. Of these, 65 patients (61.9%) showed improved oxygenation and were successfully withdrawn from HFNC. The PaO2/FiO2 ratio, SpO2/FiO2 ratio and ROX index (SpO2/FiO2*RR) at 6h, 12h and 24h of HFNC initiation were closely related to the prognosis. The ROX index after 6h of HFNC initiation (AUROC, 0.798) had good predictive capacity for outcomes of HFNC. In the multivariate logistic regression analysis, young age, gender of female, and lower SOFA score all have predictive value, while a ROX index greater than 5.55 at 6 h after initiation was significantly associated with HFNC success (OR, 17.821; 95% CI, 3.741-84.903 p<0.001). Conclusions Our study indicated that HFNC was an effective way of respiratory support in the treatment of COVID-19 patients. The ROX index after 6h after initiating HFNC had good predictive capacity for HFNC outcomes.

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

“…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%).…”

“…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.…”

Home Management of Patients with Moderate or Severe Respiratory Failure Secondary to COVID-19, Using Remote Monitoring and Oxygen with or without HFNC

“…In this clinical setting, the efficacy of HFNC in inpatients with COVID-19 has previously been evaluated, in particular when hypoxic respiratory failure is present. The study proved that HFNC was an effective treatment for these patients, and approximately 61.9% of patients showed improved oxygenation and were also able to successfully withdraw from HFNC when treated at home [2] To date, there are no known studies describing at-home management of COVID-19 patients with respiratory failure with the use of HFNC.…”

Predictive factors associated with high‐flow nasal cannula success for COVID‐19‐related acute hypoxemic respiratory failure

“…No deaths were reported in the HFNC success group with a shorter median ICU stay (7 days [4][5][6][7][8] vs 23 days [18-42], P = .0015) and a greater percentage of hospital discharge at day 28, 16 (73%) vs 1 (0.5%; P = .00001) than the HFNC failure group.…”