High-Flow Nasal Oxygen in Coronavirus Disease 2019 Patients With Acute Hypoxemic Respiratory Failure: A Multicenter, Retrospective Cohort Study*

Xia, Jingen; Zhang, Yi; Ni, Lan; Chen, Lei; Zhou, Changzhi; Gao, Chang; Wu, Xiaojing; Duan, Jun; Xie, Jungang; Guo, Qiang; Zhao, Jianping; Hu, Yi; Cheng, Zhenshun; Zhan, Qingyuan

doi:10.1097/ccm.0000000000004558

Cited by 62 publications

(97 citation statements)

References 32 publications

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“…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%

“…The high variability in the reported HFNC failure rates might be attributed to several possible explanations. For instance, the de nition of failure was not standardized in all studies, some de ned failure as the need for NIV or EI [7,8], while others de ned failure as the need for EI or death [16,20]. Furthermore, the threshold for intubation varies among ICU physicians as there is no consensus on how to determine HFNC or NIV failure.…”

Section: Discussionmentioning

confidence: 99%

“…Interestingly, after adjusting for possible confounding variables, longer duration from ICU admission to EI was not associated with increased mortality in their cohort. A multicenter retrospective study included 43 patients treated with HFNC reported success with HFNC in 53.5% of the patients, while 46.5% needed EI or died [16]. While the overall hospital mortality of that cohort was 32.9%, the hospital mortality rate for failed HFNC was 65%.…”

Section: Discussionmentioning

confidence: 99%

“…While the overall hospital mortality of that cohort was 32.9%, the hospital mortality rate for failed HFNC was 65%. Male sex and low SpO 2 at admission were independent predictors of HFNC failure in the multivariate regression model [16]. 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.…”

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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