Impact of HFNC application on mortality and intensive care length of stay in acute respiratory failure secondary to COVID-19 pneumonia

Sayan, İsmet; Altınay, Mustafa; Çınar, Ayşe Surhan; Türk, Hacer Şebnem; Peker, Nebia; Şahin, Kerim; Coşkun, Nurcan; Demir, Gamze Dilara

doi:10.1016/j.hrtlng.2021.02.009

Cited by 20 publications

(38 citation statements)

References 28 publications

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“…Compared to standard oxygen therapy, HFNO leads to a significant reduction in the rate of intubation, but its effect on mortality was not clear. [1][2][3] In a study by Teng et al with a small number of patients (n = 22), in addition to an improvement to respiratory indexes, the researchers also found a significant decrease in lymphocytes and CRP after 72 hours of HNFO treatment compared to conventional oxygen therapy. 4 The rates of intubation and mortality did not differ between patients receiving NIV or HFNO but a randomized study reported that HFNO was associated with an increased intubation rate compared to Helmet NIV.…”

Section: Resultsmentioning

confidence: 95%

The Role of High Flow Nasal Oxygen in the Management of Severe COVID-19: A Systematic Review

Paraskevas¹,

Oikonomou²,

Lagadinou³

et al. 2022

Acta Med Port

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Introduction: Oxygen therapy remains the cornerstone for managing patients with severe SARS-CoV-2 infection and several modalities of non-invasive ventilation are used worldwide. High-flow oxygen via nasal canula is one therapeutic option which may in certain cases prevent the need of mechanical ventilation. The aim of this review is to summarize the current evidence on the use of high-flow nasal oxygen in patients with severe SARS-CoV-2 infection.Material and Methods: We conducted a systematic literature search of the databases PubMed and Cochrane Library until April 2021 using the following search terms: “high flow oxygen and COVID-19” and “high flow nasal and COVID-19’’.Results: Twenty-three articles were included in this review, in four of which prone positioning was used as an adjunctive measure. Most of the articles were cohort studies or case series. High-flow nasal oxygen therapy was associated with a reduced need for invasive ventilation compared to conventional oxygen therapy and led to an improvement in secondary clinical outcomes such as length of stay. The efficacy of high-flow nasal oxygen therapy was comparable to that of other non-invasive ventilation options, but its tolerability is likely higher. Failure of this modality was associated with increased mortality.Conclusion: High flow nasal oxygen is an established option for respiratory support in COVID-19 patients. Further investigation is required to quantify its efficacy and utility in preventing the requirement of invasive ventilation.

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Section: Resultsmentioning

confidence: 95%

The Role of High Flow Nasal Oxygen in the Management of Severe COVID-19: A Systematic Review

Paraskevas¹,

Oikonomou²,

Lagadinou³

et al. 2022

Acta Med Port

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“…Studies with smaller cohorts found a decrease in mortality in patients treated with HFNCO. 6,8,11 The higher mortality in the HFNCO failure group in our cohort could be explained by a high rate of complications following the intubation. We found 19.4% ventilation collapse, which is similar to what is found in patients not infected with the SARS-CoV-2, which found a ventilation collapse in 9.6%-29% of cases.…”

Section: Discussionmentioning

confidence: 82%

“…However, the impact of HFNCO on the length of stay in ICU diverges in the literature. 6,8,11 These differences could be explained by a higher frequency of patients presenting less severe infection or by the achievement of early therapeutic limitation in patients treated with HFNCO in our cohort. However, the patients in the HFNCO alone group still presented an average PaO 2 /FiO 2 ratio inferior to 150, testifying to the severity of their pneumonia.…”

Section: Discussionmentioning

confidence: 87%

Factors associated with mechanical ventilation in SARS‐CoV‐2 patients treated with high‐flow nasal cannula oxygen and outcomes

Leroux

Schock

Augereau

et al. 2021

Journal of Medical Virology

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Five percent of patients infected with SARS-CoV-2 require advanced respiratory support. The high-flow nasal cannula oxygenotherapy (HFNCO) appears to be effective and safe to reduce the need for mechanical ventilation. However, the factors associated with HFNCO failure as well as the outcomes of patients receiving this noninvasive respiratory strategy remain unclear. Thus, we performed this study to determine factors leading to intubation of SARS-CoV-2 patients treated with HFNCO and patients' outcomes. We retrospectively analyzed the medical charts of patients admitted in our ICU center for acute respiratory failure due to SARS-CoV-2 infection and who initially benefited from HFNCO, between September 1, 2020, and March 1, 2021. We included all adults patients who received HFNCO and compared two groups: those treated with HFNCO alone and those who failed HFNCO. Patients treated with HFNCO and secondarily limited to the use of mechanical ventilation were excluded from the analysis. Sixty-nine patients were included, 33 were treated with HFNCO alone and 36 failed HFNCO. We found more patients with shock in the HFNCO failure group (p = 0.001). The mean IGSII score was higher in the HFNCO failure group (p < 0.001). The minimum PaO 2 /FiO 2 was lower in the HFNCO failure group (p = 0.024). The length of stay in ICU was higher in the HFNCO failure group (p < 0.001). The mean duration of HFNCO before intubation was 1.77 days. Six-week mortality was higher in the HFNCO failure group (p = 0.034). Ten patients had a complication during intubation. The HFNCO leads to reduce the intubation rate, the length of stay in ICU, and the mortality. Determining the factors associated with HFNCO failure is important to avoid complications following late intubation.

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“…After excluding duplicates and evaluating the full texts of articles, we identified 25 eligible studies (1 RCT, 12 case-control studies, and 12 cohort studies). 14 – 38 The search and screening process is described in Figure 1 . The main characteristics of the articles included in the meta-analysis are shown in Tables 1 , 2 , 3 and 4 .…”

Section: Resultsmentioning

confidence: 99%

Effectiveness of the use of a high-flow nasal cannula to treat COVID-19 patients and risk factors for failure: a meta-analysis

Dai

Tan

et al. 2022

Ther Adv Respir Dis

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Background: Coronavirus disease 2019 (COVID-19) has spread globally, and many patients with severe cases have received oxygen therapy through a high-flow nasal cannula (HFNC). Objectives: We assessed the efficacy of HFNC for treating patients with COVID-19 and risk factors for HFNC failure. Methods: We searched PubMed, Embase, and the Cochrane Central Register of randomized controlled trials (RCTs) and observational studies of HFNC in patients with COVID-19 published in English from January 1st, 2020 to August 15th, 2021. The primary aim was to assess intubation, mortality, and failure rates in COVID-19 patients supported by HFNC. Secondary aims were to compare HFNC success and failure groups and to describe the risk factors for HFNC failure. Results: A total of 25 studies fulfilled selection criteria and included 2851 patients. The intubation, mortality, and failure rates were 0.44 (95% confidence interval (CI): 0.38–0.51, I2 = 84%), 0.23 (95% CI: 0.19–0.29, I2 = 88%), and 0.47 (95% CI: 0.42–0.51, I2 = 56%), respectively. Compared to the success group, age, body mass index (BMI), Sequential Organ Failure Assessment (SOFA) score, Acute Physiology and Chronic Health Evaluation (APACHE) II score, D-dimer, lactate, heart rate, and respiratory rate were higher and PaO2, PaO2/FiO2, ROX index (the ratio of SpO2/FiO2 to respiratory rate), ROX index after the initiation of HFNC, and duration of HFNC were lower in the failure group (all Ps < 0.05). There were also more smokers and more comorbidities in the failure group (all Ps < 0.05). Pooled odds ratios (ORs) revealed that older age (OR: 1.04, 95% CI: 1.01–1.07, P = 0.02, I2 = 88%), a higher white blood cell (WBC) count (OR: 1.06, 95% CI: 1.01–1.12, P = 0.02, I2 = 0%), a higher heart rate (OR: 1.42, 95% CI: 1.15–1.76, P < 0.01, I2 = 0%), and a lower ROX index(OR: 0.61, 95% CI: 0.39–0.95, P = 0.03, I2 = 93%) after the initiation of HFNC were all significant risk factors for HFNC failure. Conclusions: HFNC is an effective way of providing respiratory support in the treatment of COVID-19 patients. Older age, a higher WBC count, a higher heart rate, and a lower ROX index after the initiation of HFNC are associated with an increased risk of HFNC failure.

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Impact of HFNC application on mortality and intensive care length of stay in acute respiratory failure secondary to COVID-19 pneumonia

Cited by 20 publications

References 28 publications

The Role of High Flow Nasal Oxygen in the Management of Severe COVID-19: A Systematic Review

The Role of High Flow Nasal Oxygen in the Management of Severe COVID-19: A Systematic Review

Factors associated with mechanical ventilation in SARS‐CoV‐2 patients treated with high‐flow nasal cannula oxygen and outcomes

Effectiveness of the use of a high-flow nasal cannula to treat COVID-19 patients and risk factors for failure: a meta-analysis

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