Predictors of high flow oxygen therapy failure in COVID-19-related severe hypoxemic respiratory failure

Journal of Thoracic Disease

article

Eftychia Polydora¹  Michaella Alexandrou¹  Stamatios Tsipilis¹  Nikolaos Athanasiou¹  Michail Katsoulis⁴  Artemis Rodopoulou¹  Apostolos Pappas¹  Ioannis Kalomenidis¹ 

[1] COVID-19 Unit, “Evaggelismos” General Hospital;1st Department of Critical Care and Pulmonary Medicine, National and Kapodistrian University of Athens, Evaggelismos Hospital;Pulmonary Department, Evaggelismos Hospital;Institute of Health Informatics, University College London

关键词: COVID-19;    acute respiratory distress syndrome (ARDS);    respiratory failure;    high flow nasal cannula (HFNC);    intubation;   

DOI  :  10.21037/jtd-21-1373

学科分类：呼吸医学

来源: Pioneer Bioscience Publishing Company

【 摘 要 】

Background: During COVID-19 pandemic, people who developed pneumonia and needed supplemental oxygen, where treated with low-flow oxygen therapy systems and non-invasive methods, including oxygen therapy using high flow nasal cannula (HFNC) and the application of bi-level or continuous positive airway pressure (BiPAP or CPAP). We aimed to investigate the outcomes of critical COVID-19 patients treated with HFNC and unveil predictors of HFNC failure. Methods: We retrospectively enrolled patients admitted to COVID-19 wards and treated with HFNC for COVID-19-related severe hypoxemic respiratory failure. The primary outcome of this study was treatment failure, such as the composite of intubation or death during hospital stay. The association between treatment failure and clinical features was evaluated using logistic regression models. Results: One hundred thirty-two patients with a median (IQR) PaO2/FiO2 ratio 96 (63–173) mmHg at HFNC initiation were studied. Overall, 45.4% of the patients were intubated. Hospital mortality was 31.8%. Treatment failure (intubation or death) occurred in 50.75% and after adjustment for age, gender, Charlson Comorbidity index (CCI) score and National Early Warning Score 2 (NEWS2) score on admission and PaO2/FiO2 ratio and acute respiratory distress syndrome (ARDS) severity at the time of HFNO initiation, it was significantly associated with the presence of dyspnea [adjusted OR 2.48 (95% CI: 1.01–6.12)], and higher Urea serum levels [adjusted OR 1.25 (95% CI: 1.03–1.51) mg/dL]. Conclusions: HFNC treatment was successful in almost half of the patients with severe COVID-19-related acute hypoxemic respiratory failure (AHRF). The presence of dyspnea and high serum Urea levels on admission are closely related to HFNC failure.

【 授权许可】

Unknown