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Clinical outcomes of high-flow nasal cannula in COVID-19 associated postextubation respiratory failure. A single-centre case series.
Anaesthesiol Intensive Ther. 2020; 52(5):373-376.AI

Abstract

INTRODUCTION

A high-flow nasal cannula (HFNC) is an alternative device for oxygena-tion, which improves gas exchange and reduces the work of breathing. Postextubation respiratory failure causes increased morbidity and mortality. HFNC has been widely employed during the COVID-19 pandemic. The purpose of this paper is to report a single-centre experience on the effectiveness and safety of HFNC in weaning COVID-19 patients.

MATERIAL AND METHODS

Nine patients showed severe acute respiratory failure and interstitial pneumonia due to SARS-CoV-2. After mechanical ventilation (5 Helmet CPAP, 4 invasive mechanical ventilation), they were de-escalated to HFNC. Settings were: 34-37°C, flow from 50 to 60 L min-1. FiO2 was set to achieve appropriate SpO2.

RESULTS

Nine patients (4 females; age 63 ± 13.27 years; BMI 27.2 ± 4.27) showed a baseline PaO2/FiO2 of 109 ± 45 mm Hg. After a long course of ventilation all patients improved (PaO2/FiO2 336 ± 72 mm Hg). Immediately after initiation of HFNC (2 hours), PaO2/FiO2 was 254 ± 69.3 mm Hg. Mean ROX index at two hours was 11.17 (range: 7.38-14.4). It was consistent with low risk of HFNC failure. No difference was observed on lactate. After 48 hours of HFNC oxygen therapy (day 3), mean PaO2/FiO2 increased to 396 ± 83.5 mm Hg. All patients recovered from respiratory failure after 7 ± 4.1 days.

CONCLUSIONS

HFNC might be helpful in weaning COVID-19 respiratory failure. Effectiveness and comfort should be assessed between 2 and 48 hours. Clinical outcomes, oxygenation, and ROX index should be considered, to rule out the need for intubation. Further evidence is required for firm conclusions.

Authors+Show Affiliations

Department of Respiratory Pathophysiology, Monaldi-Cotugno Hospital, Naples, Italy.Department of Respiratory Pathophysiology, Monaldi-Cotugno Hospital, Naples, Italy.Department of Respiratory Pathophysiology, Monaldi-Cotugno Hospital, Naples, Italy.Department of Respiratory Pathophysiology, Monaldi-Cotugno Hospital, Naples, Italy.Department of Respiratory Pathophysiology, Monaldi-Cotugno Hospital, Naples, Italy.Department of Respiratory Pathophysiology, Monaldi-Cotugno Hospital, Naples, Italy.

Pub Type(s)

Journal Article
Observational Study

Language

eng

PubMed ID

33242934

Citation

Simioli, Francesca, et al. "Clinical Outcomes of High-flow Nasal Cannula in COVID-19 Associated Postextubation Respiratory Failure. a Single-centre Case Series." Anaesthesiology Intensive Therapy, vol. 52, no. 5, 2020, pp. 373-376.
Simioli F, Annunziata A, Langella G, et al. Clinical outcomes of high-flow nasal cannula in COVID-19 associated postextubation respiratory failure. A single-centre case series. Anaesthesiol Intensive Ther. 2020;52(5):373-376.
Simioli, F., Annunziata, A., Langella, G., Polistina, G. E., Martino, M., & Fiorentino, G. (2020). Clinical outcomes of high-flow nasal cannula in COVID-19 associated postextubation respiratory failure. A single-centre case series. Anaesthesiology Intensive Therapy, 52(5), 373-376. https://doi.org/10.5114/ait.2020.101007
Simioli F, et al. Clinical Outcomes of High-flow Nasal Cannula in COVID-19 Associated Postextubation Respiratory Failure. a Single-centre Case Series. Anaesthesiol Intensive Ther. 2020;52(5):373-376. PubMed PMID: 33242934.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clinical outcomes of high-flow nasal cannula in COVID-19 associated postextubation respiratory failure. A single-centre case series. AU - Simioli,Francesca, AU - Annunziata,Anna, AU - Langella,Gerardo, AU - Polistina,Giorgio E, AU - Martino,Maria, AU - Fiorentino,Giuseppe, PY - 2020/11/28/pubmed PY - 2020/11/28/medline PY - 2020/11/27/entrez KW - COVID-19 KW - ROX index. KW - high-flow nasal cannula KW - postextubation respiratory failure KW - weaning KW - ventilation SP - 373 EP - 376 JF - Anaesthesiology intensive therapy JO - Anaesthesiol Intensive Ther VL - 52 IS - 5 N2 - INTRODUCTION: A high-flow nasal cannula (HFNC) is an alternative device for oxygena-tion, which improves gas exchange and reduces the work of breathing. Postextubation respiratory failure causes increased morbidity and mortality. HFNC has been widely employed during the COVID-19 pandemic. The purpose of this paper is to report a single-centre experience on the effectiveness and safety of HFNC in weaning COVID-19 patients. MATERIAL AND METHODS: Nine patients showed severe acute respiratory failure and interstitial pneumonia due to SARS-CoV-2. After mechanical ventilation (5 Helmet CPAP, 4 invasive mechanical ventilation), they were de-escalated to HFNC. Settings were: 34-37°C, flow from 50 to 60 L min-1. FiO2 was set to achieve appropriate SpO2. RESULTS: Nine patients (4 females; age 63 ± 13.27 years; BMI 27.2 ± 4.27) showed a baseline PaO2/FiO2 of 109 ± 45 mm Hg. After a long course of ventilation all patients improved (PaO2/FiO2 336 ± 72 mm Hg). Immediately after initiation of HFNC (2 hours), PaO2/FiO2 was 254 ± 69.3 mm Hg. Mean ROX index at two hours was 11.17 (range: 7.38-14.4). It was consistent with low risk of HFNC failure. No difference was observed on lactate. After 48 hours of HFNC oxygen therapy (day 3), mean PaO2/FiO2 increased to 396 ± 83.5 mm Hg. All patients recovered from respiratory failure after 7 ± 4.1 days. CONCLUSIONS: HFNC might be helpful in weaning COVID-19 respiratory failure. Effectiveness and comfort should be assessed between 2 and 48 hours. Clinical outcomes, oxygenation, and ROX index should be considered, to rule out the need for intubation. Further evidence is required for firm conclusions. SN - 1731-2531 UR - https://www.unboundmedicine.com/medline/citation/33242934/Clinical_outcomes_of_high_flow_nasal_cannula_in_COVID_19_associated_postextubation_respiratory_failure__A_single_centre_case_series_ L2 - https://doi.org/10.5114/ait.2020.101007 DB - PRIME DP - Unbound Medicine ER -