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Application of high-flow nasal cannula in hypoxemic patients with COVID-19: a retrospective cohort study.
BMC Pulm Med. 2020 Dec 24; 20(1):324.BP

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 Of these, 65 patients (61.9%) showed improved oxygenation and were successfully withdrawn from HFNC.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.

Authors+Show Affiliations

Department of Critical Care Medicine, Wuhan Pulmonary Hospital, Wuhan, 430030, China.Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.Department of Critical Care Medicine, Northern Jiangsu People's Hospital, Yangzhou, 225001, Jiangsu Province, China.Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020, China.Department of Emergency and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.Department of Critical Care Medicine, Wuhan Pulmonary Hospital, Wuhan, 430030, China.Department of Emergency and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.Department of Emergency and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China. xiecuihong08@163.com.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

33357219

Citation

Hu, Ming, et al. "Application of High-flow Nasal Cannula in Hypoxemic Patients With COVID-19: a Retrospective Cohort Study." BMC Pulmonary Medicine, vol. 20, no. 1, 2020, p. 324.
Hu M, Zhou Q, Zheng R, et al. Application of high-flow nasal cannula in hypoxemic patients with COVID-19: a retrospective cohort study. BMC Pulm Med. 2020;20(1):324.
Hu, M., Zhou, Q., Zheng, R., Li, X., Ling, J., Chen, Y., Jia, J., & Xie, C. (2020). Application of high-flow nasal cannula in hypoxemic patients with COVID-19: a retrospective cohort study. BMC Pulmonary Medicine, 20(1), 324. https://doi.org/10.1186/s12890-020-01354-w
Hu M, et al. Application of High-flow Nasal Cannula in Hypoxemic Patients With COVID-19: a Retrospective Cohort Study. BMC Pulm Med. 2020 Dec 24;20(1):324. PubMed PMID: 33357219.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Application of high-flow nasal cannula in hypoxemic patients with COVID-19: a retrospective cohort study. AU - Hu,Ming, AU - Zhou,Qiang, AU - Zheng,Ruiqiang, AU - Li,Xuyan, AU - Ling,Jianmin, AU - Chen,Yumei, AU - Jia,Jing, AU - Xie,Cuihong, Y1 - 2020/12/24/ PY - 2020/05/14/received PY - 2020/11/22/accepted PY - 2020/12/28/entrez PY - 2020/12/29/pubmed PY - 2021/1/5/medline KW - COVID-19 KW - ROX index KW - high-flow nasal cannula oxygen therapy KW - predictive factor KW - respiratory support SP - 324 EP - 324 JF - BMC pulmonary medicine JO - BMC Pulm Med VL - 20 IS - 1 N2 - 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. SN - 1471-2466 UR - https://www.unboundmedicine.com/medline/citation/33357219/Application_of_high_flow_nasal_cannula_in_hypoxemic_patients_with_COVID_19:_a_retrospective_cohort_study_ L2 - https://bmcpulmmed.biomedcentral.com/articles/10.1186/s12890-020-01354-w DB - PRIME DP - Unbound Medicine ER -