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High flow nasal cannula oxygenation in COVID-19 related acute respiratory distress syndrome: a safe way to avoid endotracheal intubation?
Ther Adv Respir Dis. 2021 Jan-Dec; 15:17534666211019555.TA

Abstract

BACKGROUNDS

High flow nasal cannula (HFNC) is an alternative therapy for acute respiratory distress syndrome (ARDS) due to coronavirus disease 2019 (COVID-19). This study aimed first to describe outcomes of patients suffering from COVID-19-related ARDS treated with HFNC; secondly to evaluate safety of HFNC (patients and healthcare workers) and compare patients according to respiratory outcome.

METHODS

A retrospective cohort was conducted in French general hospital intensive care unit (ICU). Patients were included if receiving HFNC for hypoxemia (saturation pulse oxygen (SpO2) <92% under oxygen ⩾6 L/min) associated with ARDS and positive SARS-CoV-2 polymerase chain reaction (PCR). Main clinical characteristics and outcomes are described in patients: (a) with do not intubate order (HFNC-DNIO); (b) who did not need intubation (HFNC-only); and (c) eventually intubated (HFNC-intubation). Medians are presented with (1st-3rd) interquartile range.

RESULTS

From 26 February to 30 June 2020, 46 patients of median age 75 (70-79) years were included. In the HFNC-DNIO group (n = 11), partial arterial oxygen pressure (PaO2)/inhaled fraction of oxygen (FiO2) ratio median worst PaO2/FiO2 ratio was 109 (102-172) and hospital mortality was 54.5%. Except the HFNC-DNIO patients (n = 35), 20 patients (57%) were eventually intubated (HFNC-intubation group) and 15 were only treated by HFNC (HFNC-only). HFNC-intubation patients presented higher worst respiratory rates per minute in ICU [37 (34-41) versus 33 (24-34) min, p < 0.05] and worsened ICU admission PaO2/FiO2 ratios [121 (103-169) versus 191 (162-219), p < 0.001] compared with HFNC-only patients. Hospital mortality was 35% (n = 7/20) in HFNC-intubation group, 0% in HFNC-only group with a global mortality of these two groups of 20% (n = 7/35). Among tests performed in healthcare workers, 1/12 PCR in symptomatic healthcare workers and 1.8% serologies in asymptomatic healthcare workers were positive. After review of each case, COVID-19 was likely to be acquired outside hospital.

CONCLUSIONS

HFNC seems to be useful for COVID-19-related ARDS and safe for healthcare workers. ARDS severity with PaO2/FiO2 <150 associated with respiratory rate >35/min could be regarded as a predictor of intubation.The reviews of this paper are available via the supplemental material section.

Authors+Show Affiliations

Service de réanimation polyvalente, Centre Hospitalier Bretagne Atlantique, 20, boulevard du Général Maurice Guillaudot, Vannes 56 000, France.Service de réanimation polyvalente, Centre Hospitalier Bretagne Atlantique, Vannes, France.Service de réanimation polyvalente, Centre Hospitalier Bretagne Atlantique, Vannes, France.Service de pneumologie, Centre Hospitalier Bretagne Atlantique, Vannes, France.Service de médecine interne, maladie infectieuse et hématologie, Centre Hospitalier Bretagne Atlantique, Vannes, France.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

34057844

Citation

Delbove, Agathe, et al. "High Flow Nasal Cannula Oxygenation in COVID-19 Related Acute Respiratory Distress Syndrome: a Safe Way to Avoid Endotracheal Intubation?" Therapeutic Advances in Respiratory Disease, vol. 15, 2021, p. 17534666211019555.
Delbove A, Foubert A, Mateos F, et al. High flow nasal cannula oxygenation in COVID-19 related acute respiratory distress syndrome: a safe way to avoid endotracheal intubation? Ther Adv Respir Dis. 2021;15:17534666211019555.
Delbove, A., Foubert, A., Mateos, F., Guy, T., & Gousseff, M. (2021). High flow nasal cannula oxygenation in COVID-19 related acute respiratory distress syndrome: a safe way to avoid endotracheal intubation? Therapeutic Advances in Respiratory Disease, 15, 17534666211019555. https://doi.org/10.1177/17534666211019555
Delbove A, et al. High Flow Nasal Cannula Oxygenation in COVID-19 Related Acute Respiratory Distress Syndrome: a Safe Way to Avoid Endotracheal Intubation. Ther Adv Respir Dis. 2021 Jan-Dec;15:17534666211019555. PubMed PMID: 34057844.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - High flow nasal cannula oxygenation in COVID-19 related acute respiratory distress syndrome: a safe way to avoid endotracheal intubation? AU - Delbove,Agathe, AU - Foubert,Ambroise, AU - Mateos,François, AU - Guy,Tiphaine, AU - Gousseff,Marie, PY - 2021/5/31/entrez PY - 2021/6/1/pubmed PY - 2021/6/11/medline KW - ARDS KW - COVID-19 KW - HFNC KW - SARS-Cov-2 KW - intubation rate SP - 17534666211019555 EP - 17534666211019555 JF - Therapeutic advances in respiratory disease JO - Ther Adv Respir Dis VL - 15 N2 - BACKGROUNDS: High flow nasal cannula (HFNC) is an alternative therapy for acute respiratory distress syndrome (ARDS) due to coronavirus disease 2019 (COVID-19). This study aimed first to describe outcomes of patients suffering from COVID-19-related ARDS treated with HFNC; secondly to evaluate safety of HFNC (patients and healthcare workers) and compare patients according to respiratory outcome. METHODS: A retrospective cohort was conducted in French general hospital intensive care unit (ICU). Patients were included if receiving HFNC for hypoxemia (saturation pulse oxygen (SpO2) <92% under oxygen ⩾6 L/min) associated with ARDS and positive SARS-CoV-2 polymerase chain reaction (PCR). Main clinical characteristics and outcomes are described in patients: (a) with do not intubate order (HFNC-DNIO); (b) who did not need intubation (HFNC-only); and (c) eventually intubated (HFNC-intubation). Medians are presented with (1st-3rd) interquartile range. RESULTS: From 26 February to 30 June 2020, 46 patients of median age 75 (70-79) years were included. In the HFNC-DNIO group (n = 11), partial arterial oxygen pressure (PaO2)/inhaled fraction of oxygen (FiO2) ratio median worst PaO2/FiO2 ratio was 109 (102-172) and hospital mortality was 54.5%. Except the HFNC-DNIO patients (n = 35), 20 patients (57%) were eventually intubated (HFNC-intubation group) and 15 were only treated by HFNC (HFNC-only). HFNC-intubation patients presented higher worst respiratory rates per minute in ICU [37 (34-41) versus 33 (24-34) min, p < 0.05] and worsened ICU admission PaO2/FiO2 ratios [121 (103-169) versus 191 (162-219), p < 0.001] compared with HFNC-only patients. Hospital mortality was 35% (n = 7/20) in HFNC-intubation group, 0% in HFNC-only group with a global mortality of these two groups of 20% (n = 7/35). Among tests performed in healthcare workers, 1/12 PCR in symptomatic healthcare workers and 1.8% serologies in asymptomatic healthcare workers were positive. After review of each case, COVID-19 was likely to be acquired outside hospital. CONCLUSIONS: HFNC seems to be useful for COVID-19-related ARDS and safe for healthcare workers. ARDS severity with PaO2/FiO2 <150 associated with respiratory rate >35/min could be regarded as a predictor of intubation.The reviews of this paper are available via the supplemental material section. SN - 1753-4666 UR - https://www.unboundmedicine.com/medline/citation/34057844/High_flow_nasal_cannula_oxygenation_in_COVID_19_related_acute_respiratory_distress_syndrome:_a_safe_way_to_avoid_endotracheal_intubation L2 - https://journals.sagepub.com/doi/10.1177/17534666211019555?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -