RT Journal Article
SR Electronic
T1 High-Flow Nasal Cannula Therapy in Patients With COVID-19: Predictive Response Factors
JF Respiratory Care
FD American Association for Respiratory Care
SP respcare.09764
DO 10.4187/respcare.09764
A1 Sonia M Raboni
A1 Valeria C Neves
A1 Rauce M Silva
A1 Giovanni L Breda
A1 Andressa CL Ceregato
A1 Thayza P Broza
A1 Glauber de Oliveira
A1 Lucelia L Melo-Diaz
A1 Claudia B Braga
A1 César F Carraro
A1 Natalia C Arroyo
A1 Rafael F Bardy
A1 Gisele F Devetak
A1 Caroline M Ozawa
A1 Maria Esther Graf
A1 Vitor L Dias
A1 Marcelo A Ducroquet
A1 Daniella P Nunes
A1 Caroline S Sokoloski
A1 Ricardo R Petterle
YR 2022
UL http://rc.rcjournal.com/content/early/2022/08/09/respcare.09764.abstract
AB BACKGROUND: COVID-19 pneumonia has been responsible for many ICU patients’ admissions with hypoxemic respiratory failure, and oxygen therapy is one of the pillars of its treatment. The current pandemic scenario has limited the availability of ICU beds and access to invasive ventilation equipment. High-flow nasal cannula (HFNC) can reduce the need for orotracheal intubation compared with conventional oxygen therapy, providing better results than noninvasive respiratory support. However, HFNC use has been controversial due to concerns about the benefits and risks of aerosol dispersion. In this context, we evaluated the performance of the HFNC therapy in patients with COVID-19 and investigated factors that can predict favorable responses.METHODS: A prospective observational study was conducted, which included hospitalized adult subjects with COVID-19 in the respiratory wards who needed oxygen therapy. Clinical and laboratory parameters were collected to compare HFNC therapy use and the outcomes.RESULTS: In 6 months, 128 subjects were included and the success rate of HFNC therapy was 53%. Logistic regression analysis showed that the Charlson comorbidity score, need for oxygen flow, FIO2, and breathing frequency predicted therapy failure. The mortality rate increased among the non-responders versus the responders (47% vs 3%), 48% of failure occurred in the first 24 h of the HFNC therapy. A ROX (respiratory frequency – oxygenation) index > 4.98 in 6 h and > 4.53 in 24 h predicted success of the HFNC therapy with an area under the curve of 0.7, and a ROX index < 3.47 predicted failure with 88% of specificity.CONCLUSIONS: HFNC in the subjects with COVID-19 was associated with reduced mortality and improved oxygenation in the subjects with respiratory distress. Close monitoring of specific parameters defines eligible patients and rapidly identifies those in need of invasive ventilatory support.