by Xia, Jingen; Zhang, Yi; Ni, Lan; Chen, Lei; Zhou,
Changzhi; Gao, Chang; Wu, Xiaojing; Duan, Jun; Xie, Jungang; Guo, Qiang; Zhao,
Jianping; Hu, Yi; Cheng, Zhenshun; Zhan, Qingyuan
Critical Care
Medicine: November 2020
- Volume 48 - Issue 11 - p e1079-e1086
Objectives:
An ongoing outbreak of coronavirus disease 2019 is spreading
globally. Acute hypoxemic respiratory failure is the most common complication
of coronavirus disease 2019. However, the clinical effectiveness of early
high-flow nasal oxygen treatment in patients with coronavirus disease 2019 with
acute hypoxemic respiratory failure has not been explored. This study aimed to
analyze the effectiveness of high-flow nasal oxygen treatment and to identify
the variables predicting high-flow nasal oxygen treatment failure in
coronavirus disease 2019 patients with acute hypoxemic respiratory failure.
Design:
A multicenter, retrospective cohort study. Setting: Three
tertiary hospitals in Wuhan, China. Patients: Forty-three confirmed coronavirus
disease 2019 adult patients with acute hypoxemic respiratory failure treated
with high-flow nasal oxygen. Interventions: None.
Measurements and Main Results:
Mean age of the enrolled patients was 63.0 ± 9.7 years;
female patients accounted for 41.9%. High-flow nasal oxygen failure (defined as
upgrading respiratory support to positive pressure ventilation or death) was
observed in 20 patients (46.5%), of which 13 (30.2%) required endotracheal
intubation. Patients with high-flow nasal oxygen success had a higher median oxygen
saturation (96.0% vs 93.0%; p < 0.001) at admission than those with
high-flow nasal oxygen failure. High-flow nasal oxygen failure was more likely
in patients who were older (p = 0.030) and male (p = 0.037), had a significant
increase in respiratory rate and a significant decrease in the ratio of oxygen
saturation/Fio2 to respiratory rate index within 3 days of high-flow nasal
oxygen treatment. In a multivariate logistic regression analysis model, male
and lower oxygen saturation at admission remained independent predictors of
high-flow nasal oxygen failure. The hospital mortality rate of the cohort was
32.5%; however, the hospital mortality rate in patients with high-flow nasal
oxygen failure was 65%.
Conclusions:
High-flow nasal oxygen may be effective for treating
coronavirus disease 2019 patients with mild to moderate acute hypoxemic
respiratory failure. However, high-flow nasal oxygen failure was associated
with a poor prognosis. Male and lower oxygenation at admission were the two
strong predictors of high-flow nasal oxygen failure.
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