Open AccessHigh-flow nasal cannula therapy for hypoxemic respiratory failure in patients with COVID-19
Author(s) -
Adrián Palacios Chavarría,
Erika Salinas Lezama,
Mauricio González-Navarro,
Rafael Ricardo Valdez Vázquez,
Héctor Herrera Bello,
Julieta Lomelín Gascon,
Linda Morales Juárez,
Mónica Avendaño,
Luis Esteban Ramirez Gonzalez,
Rodrigo Benavides,
Renate Victoria Álvarez Wyssmann,
Brenda Sandoval Ortiz,
Mariana Lizbeth Rodríguez de la Cerda,
Lidia Moreno Castañeda,
Luis Alberto Martínez-Juárez,
Héctor Gallardo-Rincón,
Roberto Tapia-Conyer
Publication year - 2021
Publication title -
therapeutic advances in infectious disease
Language(s) - English
Resource type - Journals
eISSN - 2049-937X
pISSN - 2049-9361
DOI - 10.1177/20499361211042959
Subject(s) - medicine , nasal cannula , interquartile range , hazard ratio , intensive care unit , respiratory failure , mechanical ventilation , confidence interval , anesthesia , surgery , cannula
High-flow nasal cannula (HFNC) therapy in patients with hypoxemic respiratory failure due to COVID-19 is poorly understood and remains controversial.Methods: We evaluated a large cohort of patients with COVID-19-related hypoxemic respiratory failure at the temporary COVID-19 hospital in Mexico City. The primary outcome was the success rate of HFNC to prevent the progression to invasive mechanical ventilation (IMV). We also evaluated the risk factors associated with HFNC success or failure.Results: HFNC use effectively prevented IMV in 71.4% of patients [270 of 378 patients; 95% confidence interval (CI) 66.6–75.8%]. Factors that were significantly different at admission included age, the presence of hypertension, and the Charlson comorbidity index. Predictors of therapy failure (adjusted hazard ratio, 95% CI) included the comorbidity-age-lymphocyte count-lactate dehydrogenase (CALL) score at admission (1.27, 1.09–1.47; p < 0.01), Rox index at 1 hour (0.82, 0.7–0.96; p = 0.02), and no prior steroid treatment (0.34, 95% CI 0.19–0.62; p < 0.0001). Patients with HFNC success rarely required admission to the intensive care unit and had shorter lengths of hospital stay [19/270 (7.0%) and 15.0 (interquartile range, 11–20) days, respectively] than those who required IMV [104/108 (96.3%) and 26.5 (20–36) days, respectively].Conclusion: Treating patients with HFNC at admission led to improvement in respiratory parameters in many patients with COVID-19.