Delivering Care From an Unstable Evidence Base: The Evolving Care of Coronavirus Disease 2019 Through the Lens of High-Flow Nasal Oxygen
| Autor: | Mark Caridi-Scheible, Sara C. Auld |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
2019-20 coronavirus outbreak Coronavirus disease 2019 (COVID-19) high-flow nasal oxygen Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Pneumonia Viral Online Clinical Investigation medicine.disease_cause Critical Care and Intensive Care Medicine Betacoronavirus coronavirus disease 2019 Medicine Humans Intensive care medicine Pandemics Coronavirus Retrospective Studies business.industry SARS-CoV-2 acute hypoxemic respiratory failure COVID-19 acute respiratory distress syndrome Oxygen ComputingMethodologies_DOCUMENTANDTEXTPROCESSING business High flow Coronavirus Infections Respiratory Insufficiency |
| Zdroj: | Critical Care Medicine |
| ISSN: | 1530-0293 |
| Popis: | Supplemental Digital Content is available in the text. 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. |
| Databáze: | OpenAIRE |
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