1111: PREDICTORS OF HIGH-FLOW NASAL CANNULA FAILURE IN COVID-19

Abstract

Introduction: Severe coronavirus disease-19 (COVID-19) is characterized by progressive hypoxemia and patients may require advanced oxygen therapy, including high-flow nasal cannula (HFNC) therapy and mechanical ventilation. Previous data has suggested that the ROX index, IL-6 levels, thrombocytopenia, and kidney injury may predict failure of high-flow nasal cannula therapy. Our study aims to evaluate risk factors that predict HFNC failure in our patient population. Methods: Retrospective cohort study of patients treated for COVID-19 across 4 hospitals in Atlanta, Georgia between February 2020 and February 2021. Patients placed on high-flow nasal cannula within the first 24 hours of admission and who remained on high-flow nasal cannula for at least 6 consecutive hours were identified. Patients that met our cohort criteria were followed for the first seven days of admission and transition across oxygen therapy modalities were examined. Demographic and comorbidity data of patients who failed high-flow nasal cannula therapy within the first 7 days, defined as need for mechanical ventilation or death, were compared to patients who did not fail. Results: There were 1205 patients placed on high-flow nasal cannula oxygen therapy in our hospitals between February 2020 and February 2021. In total, 465 patients met inclusion criteria. Of the cohort, 35.9% remained on high-flow, 32.0 % transitioned to low-flow or room air, and 31.6% failed high-flow nasal cannula therapy within the first week of hospitalization (26.2% failed due to requiring intubation and 5.4% failed due to death). When comparing demographics and comorbidities, patients who failed were older (median age 67.5 vs 62 years, p=0.01) and more frequently had renal disease (28.8% vs 18.5%, p=0.02). There were no significant differences in sex, race, congestive heart failure, pulmonary disease, hypertension, diabetes mellitus, liver disease, or metastatic cancer. Conclusions: In our patient population, 31.6% of patients failed high-flow nasal cannula therapy within the first week of admission due to mechanical ventilation or death. Age and renal disease were significant risk factors for high-flow nasal cannula therapy failure in COVID-19 patients.