Course of illness and outcomes in older COVID-19 patients treated with HFNC: a retrospective analysis.

Liehua Deng,Fang Jiang,Xiaoyan Wang,Zhenhua Mai,Conghua Han,Zhengyuan Xia,Zheng Wang,Shaoqing Lei,Jing Tang,Hong Liu,Yuanli Zhang,Liangqing Zhang,Sheng Wang,David A Lubarsky,Chi Wai Cheung,Zhongyuan Xia,Danyong Liu,Dun-Jin Zhou ,Richard L Applegate ,Xiaoying Sun

doi:10.18632/aging.203224

Abstract

Coronavirus disease-2019 (COVID-19) has rapidly spread worldwide and causes high mortality of elderly patients. High-flow nasal cannula therapy (HFNC) is an oxygen delivery method for severely ill patients. We retrospectively analyzed the course of illness and outcomes in 110 elderly COVID-19 patients (≥65 years) treated with HFNC from 6 hospitals. 38 patients received HFNC (200 mmHg < PaO2/FiO2 ≤ 300 mmHg, early HFNC group), and 72 patients received HFNC (100 mmHg < PaO2/FiO2 ≤ 200 mmHg, late HFNC group). There were no significant differences of sequential organ failure assessment (SOFA) scores and APECH II scores between early and late HFNC group on admission. Compared with the late HFNC group, patients in the early HFNC group had a lower likelihood of developing severe acute respiratory distress syndrome (ARDS), longer time from illness onset to severe ARDS and shorter duration of viral shedding after illness onset, as well as shorter lengths of ICU and hospital stay. 24 patients died during hospitalization, of whom 22 deaths (30.6%) were in the late HFNC group and 2 (5.3%) in the early HFNC group. The present study suggested that the outcomes were better in severely ill elderly patients with COVID-19 receiving early compared to late HFNC.

Highlights

Coronavirus disease-2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was first reported in December 2019 in Wuhan, Hubei, China, but has rapidly spread worldwide [1]
Mortality was lower (5.3%) in 38 patients who received HNFC treatment at the mild acute respiratory distress syndrome (ARDS) stage, compared to 30.6% in 72 patients in whom HNFC treatment was started at the moderate www.aging-us.com www.aging-us.com
10.5% patients in the early High-flow nasal cannula therapy (HFNC) group converted to invasive mechanic ventilation, which is in contrast to the 52.7% in the late HFNC group (Table 2)

Summary

Introduction

Coronavirus disease-2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was first reported in December 2019 in Wuhan, Hubei, China, but has rapidly spread worldwide [1]. Initial reports from China [4], Italy [5] and the United States [6] suggested high mortality for elderly and critically ill patients with COVID-19. Respiratory support and intensive care management are vital to saving lives Reports showed that both conventional oxygen therapy and noninvasive ventilation (NIV), such as NIPPV (noninvasive positive pressure ventilation), are commonly used in COVID-19 patients to improve oxygenation and reduce the possibility of intubation [10, 11]. A guideline for the management of critically ill adults with COVID-19 published in JAMA March 26, 2020 recommended the use of HFNC relative to NIPPV in the circumstance of acute hypoxemic respiratory failure despite conventional oxygen therapy [12]. We retrospectively analyzed the course of illness and outcomes in elderly (≥65 years) COVID-19 patients treated with HFNC

Methods

Results

Conclusion