Abstract
PurposeWe aimed to describe the use of high-flow nasal oxygen (HFNO) in patients with COVID-19 acute respiratory failure and factors associated with a shift to invasive mechanical ventilation.MethodsThis is a multicenter, observational study from a prospectively collected database of consecutive COVID-19 patients admitted to 36 Spanish and Andorran intensive care units (ICUs) who received HFNO on ICU admission during a 22-week period (March 12-August 13, 2020). Outcomes of interest were factors on the day of ICU admission associated with the need for endotracheal intubation. We used multivariable logistic regression and mixed effects models. A predictive model for endotracheal intubation in patients treated with HFNO was derived and internally validated.ResultsFrom a total of 259 patients initially treated with HFNO, 140 patients (54%) required invasive mechanical ventilation. Baseline non-respiratory Sequential Organ Failure Assessment (SOFA) score [odds ratio (OR) 1.78; 95% confidence interval (CI) 1.41-2.35], and the ROX index calculated as the ratio of partial pressure of arterial oxygen to inspired oxygen fraction divided by respiratory rate (OR 0.53; 95% CI: 0.37-0.72), and pH (OR 0.47; 95% CI: 0.24-0.86) were associated with intubation. Hospital site explained 1% of the variability in the likelihood of intubation after initial treatment with HFNO. A predictive model including non-respiratory SOFA score and the ROX index showed excellent performance (AUC 0.88, 95% CI 0.80-0.96).ConclusionsAmong adult critically ill patients with COVID-19 initially treated with HFNO, the SOFA score and the ROX index may help to identify patients with higher likelihood of intubation.
Highlights
The novel coronavirus 2019 (COVID-19) infection has spread worldwide causing thousands of cases of acute respiratory failure with an associated high mortality rate [1, 2]
Study population For the present study, all consecutive patients included in the database from March 12 to August 13, 2020 that fulfilled the following inclusion criteria were analyzed: age ≥18 years, Intensive care unit (ICU) admission with a diagnosis of COVID-19 related acute respiratory failure, positive confirmatory nasopharyngeal or pulmonary tract sample, and High-flow nasal oxygen (HFNO) initiated on ICU admission day
We report odds ratios (OR) with their associated 95% confidence intervals (CI)
Summary
The novel coronavirus 2019 (COVID-19) infection has spread worldwide causing thousands of cases of acute respiratory failure with an associated high mortality rate [1, 2]. Critically-ill patients with COVID-19 often have profound hypoxemia which may partially explain the extremely high use of invasive ventilatory support for long periods of time shown in these subjects [3, 4]. This issue, combined with the sharp rise in the incidence of this disease, has led to an unprecedented pressure on many healthcare systems and hospitals worldwide [4,5,6,7]. Identifying those at higher risk of failure could be highly valuable for avoiding delays in choosing the best management approach
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