High-flow nasal cannula oxygen therapy in hypoxic patients with COVID-19 pneumonia: a retrospective cohort study confirming the utility of respiratory rate index

AbstractHigh-flow nasal cannula (HFNC) therapy is commonly used in the pediatric intensive care unit (PICU) for postextubation respiratory support. This hypothesis-generating retrospective cohort study aimed to compare postextubation PICU length of stay in infants extubated to HFNC and low flow oxygen (LF) in PICU following cardiac surgery. Of 136 infants (newborn to 1 year) who were intubated and mechanically ventilated in PICU following cardiac surgery, 72 (53%) were extubated to HFNC and 64 (47%) to LF. Compared with patients extubated to LF, those extubated to HFNC had significantly longer durations of cardiopulmonary bypass (152 vs. 109 minutes; p = 0.002), aortic cross-clamp (90 vs. 63 minutes; p = 0.003), and invasive mechanical ventilation (3.2 vs. 1.6 days; p < 0.001), though demographic and preoperative clinical variables were similar. No significant difference was observed in postextubation PICU length of stay between HFNC and LF groups in unadjusted analysis (3.3 vs. 2.6 days, respectively; p = 0.19) and after controlling for potential confounding variables (F [1,125] = 0.17, p = 0.68, R2 = 0.16). Escalation of therapy was similar between HFNC and LF groups (8.3 vs. 14.1%; p = 0.41). HFNC was effective as rescue therapy for six patients in the LF group requiring escalation of therapy. Need for reintubation was similar between HFNC and LF groups (8.3 vs. 4.7%; p = 0.5). Although extubation to HFNC was associated with a trend toward longer postextubation PICU length of stay and was successfully used as rescue therapy for several infants extubated to LF, our results must be interpreted with caution given the limitations of our study.

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Is high flow nasal cannula as an effective oxygen delivery alternative in intensive care unit?

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20191159 ◽

2019 ◽

Vol 6 (2) ◽

pp. 460

Author(s):

Amrish Patel ◽

Jitesh Atram ◽

H. S. Dumra ◽

Mansi Dandnaik ◽

Gopal Raval

Keyword(s):

Intensive Care ◽

Respiratory Failure ◽

Respiratory Rate ◽

Oxygen Delivery ◽

Oxygen Therapy ◽

Work Of Breathing ◽

High Flow ◽

Nasal Cannula ◽

Comfort Level ◽

High Flow Nasal Cannula

Background: High-flow nasal cannula (HFNC) oxygen therapy is carried out using an air/oxygen blender, active humidifier, single heated tube, and nasal cannula. It is an oxygen delivery system which uses air blender to deliver accurate oxygen concentration to the patient from 21% to 100% at desired temperature. It can be administered via wide bore nasal cannula or to the tracheostomy tube via connector. It can give upto 60L/min flow hence can generate positive end expiratory pressure between 2 to 7 cmH20. By providing humidified oxygen along with the high flow rates it satisfies air hunger and reduces work of breathing for the patient.Methods: This is a retrospective observational study. Patients with persistent hypoxia in spite of conventional oxygen therapy were treated with HFNC. Patients with possible need for immediate invasive ventilator support were excluded. Clinical respiratory parameters and oxygenation were compared under conventional and HFNC oxygen therapy.Results: Thirty patients, aged more than 18 years admitted in intensive respiratory care unit with acute hypoxemic respiratory failure from June 2017 to January 2018 were included in the study. Study period was of 6 months. Etiology of acute respiratory failure (ARF) was mainly pneumonia (n = 17), interstitial lung disease (n = 5), bronchial asthma (n=3) and others (n = 5). There was statistically significant reduction in respiratory rate (29.40 before Vs 23.50 after; P- <0.0001) and significant improvement in comfort level of the patient after HFNC therapy. Median duration of HFNC was 48 hrs (24-360) hours. Five patients were intubated later on and 4 died in the intensive care unit.Conclusions: Use of HFNC in patients with persistent ARF was associated with significant and sustained improvement of clinical parameters (respiratory rate). It can be used comfortably for prolonged periods.

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High-Flow Nasal Cannula for Patients with Acute Respiratory Failure Treated in a General Medical Ward: A Prospective Cohort Study

Journal of the Medical Association of Thailand ◽

10.35755/jmedassocthai.2021.07.12689 ◽

2021 ◽

Vol 104 (7) ◽

pp. 1179-1186

Keyword(s):

Cohort Study ◽

Respiratory Failure ◽

Acute Respiratory Failure ◽

Respiratory Rate ◽

Prospective Cohort ◽

High Flow ◽

Nasal Cannula ◽

High Flow Nasal Cannula ◽

General Medical Ward ◽

Medical Wards

Background: Hypoxemia and the need for oxygen administration are frequent causes of hospital admission. High-flow nasal cannula (HFNC) delivers heated humidified high-flow gas at an adjustable inspired oxygen fraction via a large-bore nasal cannula and provide specific physiological benefits. The efficacy of HFNC has been investigated in the intensive care unit but data in other care settings are scarce, especially in low- and middle-income countries. Objective: To describe the safety and associated clinical outcomes of HFNC used in patients admitted to general medical wards. Materials and Methods: The present study was a prospective cohort study that enrolled adult patients with acute respiratory failure and no other major organ failures admitted to the general medical wards at Siriraj Hospital in Bangkok and treated with HFNC. Enrolled subjects were managed by a multidisciplinary care team trained in HFNC usage. The primary outcome was to determine the rate of HFNC failure, defined as the subsequent need for endotracheal intubation, non-invasive ventilation (NIV), reintubation, or death within 48 hours. Secondary outcomes included determining the in-hospital mortality, 28-day mortality, and the factors associated with HFNC failure. Results: Seventy-one subjects were enrolled. In these patients, acute de novo hypoxemic respiratory failure was the most common indication for HFNC (42.3%), followed by prophylaxis after extubation (38.0%), and cardiogenic pulmonary edema (19.7%). The overall rate of HFNC failure was 25.4%. The overall in-hospital and 28-day mortality rates were 14.1% and 21.1%, respectively. The only factor associated with HFNC failure was the respiratory rate at day 1. Conclusion: The use of HFNC in general medical wards is feasible, but a 25% rate of failure within 48 hours can be expected. A higher respiratory rate at day 1 is associated with the failure of HFNC. Keywords: Acute respiratory failure; General medical ward; High-flow oxygen therapy; Outcomes; Safety

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Outcomes of Heated High Flow Nasal Cannula in Patients With Severe or Life-Threatening COVID-19 at a Military Treatment Facility—A Retrospective Cohort Study

Military Medicine ◽

10.1093/milmed/usab378 ◽

2021 ◽

Author(s):

Capt Yonatan P Dollin ◽

Capt Brian P Elliott ◽

Ronald Markert ◽

Maj Matthew T Koroscil

Keyword(s):

Cohort Study ◽

Length Of Stay ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Medical Center ◽

High Flow ◽

High Flow Nasal Cannula ◽

Life Threatening ◽

Treatment Facilities ◽

Military Treatment Facilities

ABSTRACT Introduction The coronavirus-19 (COVID-19) pandemic has forced radical changes in management of healthcare in military treatment facilities (MTFs). Military treatment facilities serve unique patients that have a service connection; thus, research and data on this population are relatively sparse. The purpose of this study was to provide descriptive data on characteristics and outcomes of MTF patients with COVID-19 who are treated with heated high-flow nasal cannula (HHFNC). Materials and Methods We performed a single-center retrospective cohort study at the Wright-Patterson Medical Center, a 52-bed hospital in an urban setting. We received approval from our Institutional Review Board. The cohort included patients admitted from June 1, 2020, through May 15, 2021 with severe or life-threatening COVID-19 from a positive severe acute respiratory syndrome–related coronavirus 2 reverse transcription polymerase chain reaction test who were placed on HHFNC during their hospital stay. Severe disease was defined as dyspnea, respiratory rate ≥30/min, blood oxygen saturation ≤93% without supplemental oxygen, partial pressure of arterial oxygen to fraction of inspired oxygen ratio <300, or lung infiltrates involving >50% of lung fields within 24-48 hours. Life-threatening disease was defined as having septic shock or multiple organ dysfunction or requiring intubation. Patients meeting these criteria were retrieved from a quality improvement cohort that represents a consecutive group of patients with COVID-19 admitted to the Wright-Patterson Medical Center. Results Our MTF managed 70 cases of severe or life-threatening COVID-19 from June 1, 2020, to May 15, 2021. Of the 70 cases, 19 (27%) were placed on HHFNC. After initiation of HHFNC, median SpO2/FiO2 was 281.8 and at 24 hours 145.4. Median respiratory rate oxygenation at these times were 10.7 and 9.4, respectively. Fifty percent required mechanical ventilation during hospitalization. Median intensive care unit length of stay was 11 days, with a maximum stay of 39 days. Median hospital length of stay was 12 days, with a maximum of 39 days. Conclusion Our retrospective cohort study characterized and analyzed outcomes observed in a MTF population, with severe or life-threatening COVID-19, who were treated with HHFNC. While the study did not have the power to make concrete conclusions on the optimal form of respiratory support for COVID-19 patients, our data support HHFNC as a reasonable treatment modality despite some notable differences between our cohort and prior studied patient populations.

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Respiratory management of acute exacerbation of interstitial pneumonia using high-flow nasal cannula oxygen therapy: a single center cohort study

Journal of Thoracic Disease ◽

10.21037/jtd.2018.12.114 ◽

2019 ◽

Vol 11 (1) ◽

pp. 103-112 ◽

Cited By ~ 2

Author(s):

Jiro Ito ◽

Kazuma Nagata ◽

Takeshi Morimoto ◽

Mariko Kogo ◽

Daichi Fujimoto ◽

...

Keyword(s):

Cohort Study ◽

Acute Exacerbation ◽

Interstitial Pneumonia ◽

Oxygen Therapy ◽

High Flow ◽

Nasal Cannula ◽

Single Center ◽

High Flow Nasal Cannula ◽

Respiratory Management

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Mortality of a Pregnant Patient Diagnosed with COVID-19: A Case Report

International Journal of Science and Healthcare Research ◽

10.52403/ijshr.20210712 ◽

2021 ◽

Vol 6 (3) ◽

pp. 66-69

Author(s):

Uday Mahajan ◽

Deepika Kapil

Keyword(s):

Case Report ◽

Respiratory Rate ◽

Pulse Rate ◽

Oxygen Therapy ◽

Pregnant Patient ◽

Respiratory Alkalosis ◽

Albumin Level ◽

High Flow ◽

Nasal Cannula ◽

High Flow Nasal Cannula

On her presentation she was conscious pulse rate was 92 beats per minute and respiratory rate was 16/minute and decreased air entry bilateral lungs and coarse crepitations in both infrascapular and infraaxillary and mammary area- not maintaining saturation with spo2 69% at room air. She was put on nonbreathable mask @ 15 L/minute and she achieved spo2of 92%. Her fetal assessment was done using NST which was reactive. She was managed conservatively on antiviral, antibiotic, oxygen therapy by combination of high flow nasal cannula @60L/min at fio2 80% along with NRM @15 L/min. She was planned for induction once stable and once weaned from high flow nasal cannula. However she kept deteriorating and became tachypneic, dehydrated and delirious. Her repeated investigation revealed rise in TLC of 11800/ul and falling albumin level of 2.6 g/dl and rise in ferritin of 726ng/ml. Her subsequent ABG were suggestive of respiratory alkalosis. Subsequently she was not maintaining saturation and she was intubated and she collapsed. Keywords: Mortality, pregnant patient, COVID-19, respiratory alkalosis.

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