High-flow nasal cannula therapy in a predominantly African American population with COVID-19 associated acute respiratory failure

ImportanceUse of non-invasive respiratory modalities in COVID-19 has the potential to reduce rates of intubation and mortality in severe disease however data regarding the use of high-flow nasal cannula (HFNC) in this population is limited.ObjectiveTo interrogate clinical and laboratory features of SARS-CoV-2 infection associated with high-flow failure.DesignWe conducted a retrospective cohort study to evaluate characteristics of high-flow therapy use early in the pandemic and interrogate factors associated with respiratory therapy failure.SettingMultisite single centre hospital system within the metropolitan Detroit region.ParticipantsPatients from within the Detroit Medical Center (n=104, 89% African American) who received HFNC therapy during a COVID-19 admission between March and May of 2020.Primary outcomeHFNC failure is defined as death or intubation while on therapy.ResultsTherapy failure occurred in 57% of the patient population, factors significantly associated with failure centred around markers of multiorgan failure including hepatic dysfunction/transaminitis (OR=6.1, 95% CI 1.9 to 19.4, p<0.01), kidney injury (OR=7.0, 95% CI 2.7 to 17.8, p<0.01) and coagulation dysfunction (OR=4.5, 95% CI 1.2 to 17.1, p=0.03). Conversely, comorbidities, admission characteristics, early oxygen requirements and evaluation just prior to HFNC therapy initiation were not significantly associated with success or failure of therapy.ConclusionsIn a population disproportionately affected by COVID-19, we present key indicators of likely HFNC failure and highlight a patient population in which aggressive monitoring and intervention are warranted.

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Nasogastric tube, a warning sign for high-flow nasal cannula failure in infants with bronchiolitis

Scientific Reports ◽

10.1038/s41598-020-72687-z ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Milena Siciliano Nascimento ◽

Danielle E. R. Quinto ◽

Gisele C. Z. Oliveira ◽

Celso M. Rebello ◽

Cristiane do Prado

Keyword(s):

Hospital Admission ◽

Nasogastric Tube ◽

Ventilatory Support ◽

Study Groups ◽

High Flow ◽

Nasal Cannula ◽

Warning Sign ◽

High Flow Nasal Cannula ◽

Therapy Failure ◽

Oral Nutrition

Abstract High-flow nasal cannula (HFNC) therapy is routinely used in the treatment of infants with bronchiolitis. This study sought to identify markers associated with failure of HFNC therapy that serve as warnings for early staging of other ventilatory support products. A retrospective study of infants with a diagnosis of bronchiolitis, receiving HFNC and admitted to the pediatric intensive care unit from January 2016 to June 2017, was conducted. The subjects were divided into two study groups according to the success or failure of HFNC therapy. Risk factors were assessed using the following variables: age, time between hospital admission and start of HFNC, equipment model, and the need for a nasogastric tube. Eighty-one infants were studied, and 18 (21.7%) of them exhibited therapy failure. The results of the logistic models showed that the chances of failure for patients requiring a nasogastric tube during HFNC use were more likely than those for patients with oral nutrition (OR = 8.17; 95% CI 2.30–28.99; p = 0.001). The HFNC failure was not associated with the device used (OR = 1.56; 95% CI 0.54–4.52; p = 0.41), time between hospital admission and HFNC installation (OR = 1.01; 95% CI 0.98–1.03; p = 0.73), or age (OR = 0.98; 95% CI 0.82–1.17; p = 0.82). Among late outcomes evaluated, the patients with therapy failure had longer total durations of O2 use (p < 0.001) and longer hospital stays (p < 0.001). The need to use a nasogastric tube during HFNC use was associated with HFNC therapy failure and can be considered as a marker of severity in children with bronchiolitis.

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Predictive factors of high-flow nasal cannula oxygen therapy failure in children with respiratory distress treated in a pediatric emergency department

The Turkish Journal of Pediatrics ◽

10.24953/turkjped.2021.06.009 ◽

2021 ◽

Vol 63 (6) ◽

pp. 1012

Author(s):

Orkun Aydın ◽

Elif Arslanoğlu Aydın ◽

Ahmet Ziya Birbilen ◽

Özlem Tekşam

Keyword(s):

Emergency Department ◽

Respiratory Distress ◽

Predictive Factors ◽

Oxygen Therapy ◽

Pediatric Emergency ◽

High Flow ◽

Nasal Cannula ◽

Pediatric Emergency Department ◽

High Flow Nasal Cannula ◽

Therapy Failure

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Update on the Role of High-Flow Nasal Cannula in Infants with Bronchiolitis

Children ◽

10.3390/children8020066 ◽

2021 ◽

Vol 8 (2) ◽

pp. 66

Author(s):

Valentina Fainardi ◽

Lara Abelli ◽

Maria Muscarà ◽

Giovanna Pisi ◽

Nicola Principi ◽

...

Keyword(s):

Oxygen Therapy ◽

Severe Disease ◽

Invasive Mechanical Ventilation ◽

High Flow ◽

Nasal Cannula ◽

Low Flow ◽

High Flow Nasal Cannula ◽

Multicenter Studies ◽

Good Tolerability

Bronchiolitis (BR), a lower respiratory tract infection mainly caused by respiratory syncytial virus (RSV), can be very severe. Presently, adequate nutritional support and oxygen therapy remain the only interventions recommended to treat patients with BR. For years, mild BR cases were treated with noninvasive standard oxygen therapy (SOT), i.e., with cold and poorly or totally non-humidified oxygen delivered by an ambient headbox or low-flow nasal cannula. Children with severe disease were intubated and treated with invasive mechanical ventilation (IMV). To improve SOT and overcome the disadvantages of IMV, new measures of noninvasive and more efficient oxygen administration have been studied. Bi-level positive air way pressure (BiPAP), continuous positive airway pressure (CPAP), and high-flow nasal cannula (HFNC) are among them. For its simplicity, good tolerability and safety, and the good results reported in clinical studies, HFNC has become increasingly popular and is now widely used. However, consistent guidelines for initiation and discontinuation of HFNC are lacking. In this narrative review, the role of HFNC to treat infants with BR is discussed. An analysis of the literature showed that, despite its widespread use, the role of HFNC in preventing respiratory failure in children with BR is not precisely defined. It is not established whether it can offer greater benefits compared to SOT and when and in which infants it can replace CPAP or BiPAP. The analysis of the results clearly indicates the need for multicenter studies and official guidelines. In the meantime, HFNC can be considered a safe and effective method to treat children with mild to moderate BR who do not respond to SOT.

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High-flow nasal cannula therapy for hypoxemic respiratory failure in patients with COVID-19

Therapeutic Advances in Infectious Disease ◽

10.1177/20499361211042959 ◽

2021 ◽

Vol 8 ◽

pp. 204993612110429

Author(s):

Adrian Palacios Chavarria ◽

Erika Salinas Lezama ◽

Mauricio Gonzalez Navarro ◽

Rafael Ricardo Valdez Vazquez ◽

Héctor Herrera Bello ◽

...

Keyword(s):

Respiratory Failure ◽

Primary Outcome ◽

Invasive Mechanical Ventilation ◽

High Flow ◽

Nasal Cannula ◽

High Flow Nasal Cannula ◽

Therapy Failure ◽

Hypoxemic Respiratory Failure ◽

Respiratory Parameters ◽

Comorbidity Index

Introduction: High-flow nasal cannula (HFNC) therapy in patients with hypoxemic respiratory failure due to COVID-19 is poorly understood and remains controversial. Methods: We evaluated a large cohort of patients with COVID-19-related hypoxemic respiratory failure at the temporary COVID-19 hospital in Mexico City. The primary outcome was the success rate of HFNC to prevent the progression to invasive mechanical ventilation (IMV). We also evaluated the risk factors associated with HFNC success or failure. Results: HFNC use effectively prevented IMV in 71.4% of patients [270 of 378 patients; 95% confidence interval (CI) 66.6–75.8%]. Factors that were significantly different at admission included age, the presence of hypertension, and the Charlson comorbidity index. Predictors of therapy failure (adjusted hazard ratio, 95% CI) included the comorbidity-age-lymphocyte count-lactate dehydrogenase (CALL) score at admission (1.27, 1.09–1.47; p < 0.01), Rox index at 1 hour (0.82, 0.7–0.96; p = 0.02), and no prior steroid treatment (0.34, 95% CI 0.19–0.62; p < 0.0001). Patients with HFNC success rarely required admission to the intensive care unit and had shorter lengths of hospital stay [19/270 (7.0%) and 15.0 (interquartile range, 11–20) days, respectively] than those who required IMV [104/108 (96.3%) and 26.5 (20–36) days, respectively]. Conclusion: Treating patients with HFNC at admission led to improvement in respiratory parameters in many patients with COVID-19.

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