scholarly journals High flow nasal cannula oxygenation in COVID-19 related acute respiratory distress syndrome: a safe way to avoid endotracheal intubation?

2021 ◽  
Vol 15 ◽  
pp. 175346662110195
Author(s):  
Agathe Delbove ◽  
Ambroise Foubert ◽  
François Mateos ◽  
Tiphaine Guy ◽  
Marie Gousseff
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Hospital Mortality ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Healthcare Workers ◽  
Distress Syndrome ◽  
High Flow ◽  
Nasal Cannula ◽  
Arterial Oxygen ◽  
High Flow Nasal Cannula

Backgrounds: High flow nasal cannula (HFNC) is an alternative therapy for acute respiratory distress syndrome (ARDS) due to coronavirus disease 2019 (COVID-19). This study aimed first to describe outcomes of patients suffering from COVID-19-related ARDS treated with HFNC; secondly to evaluate safety of HFNC (patients and healthcare workers) and compare patients according to respiratory outcome. Methods: A retrospective cohort was conducted in French general hospital intensive care unit (ICU). Patients were included if receiving HFNC for hypoxemia (saturation pulse oxygen (SpO2) <92% under oxygen ⩾6 L/min) associated with ARDS and positive SARS-CoV-2 polymerase chain reaction (PCR). Main clinical characteristics and outcomes are described in patients: (a) with do not intubate order (HFNC-DNIO); (b) who did not need intubation (HFNC-only); and (c) eventually intubated (HFNC-intubation). Medians are presented with (1st–3rd) interquartile range. Results: From 26 February to 30 June 2020, 46 patients of median age 75 (70–79) years were included. In the HFNC-DNIO group ( n = 11), partial arterial oxygen pressure (PaO2)/inhaled fraction of oxygen (FiO2) ratio median worst PaO2/FiO2 ratio was 109 (102–172) and hospital mortality was 54.5%. Except the HFNC-DNIO patients ( n = 35), 20 patients (57%) were eventually intubated (HFNC-intubation group) and 15 were only treated by HFNC (HFNC-only). HFNC-intubation patients presented higher worst respiratory rates per minute in ICU [37 (34–41) versus 33 (24–34) min, p < 0.05] and worsened ICU admission PaO2/FiO2 ratios [121 (103–169) versus 191 (162–219), p < 0.001] compared with HFNC-only patients. Hospital mortality was 35% ( n = 7/20) in HFNC-intubation group, 0% in HFNC-only group with a global mortality of these two groups of 20% ( n = 7/35). Among tests performed in healthcare workers, 1/12 PCR in symptomatic healthcare workers and 1.8% serologies in asymptomatic healthcare workers were positive. After review of each case, COVID-19 was likely to be acquired outside hospital. Conclusions: HFNC seems to be useful for COVID-19-related ARDS and safe for healthcare workers. ARDS severity with PaO2/FiO2 <150 associated with respiratory rate >35/min could be regarded as a predictor of intubation. The reviews of this paper are available via the supplemental material section.

scholarly journals High-flow nasal cannula for Acute Respiratory Distress Syndrome (ARDS) due to COVID-19

2020 ◽  
Vol 15 ◽  
Author(s):  
Carolina Panadero ◽  
Araceli Abad-Fernández ◽  
Mª Teresa Rio-Ramírez ◽  
Carmen Maria Acosta Gutiérrez ◽  
Mariara Calderón-Alcalá ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
High Flow ◽  
Nasal Cannula ◽  
Intubation Rate ◽  
High Flow Nasal Cannula ◽  
Increased Risk ◽  
Bridge Therapy

Background: High-flow nasal cannula oxygen therapy (HFNC) has been shown to be a useful therapy in the treatment of patients with Acute Respiratory Distress Syndrome (ARDS), but its efficacy is still unknown in patients with COVID-19. Our objective is to describe its utility as therapy for the treatment of ARDS caused by SARS-CoV-2. Methods: A retrospective, observational study was performed at a single centre, evaluating patients with ARDS secondary to COVID-19 treated with HFNC. The main outcome was the intubation rate at day 30, which defined failure of therapy. We also analysed the role of the ROX index to predict the need for intubation.Results: In the study period, 196 patients with bilateral pneumonia were admitted to our pulmonology unit, 40 of whom were treated with HFNC due to the presence of ARDS. The intubation rate at day 30 was 52.5%, and overall mortality was 22.5%. After initiating HFNC, the SpO2/FiO2 ratio was significantly better in the group that did not require intubation (113.4±6.6 vs 93.7±6.7, p=0.020), as was the ROX index (5.0±1.6 vs 4.0±1.0, p=0.018). A ROX index less than 4.94 measured 2 to 6 h after the start of therapy was associated with increased risk of intubation (HR 4.03 [95% CI 1.18 – 13.7]; p=0.026).Conclusion: High-flow therapy is a useful treatment in ARDS in order to avoid intubation or as a bridge therapy, and no increased mortality was observed secondary to the delay in intubation. After initiating HFNC, a ROX index below 4.94 predicts the need for intubation.

scholarly journals The Effect of the Treatment with Heated Humidified High-Flow Nasal Cannula on Neonatal Respiratory Distress Syndrome in China: A Single-Center Experience

2017 ◽  
Vol 2017 ◽  
pp. 1-6 ◽  
Author(s):  
Ge Zheng ◽  
Xiao-qiu Huang ◽  
Hui-hui Zhao ◽  
Guo-Xing Jin ◽  
Bin Wang
Keyword(s):  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Airway Pressure ◽  
Distress Syndrome ◽  
Positive Airway Pressure ◽  
High Flow ◽  
Nasal Cannula ◽  
Respiratory Support ◽  
High Flow Nasal Cannula ◽  
Neonatal Respiratory Distress

Background. Noninvasive respiratory support is considered the optimal method of providing assistance to preterm babies with breathing problems, including nasal continuous positive airway pressure (NCPAP) and humidified high flow nasal cannula (HHHFNC). The evidence of the efficacy and safety of HHHFNC used as the primary respiratory support for respiratory distress syndrome (RDS) is insufficient in low- and middle-income countries. Objective. To investigate the effect of heated humidified high flow nasal cannula on neonatal respiratory distress syndrome compared with nasal continuous positive airway pressure. Methods. An observational cross-sectional study was performed at a tertiary neonatal intensive care unit in suburban Wenzhou, China, in the period between January 2014 and December 2015. Results. A total of 128 infants were enrolled in the study: 65 in the HHHFNC group and 63 in the NCPAP group. The respiratory support with HHHFNC was similar to that with NCPAP with regard to the primary outcome. There is no significant difference between two groups in secondary outcomes. Comparing with NCPAP group, the incidence of nasal damage was lower in HHHFNC group. Conclusions. HHHFNC is an effective and well-tolerated strategy as the primary treatment of mild to moderate RDS in preterm infants older than 28 weeks of GA.

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