scholarly journals High-Flow Nasal Cannula and Prone Positioning in Awake Patients with COVID-19 Related Respiratory Failure: An Observational Study.

2021 ◽  
Author(s):  
Fekri Abroug ◽  
Zeineb Hammouda ◽  
Manel Lahmar ◽  
Wiem Nouira ◽  
Syrine Maatouk ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Observational Study ◽  
Prone Position ◽  
Supine Position ◽  
Early Response ◽  
High Flow ◽  
Nasal Cannula ◽  
Youden Index ◽  
Prone Positioning ◽  
High Flow Nasal Cannula

Abstract Background: We report an observational study on the use of High-flow nasal cannula (HFNC) and awake prone position in patients with Covid-19 related severe ARF.Methods: chart analysis of consecutive patients with confirmed Covid-19 and severe ARF (PaO2/FiO2 ratio <150) who received HFNC. Patients were systematically encouraged to lie in the prone position if tolerated. We calculated initial ROX index (the ratio of SpO2/FIO2 to respiratory rate) while in supine position and at the end of the first HFNC session whether in prone or supine position, and their difference (delta ROX). The success/failure of HFNC (need for intubation) was recorded. Predictors of HFNC failure were identified using ROC curve and logistic regression.Results: HFNC was administered to 213 out of 360 patients with COVID-19 related severe ARF (71% male, median age:59 years (IQR:50-68), median PaO2/FIO2: 104(73-143). At the start of HFNC, median ROX index was 4(3.4-5). Among included patients, 178 (83.5%) could tolerate prone position and had a median of 4.4(2-6) prone sessions during a median of 10(4-16) hours/day each, for a median of 4(2-7) days. Overall, HFNC failure occurred in 61 patients (28.1%) with similar proportions in patients who had HFNC in prone position and in patients who did not tolerate prone position (29% and 26%, respectively; relative risk:1.14. 95%CI:0.62-2.1). In the prediction of HFNC outcome, AUC was highest for delta ROX (AUC=0.83); AUC for baseline ROX (0.71), PaO2/FiO2 (0.73), and SpO2 (0.67), were significantly lower. The delta ROX cut-off ≤1.8 had the best Youden index indicating the best combination of sensitivity (0.89) and specificity (0.61) with a PLR (2.33) and a NLR (0.17) to predict HFNC failure. Logistic regression disclosed the following predictors of HFNC failure: delta ROX: RR=0.44, 95%CI=0.32-0.62; p-0.0001); baseline ROX index: RR=0.58, 95% CI:0.39-0.85, p=0.005); SOFA score (RR=1.6 for each point; 95%CI: 1.1-2.2, p=0.007); and PaO2/FiO2 at admission: RR=0.96, 95%CI=0.94-0.99). Prone position was not related to HFNC success.CONCLUSION: Awake HFNC in prone position is feasible in most patients with severe hypoxemic COVID-19. Indicators of ARF severity and the early response to HFNC, rather than prone position are independently associated with HFNC outcome.

scholarly journals Prone positioning combined with high-flow nasal cannula in severe noninfectious ARDS

Critical Care ◽  
2020 ◽  
Vol 24 (1) ◽  
Author(s):  
Orlando R. Pérez-Nieto ◽  
Manuel A. Guerrero-Gutiérrez ◽  
Ernesto Deloya-Tomas ◽  
Silvio A. Ñamendys-Silva
Keyword(s):  
High Flow ◽  
Nasal Cannula ◽  
Prone Positioning ◽  
High Flow Nasal Cannula

Observational Study of Humidified High-Flow Nasal Cannula Compared with Nasal Continuous Positive Airway Pressure

2009 ◽  
Vol 154 (2) ◽  
pp. 177-182.e2 ◽  
Author(s):  
Andrea L. Lampland ◽  
Brenda Plumm ◽  
Patricia A. Meyers ◽  
Cathy T. Worwa ◽  
Mark C. Mammel
Keyword(s):  
Continuous Positive Airway Pressure ◽  
Observational Study ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
High Flow ◽  
Nasal Cannula ◽  
High Flow Nasal Cannula

scholarly journals Predictors and outcomes of high-flow nasal cannula failure following extubation: A multicentre observational study

2021 ◽  
Vol 50 (6) ◽  
pp. 467-473
Author(s):  
Amit Kansal ◽  
Shekhar Dhanvijay ◽  
Andrew Li ◽  
Jason Phua ◽  
Matthew Edward Cove ◽  
...  
Keyword(s):  
Intensive Care ◽  
Observational Study ◽  
Extubation Failure ◽  
High Flow ◽  
Nasal Cannula ◽  
Public Hospitals ◽  
Apache Ii Score ◽  
High Flow Nasal Cannula ◽  
Airway Extubation ◽  
Icu Length Of Stay

Introduction: Despite adhering to criteria for extubation, up to 20% of intensive care patients require re-intubation, even with use of post-extubation high-flow nasal cannula (HFNC). This study aims to identify independent predictors and outcomes of extubation failure in patients who failed postextubation HFNC. Methods: We conducted a multicentre observational study involving 9 adult intensive care units (ICUs) across 5 public hospitals in Singapore. We included patients extubated to HFNC following spontaneous breathing trials. We compared patients who were successfully weaned off HFNC with those who failed HFNC (defined as re-intubation ≤7 days following extubation). Generalised additive logistic regression analysis was used to identify independent risk factors for failed HFNC. Results: Among 244 patients (mean age: 63.92±15.51 years, 65.2% male, median APACHE II score 23.55±7.35), 41 (16.8%) failed HFNC; hypoxia, hypercapnia and excessive secretions were primary reasons. Stroke was an independent predictor of HFNC failure (odds ratio 2.48, 95% confidence interval 1.83–3.37). Failed HFNC, as compared to successful HFNC, was associated with increased median ICU length of stay (14 versus 7 days, P<0.001), ICU mortality (14.6% versus 2.0%, P<0.001) and hospital mortality (29.3% versus 12.3%, P=0.006). Conclusion: Post-extubation HFNC failure, especially in patients with stroke as a comorbidity, remains a clinical challenge and predicts poorer clinical outcomes. Our observational study highlights the need for future prospective trials to better identify patients at high risk of post-extubation HFNC failure. Keywords: Adult, airway extubation, high-flow nasal cannula, mechanical ventilation, respiratory failure

scholarly journals EFFICACY OF EARLY PRONE POSITIONING IN PATIENTS WITH COVID-19 PNEUMONIA REQUIRING SUPPLEMENTAL OXYGEN, HIGH FLOW NASAL CANNULA, OR NONINVASIVE VENTILATION

CHEST Journal ◽  
2020 ◽  
Vol 158 (4) ◽  
pp. A2281-A2282
Author(s):  
Jacob Bell ◽  
Patricia Dharapak ◽  
Paru Patrawalla ◽  
Dewan Giri ◽  
Justin Gasper ◽  
...  
Keyword(s):  
Noninvasive Ventilation ◽  
Supplemental Oxygen ◽  
High Flow ◽  
Nasal Cannula ◽  
Prone Positioning ◽  
High Flow Nasal Cannula

scholarly journals Prone positioning in high-flow nasal cannula for COVID-19 patients with severe hypoxemia: a pilot study

2020 ◽  
Vol 8 (9) ◽  
pp. 598-598 ◽  
Author(s):  
Guo-Wei Tu ◽  
You-Xia Liao ◽  
Qing-Yun Li ◽  
Hui Dong ◽  
Lu-Yu Yang ◽  
...  
Keyword(s):  
Pilot Study ◽  
High Flow ◽  
Nasal Cannula ◽  
Prone Positioning ◽  
High Flow Nasal Cannula ◽  
Severe Hypoxemia

scholarly journals High flow nasal cannula versus non-invasive ventilation in severe asthma: two years prospective observational study.

2021 ◽  
Author(s):  
Carolina Solé-Delgado ◽  
Alberto García-Salido ◽  
Ainhoa Gochi-Valdovinos ◽  
Anthony González-Brabin ◽  
Maria García ◽  
...  
Keyword(s):  
Observational Study ◽  
Severe Asthma ◽  
Prospective Observational Study ◽  
Invasive Mechanical Ventilation ◽  
High Flow ◽  
Nasal Cannula ◽  
Respiratory Support ◽  
High Flow Nasal Cannula ◽  
Non Invasive ◽  
Respiratory Management

Background: in recent years, High Flow Nasal Cannula (HFNC) has been considered an alternative to non-invasive mechanical ventilation (NIMV) in severe asthma respiratory management in children. Objective: to describe the use of HFNC in children with severe asthma admitted to pediatric critical care unit (PICU). To compare its clinical characteristic and evolution with those receiving NIMV or other respiratory support. Methods: prospective observational study done in children admitted to PICU with severe asthma (October 2017 to October 2019). Data collected: epidemiological, clinical, respiratory support, thorax x-ray, pharmacological treatments and days of admission. Patients were divided into groups: 1) Only HFNC 2) HFNC and NIMV, and 3) Only NIMV. Results: Seventy-six patients included, 39 girls. The median age was two years and one month (range 160). The median pulmonary score was 5 (range 7). PICU admission lengths a median of 3 days (range 9), hospital 6 days (range 23). There were no epidemiological or clinical differences between groups. Children with only HNFC showed a shorter time of PICU days (p 0,025) and none of them required NIMV. In the group receiving both modalities, NIMV was used first and then HFNC in all cases. Children with HFNC showed higher SaO2/FiO2 ratio (p=0,025) and lower PCO2 level (p=0,032). There were no deaths. Conclusions: in our study the HFNC did not require escalation to NIMV and did not increase the length of PICU or hospital days. Normal initial blood gases and absence of high oxygen requirements were useful to select responders to HNFC.

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