High‐flow nasal cannula oxygen therapy for the treatment of acute respiratory failure secondary to SARS‐CoV‐2 pneumonia out of ICU

Abstract

Abstract Introduction and objectives High‐flow nasal cannula oxygen therapy (HFNC) has been successfully used for the treatment of acute hypoxaemic respiratory failure (AHRF) secondary to SARS‐CoV‐2 pneumonia and being effective in reducing progression to invasive mechanical ventilation. The objective of this study was to assess the usefulness of HFNC on a hospital ward for the treatment of AHRF secondary to SARS‐CoV‐2 pneumonia and its impact on the need for intensive care unit (ICU) admission and endotracheal intubation. Other objectives include identifying potential physiological parameters and/or biomarkers for predicting treatment failure and assessing the clinical course and survival. Methods Observational study based on data collected prospectively between March 2020 and February 2021 in a single hospital on patients diagnosed with AHRF secondary to SARS‐CoV‐2 pneumonia who received HFNC outside an ICU. Results One hundred and seventy‐one patients out of 1090 patients hospitalised for SARS‐CoV‐2 infection. HFNC was set as the ceiling of treatment in 44 cases; 12 survived (27.3%). Among the other 127 patients, intubation was performed in 25.9% of cases with a mortality of 11.8%. Higher creatinine levels (OR 1.942, 95% CI 1.04; 3.732; p = 0.036) and Comorbidity‐Age‐Lymphocyte‐LDH (CALL) score (OR 1.273, 95% CI 1.033; 1.617; p = 0.033) were associated with a higher risk of intubation. High platelet count at HFNC initiation was predictive of good treatment response (OR 0.935, 95% CI 0.884; 0.983; p = 0.012). Conclusions HFNC outside an ICU is a treatment with high success rate in patients with AHRF secondary to SARS‐CoV‐2 pneumonia, including in patients in whom this therapy was deemed to be the ceiling of treatment.

Keywords

• COVID‐19
• non‐invasive ventilation
• oxygen inhalation therapy
• respiratory insufficiency
• respiratory therapy