When Conventional Oxygen Therapy Fails-The Effectiveness of High-Flow Nasal Oxygen Therapy in Patients with Respiratory Failure in the Course of COVID-19
High-flow nasal oxygen (HFNO) is recommended as a first-line treatment in patients with acute hypoxemic respiratory failure due to COVID-19. We assessed the effectiveness of HFNO and predictors of failure and death. The medical records of 200 consecutive adult patients treated with HFNO were analyse...
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| Veröffentlicht in: | Journal of clinical medicine 2021-10, Vol.10 (20), p.4751 |
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| creator | Rorat, Marta Szymański, Wojciech Jurek, Tomasz Karczewski, Maciej Zelig, Jakub Simon, Krzysztof |
| description | High-flow nasal oxygen (HFNO) is recommended as a first-line treatment in patients with acute hypoxemic respiratory failure due to COVID-19. We assessed the effectiveness of HFNO and predictors of failure and death. The medical records of 200 consecutive adult patients treated with HFNO were analysed. Ninety-two patients (46%) were successfully cured, 52 (26%) required noninvasive ventilation, and 61 (30.5%) received intubation. Overall mortality was 40.5%. Risk factors of HFNO ineffectiveness were: SpO
≤ 90% with conventional oxygen therapy (HR 0.32, 95% CI 0.19-0.53,
< 0.001), SpO
≤ 74% without oxygen therapy (HR 0.44, 95% CI 0.27-0.71,
< 0.001), an age ≥ 60, comorbidities, biomarkers (C-reactive protein, procalcitonin, creatinine, lactate dehydrogenase), duration of symptoms before admission to hospital ≤ 9 days, start of treatment with HFNO ≤ 4 days. The multivariate logistic regression models (age ≥ 60, comorbidities, C-reactive protein concentration and SpO
with oxygen therapy) revealed a high predictive value of death and HFNO failure (AUC 0.851, sensitivity 0.780, specificity 0.802; AUC 0.800, sensitivity 0.776, specificity 0.739, respectively). HFNO is a safe method for treating acute hypoxemic respiratory failure, with effectiveness reaching nearly 50%. Low values of SpO
without and during oxygen therapy seem to be good diagnostic tools for predicting death and HFNO failure. |
| doi_str_mv | 10.3390/jcm10204751 |
| format | Article |
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≤ 90% with conventional oxygen therapy (HR 0.32, 95% CI 0.19-0.53,
< 0.001), SpO
≤ 74% without oxygen therapy (HR 0.44, 95% CI 0.27-0.71,
< 0.001), an age ≥ 60, comorbidities, biomarkers (C-reactive protein, procalcitonin, creatinine, lactate dehydrogenase), duration of symptoms before admission to hospital ≤ 9 days, start of treatment with HFNO ≤ 4 days. The multivariate logistic regression models (age ≥ 60, comorbidities, C-reactive protein concentration and SpO
with oxygen therapy) revealed a high predictive value of death and HFNO failure (AUC 0.851, sensitivity 0.780, specificity 0.802; AUC 0.800, sensitivity 0.776, specificity 0.739, respectively). HFNO is a safe method for treating acute hypoxemic respiratory failure, with effectiveness reaching nearly 50%. Low values of SpO
without and during oxygen therapy seem to be good diagnostic tools for predicting death and HFNO failure.</description><identifier>ISSN: 2077-0383</identifier><identifier>EISSN: 2077-0383</identifier><identifier>DOI: 10.3390/jcm10204751</identifier><identifier>PMID: 34682874</identifier><language>eng</language><publisher>Switzerland: MDPI AG</publisher><subject>Cardiovascular disease ; Clinical medicine ; Coronaviruses ; COVID-19 ; Creatinine ; Hospitals ; Infections ; Infectious diseases ; Intensive care ; Intubation ; Laboratories ; Medical prognosis ; Mortality ; Oxygen therapy ; Patients ; Performance evaluation ; Physicians ; Respiratory distress syndrome ; Respiratory failure ; Risk factors ; Severe acute respiratory syndrome coronavirus 2 ; Survival analysis ; Ventilators</subject><ispartof>Journal of clinical medicine, 2021-10, Vol.10 (20), p.4751</ispartof><rights>2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2021 by the authors. 2021</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c409t-aae2cfaa44c0dfd06fc8d1f47631951ce9b92aaf10e4900e7fcfeb0d5a7e74d33</citedby><cites>FETCH-LOGICAL-c409t-aae2cfaa44c0dfd06fc8d1f47631951ce9b92aaf10e4900e7fcfeb0d5a7e74d33</cites><orcidid>0000-0001-6605-6718 ; 0000-0001-8811-8916 ; 0000-0003-0110-0276 ; 0000-0002-5318-4945</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8541059/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8541059/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,724,777,781,882,27905,27906,53772,53774</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34682874$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Rorat, Marta</creatorcontrib><creatorcontrib>Szymański, Wojciech</creatorcontrib><creatorcontrib>Jurek, Tomasz</creatorcontrib><creatorcontrib>Karczewski, Maciej</creatorcontrib><creatorcontrib>Zelig, Jakub</creatorcontrib><creatorcontrib>Simon, Krzysztof</creatorcontrib><title>When Conventional Oxygen Therapy Fails-The Effectiveness of High-Flow Nasal Oxygen Therapy in Patients with Respiratory Failure in the Course of COVID-19</title><title>Journal of clinical medicine</title><addtitle>J Clin Med</addtitle><description>High-flow nasal oxygen (HFNO) is recommended as a first-line treatment in patients with acute hypoxemic respiratory failure due to COVID-19. We assessed the effectiveness of HFNO and predictors of failure and death. The medical records of 200 consecutive adult patients treated with HFNO were analysed. Ninety-two patients (46%) were successfully cured, 52 (26%) required noninvasive ventilation, and 61 (30.5%) received intubation. Overall mortality was 40.5%. Risk factors of HFNO ineffectiveness were: SpO
≤ 90% with conventional oxygen therapy (HR 0.32, 95% CI 0.19-0.53,
< 0.001), SpO
≤ 74% without oxygen therapy (HR 0.44, 95% CI 0.27-0.71,
< 0.001), an age ≥ 60, comorbidities, biomarkers (C-reactive protein, procalcitonin, creatinine, lactate dehydrogenase), duration of symptoms before admission to hospital ≤ 9 days, start of treatment with HFNO ≤ 4 days. The multivariate logistic regression models (age ≥ 60, comorbidities, C-reactive protein concentration and SpO
with oxygen therapy) revealed a high predictive value of death and HFNO failure (AUC 0.851, sensitivity 0.780, specificity 0.802; AUC 0.800, sensitivity 0.776, specificity 0.739, respectively). HFNO is a safe method for treating acute hypoxemic respiratory failure, with effectiveness reaching nearly 50%. Low values of SpO
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We assessed the effectiveness of HFNO and predictors of failure and death. The medical records of 200 consecutive adult patients treated with HFNO were analysed. Ninety-two patients (46%) were successfully cured, 52 (26%) required noninvasive ventilation, and 61 (30.5%) received intubation. Overall mortality was 40.5%. Risk factors of HFNO ineffectiveness were: SpO
≤ 90% with conventional oxygen therapy (HR 0.32, 95% CI 0.19-0.53,
< 0.001), SpO
≤ 74% without oxygen therapy (HR 0.44, 95% CI 0.27-0.71,
< 0.001), an age ≥ 60, comorbidities, biomarkers (C-reactive protein, procalcitonin, creatinine, lactate dehydrogenase), duration of symptoms before admission to hospital ≤ 9 days, start of treatment with HFNO ≤ 4 days. The multivariate logistic regression models (age ≥ 60, comorbidities, C-reactive protein concentration and SpO
with oxygen therapy) revealed a high predictive value of death and HFNO failure (AUC 0.851, sensitivity 0.780, specificity 0.802; AUC 0.800, sensitivity 0.776, specificity 0.739, respectively). HFNO is a safe method for treating acute hypoxemic respiratory failure, with effectiveness reaching nearly 50%. Low values of SpO
without and during oxygen therapy seem to be good diagnostic tools for predicting death and HFNO failure.</abstract><cop>Switzerland</cop><pub>MDPI AG</pub><pmid>34682874</pmid><doi>10.3390/jcm10204751</doi><orcidid>https://orcid.org/0000-0001-6605-6718</orcidid><orcidid>https://orcid.org/0000-0001-8811-8916</orcidid><orcidid>https://orcid.org/0000-0003-0110-0276</orcidid><orcidid>https://orcid.org/0000-0002-5318-4945</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Cardiovascular disease Clinical medicine Coronaviruses COVID-19 Creatinine Hospitals Infections Infectious diseases Intensive care Intubation Laboratories Medical prognosis Mortality Oxygen therapy Patients Performance evaluation Physicians Respiratory distress syndrome Respiratory failure Risk factors Severe acute respiratory syndrome coronavirus 2 Survival analysis Ventilators |
| title | When Conventional Oxygen Therapy Fails-The Effectiveness of High-Flow Nasal Oxygen Therapy in Patients with Respiratory Failure in the Course of COVID-19 |
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