Acute respiratory failure, Coronavirus disease 2019, High-flow nasal cannula, Predictors of weaning from high-flow nasal cannula
Citation Information :
Vadi S, Charaniya T, Wani P, Cooke C, Raut A. Characteristics Associated with Successful Weaning from High-flow Nasal Cannula and Factors influencing Survival for COVID-19-associated Acute Respiratory Failure: A Retrospective Study. Indian J Respir Care 2023; 12 (2):191-198.
Introduction: To identify characteristics associated with successful weaning from high-flow nasal cannula (HFNC) and survival in patients with coronavirus disease 2019 (COVID-19)—associated acute respiratory failure. Methods: In this retrospective, observational study performed at a tertiary care center in Mumbai, we evaluated patients with COVID-19-associated acute respiratory failure (C-ARF) who were managed with HFNC. The primary outcome was the proportion of patients who were successfully weaned from HFNC. Secondary outcomes were factors that influenced weaning and survival. Failure of HFNC was defined as those who required invasive ventilation after initial HFNC. Results: Respiratory rate-oxygenation (ROX) 6 was positively correlated to ROX24 (r = 0.5 and p < 0.0001), ROX48 (r = 0.44 and p < 0.0001), and ROX72 (r = 0.29 and p = 0.002). In multivariable logistic regression, average C-reactive protein (CRP) [odds ratio (OR) = 1.06, 95% confidence interval (CI): 1.008–1.12], average neutrophil to lymphocyte ratio (NLR) (OR = 1.04, 95% CI: 1.004–1.08), average platelet count (OR = 0.99, 95% CI: 0.99–0.999), and average fluid balance (OR = 1.01, 95% CI: 1.002–1.02) were associated with the need for intubation. Average NLR (OR = 1.04, 95% CI: 1.005–1.08) and average platelet count (OR = 0.99, 95% CI: 0.98–0.99) were associated with mortality. Conclusion: High-flow nasal cannula (HFNC) is a suitable option in patients with C-ARF. Prospective studies are needed to validate the associated variables for the need for invasive ventilation in this group of patients.
Todur PM, Eeshwar MV, Teckchandani D, et al. Oxygen sources and delivery devices: essentials during COVID-19. Indian J Respir Care 2021;10(2):171–181. DOI: 10.4103/ijrc.ijrc_63_21
Richardson S, Hirsch JS, Narasimhan M, et al. Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City area. JAMA 2020;323(20):2052–2059. DOI: 10.1001/jama.2020.6775
Tobin MJ. Basing respiratory management of COVID-19 on physiological principles. Am J Respir Crit Care Med 2020;201(11):1319–1320. DOI: 10.1164/rccm.202004-1076ED
Rochwerg B, Granton D, Wang DX, et al. High flow nasal cannula compared with conventional oxygen therapy for acute hypoxemic respiratory failure: a systematic review and meta-analysis. Intensive Care Med 2019;45(5):563–572. DOI: 10.1007/s00134-019-05590-5
Rodriguez M, Thille AW, Boissier F, et al. Predictors of successful separation from high-flow nasal oxygen therapy in patients with acute respiratory failure: a retrospective monocenter study. Ann Intensive Care 2019;9(1):101. DOI: 10.1186/s13613-019-0578-8
Von Elm E, Altman DG, Egger M, et al. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. BMJ 2009;335(7624):806–808. DOI: 10.1136/bmj.39335.541782.ad
Roca O. Caralt B, Messika J, et al. An index combining respiratory rate and oxygenation to predict outcome of nasal high-flow therapy. Am J Respir Crit Care Med 2019;199(11):1368–1376. DOI: 10.1164/rccm.201803-0589OC
Arruda DG, Kieling GA, Melo-Diaz LL. Effectiveness of high-flow nasal cannula therapy on clinical outcomes in adults with COVID-19: a systematic review. Can J Respir Ther 2023;59:52–65. DOI: 10.29390/cjrt-2022-005
Lee JY, Kim HA, Huh K, et al. Risk factors for mortality and respiratory support in elderly patients hospitalized with COVID-19 in Korea. J Korean Med Sci 2020;35(23):e223. DOI: 10.3346/jkms.2020.35.e223
Calligaro GL, Lalla U, Audley G, et al. The utility of high-flow nasal oxygen for severe COVID- 19 pneumonia in a resource-constrained setting: A multi-center prospective observational study. EClinicalMedicine 2020;28:100570. DOI: 10.1016/j.eclinm.2020.100570
Mellado-Artigas R, Mujica LE, Ruiz ML, et al. Predictors of failure with high-flow nasal oxygen therapy in COVID - 19 patients with acute respiratory failure: a multicentre observational study. J Intensive Care 2021;9(1):23. DOI: 10.1186/s40560-021-00538-8
Zucman N, Mullaert J, Roux D, et al. Prediction of outcome of nasal high flow use during COVID-19-related acute hypoxemic respiratory failure. Intensive Care Med 2020;46(10):1924–1926. DOI: 10.1007/s00134-020-06177-1