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ORIGINAL ARTICLE
Year : 2021  |  Volume : 9  |  Issue : 3  |  Page : 215-222

High-Flow nasal cannula treatment in patients with COVID-19 acute hypoxemic respiratory failure: A prospective cohort study


1 Department of Emergency Medicine; Department of Intensive Care, King Fahd Hospital of the University, College of Medicine, Kingdom of Saudi Arabia
2 College of Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Kingdom of Saudi Arabia
3 Preventive Dental Sciences Department, College of Dentistry, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Kingdom of Saudi Arabia
4 Departments of Emergency Medicine, King Fahd Hospital of the University, College of Medicine, Kingdom of Saudi Arabia
5 Respiratory Care Services, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Kingdom of Saudi Arabia
6 Critical Care Department, Faculty of Medicine, Alexandria University, Egypt
7 Critical Care Department, Faculty of Medicine, Cairo University, Egypt
8 Department of Emergency Medicine, King Fahd Hospital of the University, College of Medicine, Kingdom of Saudi Arabia
9 Department of Pediatrics, King Fahd Hospital of the University, College of Medicine, Kingdom of Saudi Arabia
10 Department of Intensive Care, King Fahd Hospital of the University, College of Medicine, Kingdom of Saudi Arabia
11 Department of Medicine; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada

Correspondence Address:
Mohammed S Alshahrani
Departments of Emergency Medicine and Intensive Care, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, PO Box 40236, Dammam, 31952
Kingdom of Saudi Arabia
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DOI: 10.4103/sjmms.sjmms_316_21

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Background: Early use of high-flow nasal cannula (HFNC) decreases the need for endotracheal intubation (EI) in different respiratory failure causes. While HFNC is used in coronavirus disease 2019 (COVID-19)-related acute hypoxemic respiratory failure (AHRF) under weak recommendations, its efficacy remains to be investigated. Objectives: The primary objective was to examine HFNC efficacy in preventing EI among COVID-19 patients with AHRF. Secondary objectives were to determine predictors of HFNC success/failure, mortality rate, and length of hospital and intensive care unit (ICU) stay. Patients and Methods: This is a prospective cohort study conducted at a single tertiary care centre in Saudi Arabia from April to August 2020. Adult patients admitted to the ICU with AHRF secondary to COVID-19 pneumonia and managed with HFNC were included. We excluded patients who were intubated or managed with non-invasive ventilation before HFNC. Results: Forty-four patients received HFNC for a median duration of 3 days (interquartile range, 1–5 days). The mean age was 57 ± 14 years, and 86% were men. HFNC failure and EI occurred in 29 (66%) patients. Patients in whom HNFC treatment failed had a higher risk of death (52% versus 0%; P = 0.001). After adjusting for confounding factors, a high SOFA score and a low ROX index were significantly associated with HFNC failure (hazard ratio [HR], 1.42; 95% confidence interval [CI], 1.04–1.93; P = 0.025; and HR, 0.61; 95% CI, 0.42–0.88; P = 0.008, respectively). Conclusions: One-third of hypoxemic COVID-19 patients who received HFNC did not require intubation. High SOFA score and low ROX index were associated with HFNC failure.


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