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Predictors of high flow oxygen therapy failure in COVID-19-related severe hypoxemic respiratory failure

Polydora, Eftychia; Alexandrou, Michaella; Tsipilis, Stamatios; Athanasiou, Nikolaos; Katsoulis, Michail; Rodopoulou, Artemis; Pappas, Apostolos; (2022) Predictors of high flow oxygen therapy failure in COVID-19-related severe hypoxemic respiratory failure. Journal of Thoracic Disease 10.21037/jtd-21-1373. (In press). Green open access

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Abstract

Background: During COVID-19 pandemic, people who developed pneumonia and needed supplemental oxygen, where treated with low-flow oxygen therapy systems and non-invasive methods, including oxygen therapy using high flow nasal cannula (HFNC) and the application of bi-level or continuous positive airway pressure (BiPAP or CPAP). We aimed to investigate the outcomes of critical COVID-19 patients treated with HFNC and unveil predictors of HFNC failure. // Methods: We retrospectively enrolled patients admitted to COVID-19 wards and treated with HFNC for COVID-19-related severe hypoxemic respiratory failure. The primary outcome of this study was treatment failure, such as the composite of intubation or death during hospital stay. The association between treatment failure and clinical features was evaluated using logistic regression models. // Results: One hundred thirty-two patients with a median (IQR) PaO2/FiO2 ratio 96 (63–173) mmHg at HFNC initiation were studied. Overall, 45.4% of the patients were intubated. Hospital mortality was 31.8%. Treatment failure (intubation or death) occurred in 50.75% and after adjustment for age, gender, Charlson Comorbidity index (CCI) score and National Early Warning Score 2 (NEWS2) score on admission and PaO2/FiO2 ratio and acute respiratory distress syndrome (ARDS) severity at the time of HFNO initiation, it was significantly associated with the presence of dyspnea [adjusted OR 2.48 (95% CI: 1.01–6.12)], and higher Urea serum levels [adjusted OR 1.25 (95% CI: 1.03–1.51) mg/dL]. // Conclusions: HFNC treatment was successful in almost half of the patients with severe COVID-19- related acute hypoxemic respiratory failure (AHRF). The presence of dyspnea and high serum Urea levels on admission are closely related to HFNC failure.

Type: Article
Title: Predictors of high flow oxygen therapy failure in COVID-19-related severe hypoxemic respiratory failure
Open access status: An open access version is available from UCL Discovery
DOI: 10.21037/jtd-21-1373
Publisher version: https://dx.doi.org/10.21037/jtd-21-1373
Language: English
Additional information: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0).
Keywords: COVID-19; acute respiratory distress syndrome (ARDS); respiratory failure; high flow nasal cannula (HFNC); intubation
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Cardiovascular Science > Population Science and Experimental Medicine > MRC Unit for Lifelong Hlth and Ageing
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Cardiovascular Science > Population Science and Experimental Medicine
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Cardiovascular Science
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
URI: https://discovery.ucl.ac.uk/id/eprint/10147320
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