High-flow nasal cannula therapy in a predominantly African American population with COVID-19 associated acute respiratory failure
Open Access
- 21 September 2021
- journal article
- research article
- Published by BMJ in BMJ Open Respiratory Research
- Vol. 8 (1), e000875
- https://doi.org/10.1136/bmjresp-2021-000875
Abstract
Importance Use of non-invasive respiratory modalities in COVID-19 has the potential to reduce rates of intubation and mortality in severe disease however data regarding the use of high-flow nasal cannula (HFNC) in this population is limited. Objective To interrogate clinical and laboratory features of SARS-CoV-2 infection associated with high-flow failure. Design We conducted a retrospective cohort study to evaluate characteristics of high-flow therapy use early in the pandemic and interrogate factors associated with respiratory therapy failure. Setting Multisite single centre hospital system within the metropolitan Detroit region. Participants Patients from within the Detroit Medical Center (n=104, 89% African American) who received HFNC therapy during a COVID-19 admission between March and May of 2020. Primary outcome HFNC failure is defined as death or intubation while on therapy. Results Therapy failure occurred in 57% of the patient population, factors significantly associated with failure centred around markers of multiorgan failure including hepatic dysfunction/transaminitis (OR=6.1, 95% CI 1.9 to 19.4, pConclusions In a population disproportionately affected by COVID-19, we present key indicators of likely HFNC failure and highlight a patient population in which aggressive monitoring and intervention are warranted.This publication has 36 references indexed in Scilit:
- Efficacy of High-Flow Nasal Cannula Therapy in Acute Hypoxemic Respiratory Failure: Decreased Use of Mechanical VentilationRespiratory Care, 2015
- Failure of high-flow nasal cannula therapy may delay intubation and increase mortalityIntensive Care Medicine, 2015
- Use of High-Flow Nasal Cannula Oxygen Therapy in Subjects With ARDS: A 1-Year Observational StudyRespiratory Care, 2014
- Ventilator-Induced Lung InjuryThe New England Journal of Medicine, 2013
- Heated and Humidified High-Flow Oxygen Therapy Reduces Discomfort During Hypoxemic Respiratory FailureRespiratory Care, 2012
- Impact of high-flow nasal cannula oxygen therapy on intensive care unit patients with acute respiratory failure: A prospective observational studyJournal of Critical Care, 2012
- Beneficial effects of humidified high flow nasal oxygen in critical care patients: a prospective pilot studyIntensive Care Medicine, 2011
- A Modified Sequential Organ Failure Assessment Score for Critical Care TriageDisaster Medicine and Public Health Preparedness, 2010
- High flow nasal cannula versus nasal CPAP for neonatal respiratory disease: a retrospective studyJournal of Perinatology, 2007
- Characteristics and Outcomes in Adult Patients Receiving Mechanical VentilationA 28-Day International StudyJAMA, 2002