Factors affecting the outcome of the usage of high-flow nasal cannula on severe or critically ill COVID-19 patients: a multicentric study from a developing nation

In resource-constrained settings, High-Flow Nasal Cannula (HFNC) can reduce the burden on mechanical ventilation in COVID-19 induced Acute Hypoxemic Respiratory Failure (AHRF). The aim was to observe the factors those might affect the outcome of the usage of HFNC on severe/critically ill COVID-19 patients. This is a multicentric prospective observational study. We observed rRT-PCR positive severe/critically ill ICU patients requiring HFNC for more than six hours. Statistical analysis was done to correlate between factors and outcome. Weaning from HFNC was successful in 47.5% of patients. The death rate was higher in 50 years older (56.50%), and patients with asthma (60.57%), COPD (60.00%), and CKD (68.42%). Fever (91.67%), cough (72.5%), and dyspnea (67.5%) were the most common symptoms. Mortality rates were higher for patients with raised blood sugar, creatinine levels. Severely systemic inflammatory response was seen very high for the expired patients. On HFNC, percent saturation of oxygen (SpO2) and partial pressure of oxygen (PaO2) progression was significantly high for the surviving patients requiring less inspired fraction of oxygen (FiO2%). The survival rate was higher for the patients using both HFNC and non-rebreather mask (NRM) concomitantly. While after HFNC- SpO2% and FiO2% were significantly related with outcome of the HFNC only treated patients, duration of hospital stay and on HFNC- FiO2% affected the HFNC + NRM treated patients' outcome. HFNC could save more lives of critically ill AHRF patients who otherwise might need invasive or noninvasive ventilation. Some biochemical tests were observed to have association with the prognosis of the disease though HFNC was given to all. Survival benefit of dual HFNC and NRM therapy needs future study.

Clinical observation of high-flow nasal cannula with non-rebreather mask use on severe or critically ill COVID-19 diabetic patients (preprint)

Background and aims Prevalence of diabetes is a vital factor in COVID-19’s clinical prognosis. This study aimed to investigate and compare the efficacy of High-flow Nasal Cannula (HFNC) with/without non-rebreather mask (NRM) use on critical COVID-19 patients with/without diabetes. Methods For analysis and comparison, epidemiological, biochemical, and clinical data were collected from 240 HFNC (±NRM) treated severe and critical COVID-19 patients (diabetic = 136; non-diabetic = 104) admitted into ICUs of five hospitals in Chattogram, Bangladesh. Results 59.1% of patients with fever had diabetes (p=0.012). ICU stay was longer for diabetic patients (9.06±5.70) than non-diabetic patients (7.41±5.11) (p=0.020). Majority of the hypertensive patients were diabetic (68.3%; p<0.001). Majority of diabetic patients (70.4%; p<0.005) had elevated creatinine levels. Partial pressure of oxygen (mmHg) after HFNC (only) administration was significantly (p=0.031) higher in non-diabetic patients (69.30±23.56) than in diabetic patients (61.50±14.49). Diabetic (62.64±13.05) and non-diabetic patients (59.40±13.22) had almost similar partial pressure of oxygen (mmHg) from HFNC with NRM. Patients with elevated RBS required NRM with HFNC five times (AOR=5.1, 1.2-20.8) higher than others. Besides age, and hypertension were significantly associated with the HFNC+NRM treated diabetic patients. Factors those affected the HFNC only treated patients were fever and impaired glucose tolerance. Conclusions The results of this study imply that oxygen supply with HFNC and NRM may be beneficial for the elderly/hypertensive diabetic patients with COVID-19 associated AHRF; and that increased blood glucose level could be a determinant for the need of HFNC + NRM treatment. Highlights Elderly diabetic patients required both HFNC and NRM to increase oxygen saturation. Hypertension may be a factor for diabetic patients with COVID-19 requiring HFNC and NRM together. ‘HFNC + NRM’-combination therapy might be needed when blood glucose levels rise.

CHARACTERISTICS, MANAGEMENT AND OUTCOMES OF CRITICALLY ILL COVID-19 PATIENTS ADMITTED TO ICU IN HOSPITALS IN BANGLADESH: A RETROSPECTIVE STUDY (preprint)

Objectives: This study aimed to analyse the epidemiological and clinical characteristics of critical COVID-19 cases and investigate risk factors including comorbidities and age in relation with the clinical aftermath of COVID-19 in critical cases in Bangladesh. Methods: In this retrospective study, epidemiological and clinical characteristics, complications, laboratory results, and clinical management of the patients were studied from data obtained from 168 individuals diagnosed with an advanced prognosis of COVID-19 admitted in two hospitals in Bangladesh. Results: Individuals in the study sample contracted COVID-19 through community transmission. 56.5% (n = 95) cases died in intensive care units (ICU) during the study period. The median age was 56 years and 79.2% (n=134) were male. Typical clinical manifestation included Acute respiratory distress syndrome (ARDS) related complications (79.2%), fever (54.2%) and cough (25.6%) while diabetes mellitus (52.4%), hypertension (41.1%) and heart diseases (16.7%) were the conventional comorbidities. Clinical outcomes were detrimental due to comorbidities rather than age and comorbid individuals over 50 were at more risk. In the sample, oxygen saturation was low (< 95% SpO2) in 135 patients (80.4%) and 158 (93.4%) patients received supplemental oxygen. Identical biochemical parameters were found in both deceased and surviving cases. Administration of antiviral drug Remdesivir and the glucocorticoid, Dexamethasone increased the proportion of surviving patients slightly. Conclusions: Susceptibility to developing critical illness due to COVID-19 was found more in comorbid males. These atypical patients require more clinical attention from the prospect of controlling mortality rate in Bangladesh.