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Preprint in English | EuropePMC | ID: ppcovidwho-328531


Background: Non-invasive or invasive mechanical ventilation (NIV or IMV) is used to treat critically ill patients with the novel coronavirus disease 2019 (COVID-19). However, the mortality rate for these remains high. High-flow nasal cannula (HFNC) is an alternative device and prone position (PP) is a therapeutic option. However, there is also no evidence to support the efficacy of these methods for patients with COVID-19. Thus, our study aimed to evaluate the efficacy of the therapeutic combination of early high-flow nasal cannula and the prone position. Methods: We conducted an observational, retrospective, single-center study. We enrolled COVID-19 patients with HFNC support admitted to our hospital between February 1, 2020 and February 28, 2021. We considered the threshold level for HFNC use as Oxygen saturation (SpO 2 ) < 90% and respiratory rate > 20 breaths/min with a non-rebreather mask at 7 L/min or more. SpO 2 as measured by pulse oximetry to the fraction of inspired oxygen (FiO 2 ) (S/F) ratio was calculated to estimate the partial pressure of arterial oxygen to FiO 2 ratio. The primary outcome was the all-cause 28-day mortality. The secondary outcome was intubation rates, time until liberation from HFNC and the length of stay in the intensive care unit (ICU) and the hospital. Continuous variables with normal distribution are shown as mean ± standard deviation, others as median and interquartile range, and categorical variables as counts and percentages. Results: A total of 451 COVID-19 patients were enrolled. Of these, 54 (12%) patients required HFNC. The median S/F ratio before HFNC initiation was 103.9, and the worst median S/F ratio with HFNC was 181. Six patients (11%) died. If we exclude patients who are not eligible for IMV due to their PS, the presence of comorbidities, or the wishes of the patient or their family, only two patients (4%) died. IMV or NIV was required in five patients (9%), of whom three patients died. The median duration of HFNC use, ICU stay, and hospitalization were seven, seven, and 23 days, respectively. Conclusion: The combination therapy of early HFNC and PP has the potential to improve the mortality rate and reduce intubation.

Sci Rep ; 11(1): 13431, 2021 06 28.
Article in English | MEDLINE | ID: covidwho-1286474


Coronavirus disease 2019 (COVID-19) is an emerging infectious disease that leads to severe respiratory failure (RF). It is known that host exposure to viral infection triggers an iron-lowering response to mitigate pathogenic load and tissue damage. However, the association between host iron-lowering response and COVID-19 severity is not clear. This two-center observational study of 136 adult hospitalized COVID-19 patients analyzed the association between disease severity and initial serum iron, total iron-binding capacity (TIBC), and transferrin saturation (TSAT) levels. Serum iron levels were significantly lower in patients with mild RF than in the non-RF group; however, there were no significant differences in iron levels between the non-RF and severe RF groups, depicting a U-shaped association between serum iron levels and disease severity. TIBC levels decreased significantly with increasing severity; consequently, TSAT was significantly higher in patients with severe RF than in other patients. Multivariate analysis including only patients with RF adjusted for age and sex demonstrated that higher serum iron and TSAT levels were independently associated with the development of severe RF, indicating that inadequate response to lower serum iron might be an exacerbating factor for COVID-19.

COVID-19/pathology , Iron/blood , Adult , Aged , COVID-19/complications , COVID-19/virology , Female , Ferritins/blood , Hospitalization , Humans , Iron/metabolism , Logistic Models , Male , Middle Aged , Respiratory Insufficiency/etiology , SARS-CoV-2/isolation & purification , Severity of Illness Index , Transferrin/analysis