High-flow nasal cannula therapy in a predominantly African American population with COVID-19 associated acute respiratory failure.
BMJ Open Respir Res
; 8(1)2021 09.
Article
in English
| MEDLINE | ID: covidwho-1435063
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. PRIMARYOUTCOME:
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, p<0.01), kidney injury (OR=7.0, 95% CI 2.7 to 17.8, p<0.01) and coagulation dysfunction (OR=4.5, 95% CI 1.2 to 17.1, p=0.03). Conversely, comorbidities, admission characteristics, early oxygen requirements and evaluation just prior to HFNC therapy initiation were not significantly associated with success or failure of therapy.CONCLUSIONS:
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.Keywords
Full text:
Available
Collection:
International databases
Database:
MEDLINE
Main subject:
Oxygen Inhalation Therapy
/
Respiratory Insufficiency
/
COVID-19
Type of study:
Cohort study
/
Experimental Studies
/
Observational study
/
Prognostic study
Limits:
Aged
/
Female
/
Humans
/
Male
/
Middle aged
Country/Region as subject:
North America
Language:
English
Year:
2021
Document Type:
Article
Affiliation country:
Bmjresp-2021-000875
Similar
MEDLINE
...
LILACS
LIS