Your browser doesn't support javascript.
Mechanically Ventilated Patients With Coronavirus Disease 2019 Had a Higher Chance of In-Hospital Death If Treated With High-Flow Nasal Cannula Oxygen Before Intubation.
Nurok, Michael; Friedman, Oren; Driver, Matthew; Sun, Nancy; Kumaresan, Abirami; Chen, Peter; Cheng, Susan; Talmor, Daniel S; Ebinger, Joseph.
  • Nurok M; From the Departments of Anesthesiology and Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
  • Friedman O; Department of Medicine, Intensive Care Unit, Marina del Rey Hospital, Division of Pulmonary & Critical Care Medicine, Cedars-Sinai Health System and Medical Center, Los Angeles, California.
  • Driver M; Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
  • Sun N; Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
  • Kumaresan A; From the Departments of Anesthesiology and Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
  • Chen P; Division of Pulmonary and Critical Care Medicine, Department of Medicine, Women's Guild Lung Institute, Cedars-Sinai Medical Center, Cedars-Sinai Medical Center, Los Angeles, California.
  • Cheng S; Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
  • Talmor DS; Department of Anesthesia, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
  • Ebinger J; Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
Anesth Analg ; 136(4): 692-698, 2023 04 01.
Article in English | MEDLINE | ID: covidwho-2274534
ABSTRACT

BACKGROUND:

The impact of high-flow nasal cannula (HFNC) on outcomes of patients with respiratory failure from coronavirus disease 2019 (COVID-19) is unknown. We sought to assess whether exposure to HFNC before intubation was associated with successful extubation and in-hospital mortality compared to patients receiving intubation only.

METHODS:

This single-center retrospective study examined patients with COVID-19-related respiratory failure from March 2020 to March 2021 who required HFNC, intubation, or both. Data were abstracted from the electronic health record. Use and duration of HFNC and intubation were examined' as well as demographics and clinical characteristics. We assessed the association between HFNC before intubation (versus without) and chance of successful extubation and in-hospital death using Cox proportional hazards models adjusting for age, sex, race/ethnicity, obesity, hypertension, diabetes, prior chronic obstructive pulmonary disease or asthma, HCO 3 , CO 2 , oxygen-saturation-to-inspired-oxygen (SF) ratio, pulse, respiratory rate, temperature, and length of stay before intervention.

RESULTS:

A total of n = 440 patients were identified, of whom 311 (70.7%) received HFNC before intubation, and 129 (29.3%) were intubated without prior use of HFNC. Patients who received HFNC before intubation had a higher chance of in-hospital death (hazard ratio [HR], 2.08; 95% confidence interval [CI], 1.06-4.05). No difference was found in the chance of successful extubation between the 2 groups (0.70, 0.41-1.20).

CONCLUSIONS:

Among patients with respiratory failure from COVID-19 requiring mechanical ventilation, patients receiving HFNC before intubation had a higher chance of in-hospital death. Decisions on initial respiratory support modality should weigh the risks of intubation with potential increased mortality associated with HFNC.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Main subject: Oxygen Inhalation Therapy / Respiratory Insufficiency / Noninvasive Ventilation / COVID-19 Type of study: Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Limits: Humans Language: English Journal: Anesth Analg Year: 2023 Document Type: Article

Similar

MEDLINE

...
LILACS

LIS


Full text: Available Collection: International databases Database: MEDLINE Main subject: Oxygen Inhalation Therapy / Respiratory Insufficiency / Noninvasive Ventilation / COVID-19 Type of study: Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Limits: Humans Language: English Journal: Anesth Analg Year: 2023 Document Type: Article