ABSTRACT
BACKGROUND: Early use of high-flow nasal cannula (HFNC) decreases the need for endotracheal intubation (EI) in different respiratory failure causes. While HFNC is used in coronavirus disease 2019 (COVID-19)-related acute hypoxemic respiratory failure (AHRF) under weak recommendations, its efficacy remains to be investigated. OBJECTIVES: The primary objective was to examine HFNC efficacy in preventing EI among COVID-19 patients with AHRF. Secondary objectives were to determine predictors of HFNC success/failure, mortality rate, and length of hospital and intensive care unit (ICU) stay. PATIENTS AND METHODS: This is a prospective cohort study conducted at a single tertiary care centre in Saudi Arabia from April to August 2020. Adult patients admitted to the ICU with AHRF secondary to COVID-19 pneumonia and managed with HFNC were included. We excluded patients who were intubated or managed with non-invasive ventilation before HFNC. RESULTS: Forty-four patients received HFNC for a median duration of 3 days (interquartile range, 1-5 days). The mean age was 57 ± 14 years, and 86% were men. HFNC failure and EI occurred in 29 (66%) patients. Patients in whom HNFC treatment failed had a higher risk of death (52% versus 0%; P = 0.001). After adjusting for confounding factors, a high SOFA score and a low ROX index were significantly associated with HFNC failure (hazard ratio [HR], 1.42; 95% confidence interval [CI], 1.04-1.93; P = 0.025; and HR, 0.61; 95% CI, 0.42-0.88; P = 0.008, respectively). CONCLUSIONS: One-third of hypoxemic COVID-19 patients who received HFNC did not require intubation. High SOFA score and low ROX index were associated with HFNC failure.
ABSTRACT
Moyamoya disease (MMD) is a rare cerebrovascular occlusion condition characterized by progressive stenosis in the terminal portion of the internal carotid arteries on both sides. The measured incidence of MMD is 0.086 per 100,000 people. MMD has variable neurological manifestations, however, seizure is a significant manifestation of MMD with few reported studies. The combination of sickle cell disease (SCD) and MMD confers a much higher risk of ischemic stroke. In this paper, we describe a 32-year-old female with a known case of SCD taking tramadol for a vaso-occlusive crisis, who was presented to the emergency department by a family member due to a low level of consciousness. Despite ongoing management, the patient developed multiple seizure attacks and intubation was performed. A computed tomography (CT) brain angiogram was performed, and the diagnosis of MMD was made. The patient was shifted to the intensive care unit (ICU) and in spite of the ongoing management in the ICU, the patient died. In this case, we highlight the importance of considering MMD as a differential diagnosis when dealing with an SCD patient who developed refractory status epilepticus. .
