High-Flow Nasal Oxygen in Coronavirus Disease 2019 Patients With Acute Hypoxemic Respiratory Failure: A Multicenter, Retrospective Cohort Study

Jingen Xia, Yi Zhang, Lan Ni, Lei Chen, Changzhi Zhou, Chang Gao, Xiaojing Wu, Jun Duan, Jungang Xie, Qiang Guo, Jianping Zhao, Yi Hu, Zhenshun Cheng, Qingyuan Zhan, Jingen Xia, Yi Zhang, Lan Ni, Lei Chen, Changzhi Zhou, Chang Gao, Xiaojing Wu, Jun Duan, Jungang Xie, Qiang Guo, Jianping Zhao, Yi Hu, Zhenshun Cheng, Qingyuan Zhan

Abstract

Objectives: An ongoing outbreak of coronavirus disease 2019 is spreading globally. Acute hypoxemic respiratory failure is the most common complication of coronavirus disease 2019. However, the clinical effectiveness of early high-flow nasal oxygen treatment in patients with coronavirus disease 2019 with acute hypoxemic respiratory failure has not been explored. This study aimed to analyze the effectiveness of high-flow nasal oxygen treatment and to identify the variables predicting high-flow nasal oxygen treatment failure in coronavirus disease 2019 patients with acute hypoxemic respiratory failure.

Design: A multicenter, retrospective cohort study.

Setting: Three tertiary hospitals in Wuhan, China.

Patients: Forty-three confirmed coronavirus disease 2019 adult patients with acute hypoxemic respiratory failure treated with high-flow nasal oxygen.

Interventions: None.

Measurements and main results: Mean age of the enrolled patients was 63.0 ± 9.7 years; female patients accounted for 41.9%. High-flow nasal oxygen failure (defined as upgrading respiratory support to positive pressure ventilation or death) was observed in 20 patients (46.5%), of which 13 (30.2%) required endotracheal intubation. Patients with high-flow nasal oxygen success had a higher median oxygen saturation (96.0% vs 93.0%; p < 0.001) at admission than those with high-flow nasal oxygen failure. High-flow nasal oxygen failure was more likely in patients who were older (p = 0.030) and male (p = 0.037), had a significant increase in respiratory rate and a significant decrease in the ratio of oxygen saturation/FIO2 to respiratory rate index within 3 days of high-flow nasal oxygen treatment. In a multivariate logistic regression analysis model, male and lower oxygen saturation at admission remained independent predictors of high-flow nasal oxygen failure. The hospital mortality rate of the cohort was 32.5%; however, the hospital mortality rate in patients with high-flow nasal oxygen failure was 65%.

Conclusions: High-flow nasal oxygen may be effective for treating coronavirus disease 2019 patients with mild to moderate acute hypoxemic respiratory failure. However, high-flow nasal oxygen failure was associated with a poor prognosis. Male and lower oxygenation at admission were the two strong predictors of high-flow nasal oxygen failure.

Conflict of interest statement

The authors have disclosed that they do not have any potential conflicts of interest.

Figures

Figure 1.
Figure 1.
Flow chart of the study. COVID-19 = coronavirus disease 2019, HFNO = high-flow nasal oxygen, IPPV = invasive positive pressure ventilation, NPPV = noninvasive positive pressure ventilation.
Figure 2.
Figure 2.
Box plots showing the changes of median respiratory rate (RR) and the ratio of oxygen saturation/Fio2 to RR (ROX) index (25–75th percentiles) within the first 3 d of high-flow nasal oxygen (HFNO) treatment between HFNO success group and HFNO failure group. *p < 0.05, #p < 0.001 between HFNO success group and HFNO failure group. bpm = breaths per minute.

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