Natalia Celejewska-Wójcik1, Kamil Polok2,3, Karolina Górka2,4, Tomasz Stachura2,4, Aleksander Kania2,4, Paweł Nastałek2,4, Sabina Lichołai5, Jacek Krawczyk2,4, Krzysztof Wójcik4, Krzysztof Sładek2,4. 1. Department of Pulmonology and Allergology, University Hospital, Kraków, Poland; 2nd Department of Internal Medicine, Jagiellonian University Medical College, Kraków, Poland. natalia.celejewska@uj.edu.pl 2. Department of Pulmonology and Allergology, University Hospital, Kraków, Poland 3. Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Kraków, Poland 4. 2nd Department of Internal Medicine, Jagiellonian University Medical College, Kraków, Poland 5. Division of Molecular Biology and Clinical Genetics, Department of Medicine, Jagiellonian University Medical College, Kraków, Poland
Abstract
INTRODUCTION: A significant proportion of patients with COVID‑19 present with a rapidly progressing severe acute respiratory failure. OBJECTIVES: We aimed to assess the efficacy of high‑flow nasal oxygen (HFNO) therapy in severe acute respiratory failure in the course of COVID‑19 in a noncritical care setting as well as to identify predictors of HFNO failure. PATIENTS AND METHODS: This prospective observational study was conducted between March and December 2020. We enrolled all consecutive patients hospitalized with confirmed SARS‑CoV‑2 infection in whom HFNO therapy was used. The primary outcome was death or endotracheal intubation within 30 days from admission. RESULTS: Of the 380 patients with COVID‑19 hospitalized at our tertiary center, 116 individuals (30.5%) requiring HFNO due to severe pneumonia were analyzed. The primary outcome occurred in 54 patients (46.6%). The overall 30‑day mortality rates were 30.2% (35 out of 116 patients) in the entire cohort and 64.7% (34 out of 51 patients) among individuals requiring endotracheal intubation. A multivariable analysis revealed that the ROX index (the ratio of oxygen saturation / fraction of inspired oxygen to respiratory rate) below 3.85 measured within the first 12 hours of therapy was related to increased mortality (hazard ratio, 5.86; 95% CI, 3.03-11.35) compared with the ROX index of 4.88 or higher. CONCLUSIONS: The results of our study suggest that nearly half of patients treated with HFNO due to severe COVID‑19 pneumonia will require mechanical ventilation. The ROX index is a useful tool for predicting HFNO failure in this population.
INTRODUCTION: A significant proportion of patients with COVID‑19 present with a rapidly progressing severe acute respiratory failure. OBJECTIVES: We aimed to assess the efficacy of high‑flow nasal oxygen (HFNO) therapy in severe acute respiratory failure in the course of COVID‑19 in a noncritical care setting as well as to identify predictors of HFNO failure. PATIENTS AND METHODS: This prospective observational study was conducted between March and December 2020. We enrolled all consecutive patients hospitalized with confirmed SARS‑CoV‑2 infection in whom HFNO therapy was used. The primary outcome was death or endotracheal intubation within 30 days from admission. RESULTS: Of the 380 patients with COVID‑19 hospitalized at our tertiary center, 116 individuals (30.5%) requiring HFNO due to severe pneumonia were analyzed. The primary outcome occurred in 54 patients (46.6%). The overall 30‑day mortality rates were 30.2% (35 out of 116 patients) in the entire cohort and 64.7% (34 out of 51 patients) among individuals requiring endotracheal intubation. A multivariable analysis revealed that the ROX index (the ratio of oxygen saturation / fraction of inspired oxygen to respiratory rate) below 3.85 measured within the first 12 hours of therapy was related to increased mortality (hazard ratio, 5.86; 95% CI, 3.03-11.35) compared with the ROX index of 4.88 or higher. CONCLUSIONS: The results of our study suggest that nearly half of patients treated with HFNO due to severe COVID‑19 pneumonia will require mechanical ventilation. The ROX index is a useful tool for predicting HFNO failure in this population.