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. 2020 Aug;7(1):e000650.
doi: 10.1136/bmjresp-2020-000650.

Retrospective analysis of high flow nasal therapy in COVID-19-related moderate-to-severe hypoxaemic respiratory failure

Maulin Patel  1 , Andrew Gangemi  2 , Robert Marron  2 , Junad Chowdhury  2 , Ibraheem Yousef  2 , Matthew Zheng  2 , Nicole Mills  2 , Lauren Tragesser  3 , Julie Giurintano  3 , Rohit Gupta  2 , Matthew Gordon  2 , Parth Rali  2 , Gilbert D'Alonso  2 , David Fleece  4 , Huaqing Zhao  2 , Nicole Patlakh  2 , Gerard Criner  2
Affiliations

Retrospective analysis of high flow nasal therapy in COVID-19-related moderate-to-severe hypoxaemic respiratory failure

Maulin Patel et al. BMJ Open Respir Res. 2020 Aug.

Abstract

Invasive mechanical has been associated with high mortality in COVID-19. Alternative therapy of high flow nasal therapy (HFNT) has been greatly debated around the world for use in COVID-19 pandemic due to concern for increased healthcare worker transmission.This was a retrospective analysis of consecutive patients admitted to Temple University Hospital in Philadelphia, Pennsylvania, from 10 March 2020 to 24 April 2020 with moderate-to-severe respiratory failure treated with HFNT. Primary outcome was prevention of intubation. Of the 445 patients with COVID-19, 104 met our inclusion criteria. The average age was 60.66 (+13.50) years, 49 (47.12 %) were female, 53 (50.96%) were African-American, 23 (22.12%) Hispanic. Forty-three patients (43.43%) were smokers. Saturation to fraction ratio and chest X-ray scores had a statistically significant improvement from day 1 to day 7. 67 of 104 (64.42%) were able to avoid invasive mechanical ventilation in our cohort. Incidence of hospital-associated/ventilator-associated pneumonia was 2.9%. Overall, mortality was 14.44% (n=15) in our cohort with 13 (34.4%) in the progressed to intubation group and 2 (2.9%) in the non-intubation group. Mortality and incidence of pneumonia was statistically higher in the progressed to intubation group. CONCLUSION: HFNT use is associated with a reduction in the rate of invasive mechanical ventilation and overall mortality in patients with COVID-19 infection.

Keywords: respiratory infection; viral infection.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Radiographic Assessment of Lung Edema Score (RALES) grading system for chest X-ray.
Figure 2
Figure 2
Flow chart demonstrating screening for our patients. HFNT, high flow nasal therapy.
Figure 3
Figure 3
Progression of chest imaging for patients on high flow nasal therapy (HFNT). (A) Worsening bilateral infiltrates in intubation group. (B) Non-intubation group, improved infiltrates.
Figure 4
Figure 4
Kaplan-Meier estimate of survival of high flow nasal therapy (HFNT) patients, comparing intubation with non-intubation (continued HFNT) groups.
Figure 5
Figure 5
Receiver operating characteristic (ROC) curve of the predictive model for intubation.
See this image and copyright information in PMC

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