Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Nov:80:100834.
doi: 10.1016/j.resmer.2021.100834. Epub 2021 Jun 4.

Covid-19 severe hypoxemic pneumonia: A clinical experience using high-flow nasal oxygen therapy as first-line management

G Beduneau  1 , D Boyer  2 , P-G Guitard  3 , P Gouin  3 , D Carpentier  2 , S Grangé  2 , B Veber  3 , C Girault  4 , F Tamion  5
Affiliations

Covid-19 severe hypoxemic pneumonia: A clinical experience using high-flow nasal oxygen therapy as first-line management

G Beduneau et al. Respir Med Res. 2021 Nov.

Abstract

Purpose: To report a French experience in patients admitted to Intensive Care Unit (ICU) for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) requiring high fractional concentration of inspired oxygen supported by high flow nasal cannula (HFNC) as first-line therapy.

Methods: Retrospective cohort study conducted in two ICUs of a French university hospital. All consecutive patients admitted during 28-days after the first admission for SARS-CoV-2 pneumonia were screened. Demographic, clinical, respiratory support, specific therapeutics, ICU length-of-stay and survival data were collected.

Results: Data of 43 patients were analyzed: mainly men (72%), median age 61 (51-69) years, median body mass index of 28 (25-31) kg/m2, median simplified acute physiology score (SAPS II) of 29 (22-37) and median PaO2/fraction of inspired oxygen (FiO2) (P/F) ratio of 146 (100-189) mmHg. HFNC was initiated at ICU admission in 76% of patients. Median flow was 50 (45-50) L/min and median FiO2 was 0.6 (0.5-0.8). 79% of patients presented at least one comorbidity, mainly hypertension (58%). At day (D) 28, 32% of patients required invasive mechanical ventilation, 3 patients died in ICU. Risk factors for intubation were diabetes (10% vs. 43%, P=0.04) and extensive lesions on chest computed tomography (CT) (P=0.023). Patients with more than 25% of lesions on chest CT were more frequently intubated during ICU stay (P=0.012). At ICU admission (D1), patients with higher SAPS II and Sequential Organ Failure Assessment (SOFA) scores (respectively 39 (28-50) vs. 27 (22-31), P=0.0031 and 5 (2-8) vs. 2 (2-2.2), P=0.0019), and a lower P/F ratio (98 (63-109) vs. 178 (126-206), P=0.0005) were more frequently intubated. Among non-intubated patients, the median lowest P/F was 131 (85-180) mmHg. Four caregivers had to stop working following coronavirus 2 contamination, but did not require hospitalization.

Conclusion: Our clinical experience supports the use of HFNC as first line-therapy in patients with SARS-COV-2 pneumonia for whom face mask oxygen does not provide adequate respiratory support.

Keywords: High flow oxygen therapy; Hypoxemia; Mechanical ventilation; Outcomes; SARS-COV-2 pneumonia.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Study population: flow-chart.
See this image and copyright information in PMC

References

    1. Yang X., Yu Y., Xu J., Shu H., Xia J., Liu H., et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med. 2020;8:475–481. - PMC - PubMed
    1. Frat J.-P., Thille A.W., Mercat A., Girault C., Ragot S., Perbet S., et al. High-flow oxygen through nasal cannula in acute hypoxemic respiratory failure. N Engl J Med. 2015;372:2185–2196. - PubMed
    1. Darmon M. 2020. Recommandations d’experts portant sur la prise en charge en réanimation des patients en période d’épidémie à SARS-CoV2. SRLF-SFAR-SFMU-GFRUP-SPILF-SPLF.
    1. Kuteifan K., Pasquier P., Meyer C., Escarment J., Theissen O. The outbreak of COVID-19 in Mulhouse: hospital crisis management and deployment of military hospital during the outbreak of COVID-19 in Mulhouse, France. Ann Intensive Care. 2020;10:59. - PMC - PubMed
    1. Besnier E., NSeir S., Lambiotte F., Du Cheyron D., Sauneuf B., Misset B., et al. High-flow nasal cannula therapy: clinical practice in intensive care units. Ann Intensive Care. 2019;9:98. - PMC - PubMed