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. 2022 Jan;60(1):146-153.
doi: 10.1016/j.resinv.2021.10.005. Epub 2021 Oct 30.

High-flow nasal cannula oxygen therapy in hypoxic patients with COVID-19 pneumonia: A retrospective cohort study confirming the utility of respiratory rate index

Yuichiro Takeshita  1 , Jiro Terada  2 , Yasutaka Hirasawa  1 , Taku Kinoshita  1 , Hiroshi Tajima  1 , Ken Koshikawa  3 , Toru Kinouchi  3 , Yuri Isaka  3 , Yu Shionoya  1 , Yuji Tada  1 , Kenji Tsushima  1
Affiliations

High-flow nasal cannula oxygen therapy in hypoxic patients with COVID-19 pneumonia: A retrospective cohort study confirming the utility of respiratory rate index

Yuichiro Takeshita et al. Respir Investig. 2022 Jan.

Abstract

Background: Although high-flow nasal cannula (HFNC) oxygen treatment has been frequently used in coronavirus disease 2019 (COVID-19) patients with acute respiratory failure after the 3rd wave of the pandemic in Japan, the usefulness of the indicators of ventilator avoidance, including respiratory rate-oxygenation (ROX) index and other parameters, namely oxygen saturation/fraction of inspired oxygen ratio and respiratory rate (RR), remain unclear.

Methods: Between January and May 2021, our institution treated 189 COVID-19 patients with respiratory failure requiring oxygen, among which 39 patients requiring HFNC treatment were retrospectively analyzed. The group that switched from HFNC treatment to conventional oxygen therapy (COT) was defined as the HFNC success group, and the group that switched from HFNC treatment to a ventilator was defined as the HFNC failure group. We followed the patients' oxygenation parameters for a maximum of 30 days.

Results: HFNC treatment success occurred in 24 of 39 patients (62%) treated with HFNC therapy. Compared with the HFNC failure group, the HFNC success group had a significantly higher degree of RR improvement in the univariate analysis. Logistic regression analysis of HFNC treatment success adjusting for age, respiratory improvement, and a ROX index ≥5.55 demonstrated that an improved RR was associated with HFNC treatment success. The total COT duration was significantly shorter in the HFNC success group than in the HFNC failure group.

Conclusions: HFNC treatment can be useful for ventilator avoidance and allow the quick withdrawal of oxygen administration. RR improvement may be a convenient, useful, and simple indicator of HFNC treatment success.

Keywords: COVID-19; High-flow nasal cannula; Oxygen therapy; Respiratory failure; Respiratory rate.

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Conflict of interest statement

Conflict of Interest J.T. has received research funding from Teijin Pharma Ltd as part of a collaborative research project with Chiba University and Teijin Pharma Ltd. Other authors report no conflicts of interest.

Figures

Fig. 1
Fig. 1
Study population flowchart. The final study cohort comprised 39 patients. COVID-19, coronavirus disease 2019; COT, conventional oxygen therapy; NPPV, noninvasive positive-pressure ventilation; IPPV, invasive positive-pressure ventilation; HFNC, high-flow nasal cannula; DNI, do not intubate.
Fig. 2
Fig. 2
RR changes before and after HFNC treatment. The degree of improvement in RR between 0 and 6 h before HFNC treatment and between 18 and 24 h after HFNC treatment is shown. RR, respiratory rate; HFNC, high-flow nasal cannula.
Fig. 3
Fig. 3
Duration from initiation to withdrawal of oxygen administration. The Kaplan–Meier curves indicate the probability of duration of oxygen administration for the HFNC success and the HFNC failure groups. The HFNC success group showed a significantly shorter time to oxygen withdrawal (p < 0.01). HFNC, high-flow nasal cannula. HFNC, high-flow nasal cannula.
See this image and copyright information in PMC

References

    1. Patel M., Gangemi A., Marron R., Chowdhury J., Yousef I., Zheng M., et al. Retrospective analysis of high flow nasal therapy in COVID-19-related moderate-to-severe hypoxaemic respiratory failure. BMJ Open Respir Res. 2020;7 - PMC - PubMed
    1. Alhazzani W., Møller M.H., Arabi Y.M., Loeb M., Gong M.N., Fan E., et al. Surviving sepsis campaign: guidelines on the management of critically ill adults with Coronavirus disease 2019 (COVID-19) Crit Care Med. 2020;48:e440–e469. - PMC - PubMed
    1. National Institutes of Health. COVID-19 Treatment Guidelines Oxygenation and ventilation. 2020. https://www.covid19treatmentguidelines.nih.gov/critical-care/oxygenation... - PubMed
    1. The Australian and New Zealand intensive care society (ANZICS) COVID-19 guidelines. 2020. https://www.anzics.com.au/wp-content/uploads/2020/03/ANZICS-COVID-19-Gui... Version 1.
    1. Japanese Ministry of Health, Labor and Welfare . 5th edition. 2021. Guide for medical treatment of novel coronavirus infections.https://www.mhlw.go.jp/content/000785013.pdf