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Observational Study
. 2023 Feb;17(2):115-119.
doi: 10.1111/crj.13573. Epub 2022 Dec 30.

High flow nasal cannula for acute respiratory failure due to COVID-19 in patients with a 'do-not-intubate' order: A survival analysis

Illaa Smesseim  1 , Kirsten Mooij-Kalverda  1 , Lisa Hessels  2 , Daniel A Korevaar  1 , Burak Atasever  3 , Hjalmar de Graaff  4 , Abraham Goorhuis  5 , Esther Nossent  1   6 , Lieuwe Bos  1   7 , Peter Bonta  1 ; Amsterdam UMC HFNC study group:; Joost van den Aardweg  1 , Wim Boersma  2 , Ivo van der Lee  3 , Herre J Reesink  4
Affiliations
Observational Study

High flow nasal cannula for acute respiratory failure due to COVID-19 in patients with a 'do-not-intubate' order: A survival analysis

Illaa Smesseim et al. Clin Respir J. 2023 Feb.

Abstract

Introduction: High flow nasal cannula (HFNC) reduces the need for intubation in patients with hypoxaemic acute respiratory failure (ARF), but its added value in patients with severe coronavirus disease 2019 (COVID-19) and a do-not-intubate (DNI) order is unknown. We aimed to assess (variables associated with) survival in these patients.

Materials and methods: We described a multicentre retrospective observational cohort study in five hospitals in the Netherlands and assessed the survival in COVID-19 patients with severe acute respiratory failure and a DNI order who were treated with high flow nasal cannula. We also studied variables associated with survival.

Results and discussion: One-third of patients survived after 30 days. Survival was 43.9% in the subgroup of patients with a good WHO performance status and only 16.1% in patients with a poor WHO performance status. Patients who were admitted to the hospital for a longer period prior to HFNC initiation were less likely to survive. HFNC resulted in an increase in ROX values, reflective of improved oxygenation and/or decreased respiratory rate.

Conclusion: Our data suggest that a trial of HFNC could be considered to increase chances of survival in patients with ARF due to COVID-19 pneumonitis and a DNI order, especially in those with a good WHO performance status.

Keywords: ARDS; covid-19; dni-order; do-not-intubate order; hfnc.

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Conflict of interest statement

All authors have no conflicts of interest to declare that are relevant to the content of this article. All authors certify that they have no affiliations with or involvement in any organisation or entity with any financial interest or nonfinancial interest in the subject matter or materials discussed in this manuscript.

Figures

FIGURE 1
FIGURE 1
(A) Association between WHO performance status prior to high flow nasal cannula (HFNC) initiation and mortality. (B) Daily median ROX index differences between survivors and nonsurvivors
See this image and copyright information in PMC

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