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. 2023 Nov:84:101026.
doi: 10.1016/j.resmer.2023.101026. Epub 2023 May 19.

High flow nasal oxygen in frail COVID-19 patients hospitalized in intermediate care units and non-eligible to invasive mechanical ventilation

Corentin Meersseman  1 , Emmanuel Grolleau  2 , Nathalie Freymond  3 , Florent Wallet  4 , Thomas Gilbert  5 , Myriam Locatelli-Sanchez  3 , Laurence Gérinière  3 , Emilie Perrot  3 , Pierre-Jean Souquet  3 , Clara Fontaine-Delaruelle  3 , Jean-Stéphane David  4 , Sébastien Couraud  6
Affiliations

High flow nasal oxygen in frail COVID-19 patients hospitalized in intermediate care units and non-eligible to invasive mechanical ventilation

Corentin Meersseman et al. Respir Med Res. 2023 Nov.

Abstract

Background: In COVID-19 patients, older age (sixty or older), comorbidities, and frailty are associated with a higher risk for mortality and invasive mechanical ventilation (IMV) failure. It therefore seems appropriate to suggest limitations of care to older and vulnerable patients with severe COVID-19 pneumonia and a poor expected outcome, who would not benefit from invasive treatment. HFNO (high flow nasal oxygen) is a non-invasive respiratory support device already used in de novo acute respiratory failure. The main objective of this study was to evaluate the survival of patients treated with HFNO outside the ICU (intensive care unit) for a severe COVID-19 pneumonia, otherwise presenting limitations of care making them non-eligible for IMV. Secondary objectives were the description of our cohort and the identification of prognostic factors for HFNO failure.

Methods: We conducted a retrospective cohort study. We included all patients with limitations of care making them non-eligible for IMV and treated with HFNO for a severe COVID-19 pneumonia, hospitalized in a COVID-19 unit of the pulmonology department of Lyon Sud University Hospital, France, from March 2020 to March 2021. Primary outcome was the description of the vital status at day-30 after HFNO initiation, using the WHO (World Health Organization) 7-points ordinal scale.

Results: Fifty-six patients were included. Median age was 83 years [76.3-87.0], mean duration for HFNO was 7.5 days, 53% had a CFS score (Clinical Frailty Scale) >4. At day-30, 73% of patients were deceased, one patient (2%) was undergoing HFNO, 9% of patients were discharged from hospital. HFNO failure occurred in 66% of patients. Clinical signs of respiratory failure before HFNO initiation (respiratory rate >30/min, retractions, and abdominal paradoxical breathing pattern) were associated with mortality (p = 0.001).

Conclusions: We suggest that HFNO is an option in non-ICU skilled units for older and frail patients with a severe COVID-19 pneumonia, otherwise non-suitable for intensive care and mechanical ventilation. Observation of clinical signs of respiratory failure before HFNO initiation was associated with mortality.

Keywords: COVID-19; Frailty; HFNO; High flow nasal oxygen.

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Conflict of interest statement

Declaration of Competing Interest None

Figures

Figure 1
Figure 1
flow chart. LSUH: Lyon Sud University Hospital; HFNO: high flow nasal oxygen; IMV: invasive mechanical ventilation.
Figure 2
Figure 2
changes in vital status over time (WHO 7-points ordinal scale). DX: day-X; HFNO: high flow nasal oxygen.
Figure 3
Figure 3
in-hospital cumulative survival. A: depending on the value of ROX index at D0, compared to threshold (4.88); B: depending on the presence of a CFS score low (2-4) or high (5-7) at admission; C: depending on the presence or absence of signs of respiratory failure before HFNO introduction. ROX index is calculated by (SpO2/FiO2) / RR (SpO2 is oxygen pulse saturation, FiO2 is fraction of inspired dioxygen, and RR is respiratory rate); HR: hazard ratio; HFNO: high flow nasal oxygen; CFS: clinical frailty scale; clinical signs of respiratory failure include respiratory rate > 30/min, retractions, and abdominal paradoxical breathing pattern.
See this image and copyright information in PMC

References

    1. Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, et al. A Novel Coronavirus from Patients with Pneumonia in China, 2019. N Engl J Med. 2020;382:727–733. doi: 10.1056/NEJMoa2001017. - DOI - PMC - PubMed
    1. Munster VJ, Koopmans M, van Doremalen N, van Riel D, de Wit E. A Novel Coronavirus Emerging in China - Key Questions for Impact Assessment. N Engl J Med. 2020;382:692–694. doi: 10.1056/NEJMp2000929. - DOI - PubMed
    1. Wu Z, McGoogan JM. Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention. JAMA. 2020;323:1239–1242. doi: 10.1001/jama.2020.2648. - DOI - PubMed
    1. Du R-H, Liang L-R, Yang C-Q, Wang W, Cao T-Z, Li M, et al. Predictors of mortality for patients with COVID-19 pneumonia caused by SARS-CoV-2: a prospective cohort study. Eur Respir J. 2020;55 doi: 10.1183/13993003.00524-2020. - DOI - PMC - PubMed
    1. Richardson S, Hirsch JS, Narasimhan M, Crawford JM, McGinn T, Davidson KW, et al. Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area. JAMA. 2020;323:2052–2059. doi: 10.1001/jama.2020.6775. - DOI - PMC - PubMed