The Outcomes of COVID-19 Patients with ARDS Who Received High Flow Nasal Oxygen in Medical Wards Outside Intensive Care Units Under Supervision of Non-intensivists.

Yıl 2024, Cilt: 38 Sayı: 1, 1 - 10, 24.05.2024

Özgür Kılıç , Ebru Kulucan , Yusuf Taha Gullu , Mehmet Polat , M Elmali , Esra Tanyel , Melda Dilek

https://doi.org/10.18614/deutip.1345427

Öz

Objective: Efficacy of high flow nasal oxygen (HFNO) use in COVID-19 patients who developed ARDS in medical wards is poorly studied. We aimed to investigate whether use of HFNO in wards outside intensive care unit under supervision of non-intensivists has clinical effects on acute respiratory failure and whether it reduces ICU workload.
Methods: COVID 19 patients who received HFNO therapy for ARDS in medical wards of an academic hospital were analyzed retrospectively. Primary outcome was the proportion of patients who were successfully weaned from HFNO.
Results: 43 patients ( 32 male, median age 61 [54-70] years) were investigated. 14 (33 %) patients weaned from HFNO and 29 (67%) patients failed HFNO and were tranferred to ICU. HFNO was applied in the group of HFNO with success with a median duration of 7 days (4-9) and in the failed group with median 3 days (2-5), p=0.002. Median SpO2 after HFNO was higher in patients with HFNO success compared to with HFNO failure [95 (94-97) vs 93 (92-95), p=0.015]. In the group of HFNO with success, there were more hypocapnic patients than in the group of HFNO with failure [19/29 (66 %) vs 3/14 (21%); p=0.015]. Logistic regression analysis indicated that patients with hypocapnia had 9.8 times the odds of having HFNO failure compared with patients with normocapnia.No patient died among the patients succeded HFNO however 90% of patients who transferred to ICU died.
Conclusion: Use of HFNO for COVID-19 patients with ARDS at a non-critical setting seemed to be beneficial in avoiding intubation and reducing workload of ICU. However due to high mortality rate among the HFNO failed group, it would be better to be used undersupervision of intensivists and by skilled team.

Anahtar Kelimeler

COVID-19, High Flow Nasal Oxygenation, ARDS, medical ward, ICU workload

Proje Numarası

yok

Yoğun Bakım Üniteleri Dışındaki Servislerde Yoğun Bakım Uzmanı Olmayan Hekim Gözetimi Altında Yüksek Akışlı Nazal Oksijen Alan COVID-19 ARDS Hastalarının Sonuçları

Öz

Amaç: Servislerde ARDS gelişen COVID-19 hastalarında yüksek akışlı nazal oksijen (HFNO) kullanımının etkinliği yeterince araştırılmamıştır. HFNO'nun yoğun bakım dışı servislerde yoğun bakım uzmanı olmayan gözetiminde kullanımının akut solunum yetmezliği üzerine klinik etkisinin olup olmadığını ve YBÜ iş yükünü azaltıp azaltmadığını araştırmayı amaçladık.
Yöntemler: Bir akademik hastanenin servislerinde ARDS nedeniyle HFNO tedavisi alan COVID 19 hastaları retrospektif olarak incelendi. Birincil sonuç, HFNO'dan başarıyla ayrılan hastaların oranıydı. HFNO'nun başarısızlığı, yoğun bakım ihtiyacının ortaya çıkması olarak tanımlandı.
Bulgular: 43 hasta (32 erkek, medyan yaş 61 [54-70] yıl) incelendi. 14 (%33) hasta HFNO'dan ayrıldı. 29 (%67) hasta HFNO'da başarısız oldu ve yoğun bakım ünitesine nakledildi. HFNO grubunda ortanca 7 gün (4-9) başarı ile, başarısız grupta ortanca 3 gün (2-5) HFNO uygulandı, p=0,002. HFNO sonrası medyan SpO2, HFNO başarısı olan hastalarda HFNO başarısızlığına kıyasla daha yüksekti [95 (94-97) ve 93 (92-95), p=0.015]. Başarılı HFNO grubunda, başarısız HFNO grubuna göre daha fazla hipokapnik hasta vardı [19/29 (%66) - 3/14 (%21); p=0.015]. Lojistik regresyon analizi, hipokapnisi olan hastaların normokapnisi olan hastalara kıyasla 9.8 kat daha fazla HFNO yetmezliğine sahip olduğunu gösterdi. HFNO'yu başaran hastalar arasında hiçbir hasta ölmedi, ancak yoğun bakım ünitesine nakledilen hastaların %90'ı öldü.
Sonuç: ARDS'li COVID-19 hastalarında servis ortamında HFNO kullanımı, entübasyondan kaçınma ve yoğun bakım ünitesinin iş yükünü azaltmada faydalı görünüyordu. Ancak HFNO başarısızlığı olan grupta mortalite oranının yüksek olması nedeniyle yoğun bakım uzmanlarının gözetiminde ve yetenekli ekipler tarafından kullanılması daha doğru olacaktır.

Anahtar Kelimeler

COVID-19, Yüksek Akışlı Nazal Oksijenasyon, ARDS, yoğun bakım dışı servis, yoğun bakım iş yükü

Destekleyen Kurum

yok

Proje Numarası

yok

Kaynakça

• 1. Issa I, Söderberg M. High-flow nasal oxygen (HFNO) for patients with Covid-19 outside intensive care units. Respir Med. 2021;187:106554. doi:10.1016/j.rmed.2021.106554
• 2. Lyons C, Callaghan M. The use of high-flow nasal oxygen in COVID-19. Anaesthesia. 2020 Jul;75(7):843-847. doi: 10.1111/anae.15073. Epub 2020 Apr 20. PMID: 32246843.
• 3. Davison M, Watson M, Wockner L, Kinnear F. Paediatric high-flow nasal cannula therapy in children with bronchiolitis: A retrospective safety and efficacy study in a non-tertiary environment. Emerg Med Australas. 2017 Apr;29(2):198-203. doi: 10.1111/1742-6723.12741. PMID: 28332328.
• 4. Slain KN, Shein SL, Rotta AT. The use of high-flow nasal cannula in the pediatric emergency department. J Pediatr (Rio J). 2017 Nov-Dec;93 Suppl 1:36-45. doi: 10.1016/j.jped.2017.06.006. Epub 2017 Aug 15. PMID: 28818509.
• 5. Rittayamai N, Tscheikuna J, Rujiwit P. High-flow nasal cannula versus conventional oxygen therapy after endotracheal extubation: a randomized crossover physiologic study. Respir Care. 2014 Apr;59(4):485-90. doi: 10.4187/respcare.02397. Epub 2013 Sep 17. PMID: 24046462.
• 6. Williams R, Rankin N, Smith T, Galler D, Seakins P. Relationship between the humidity and temperature of inspired gas and the function of the airway mucosa. Crit Care Med. 1996 Nov;24(11):1920-9. doi: 10.1097/00003246-199611000-00025. PMID: 8917046.
• 7. Doshi P, Whittle JS, Bublewicz M, Kearney J, Ashe T, Graham R, Salazar S, Ellis TW Jr, Maynard D, Dennis R, Tillotson A, Hill M, Granado M, Gordon N, Dunlap C, Spivey S, Miller TL. High-Velocity Nasal Insufflation in the Treatment of Respiratory Failure: A Randomized Clinical Trial. Ann Emerg Med. 2018 Jul;72(1):73-83.e5. doi: 10.1016/j.annemergmed.2017.12.006. Epub 2018 Jan 6. PMID: 29310868.
• 8. Makdee O, Monsomboon A, Surabenjawong U, Praphruetkit N, Chaisirin W, Chakorn T, Permpikul C, Thiravit P, Nakornchai T. High-Flow Nasal Cannula Versus Conventional Oxygen Therapy in Emergency Department Patients With Cardiogenic Pulmonary Edema: A Randomized Controlled Trial. Ann Emerg Med. 2017 Oct;70(4):465-472.e2. doi: 10.1016/j.annemergmed.2017.03.028. Epub 2017 Jun 23. PMID: 28601264.
• 9. Bell N, Hutchinson CL, Green TC, Rogan E, Bein KJ, Dinh MM. Randomised control trial of humidified high flow nasal cannulae versus standard oxygen in the emergency department. Emerg Med Australas. 2015 Dec;27(6):537-541. doi: 10.1111/1742-6723.12490. Epub 2015 Sep 29. PMID: 26419650.
• 10. Shallik N, Bashir K, Elmoheen A, Iftikhar H, Zaki HA. High flow nasal oxygen (HFNO) in the treatment of COVID-19 infection of adult patients from – An emergency perspective: A systematic review and meta-analysis. Trends in Anaesthesia & Critical Care. 2023 Jun;50:101238. doi: 10.1016/j.tacc.2023.101238. PMCID: PMC10111871.
• 11. Tabatabaei SMH, Rajebi H, Moghaddas F, Ghasemiadl M, Talari H. Chest CT in COVID-19 pneumonia: what are the findings in mid-term follow-up? Emerg Radiol. 2020 Dec;27(6):711-719. doi: 10.1007/s10140-020-01869-z. Epub 2020 Nov 9. PMID: 33165674; PMCID: PMC7649573.
• 12. Riviello ED, Kiviri W, Twagirumugabe T, Mueller A, Banner-Goodspeed VM, Officer L, Novack V, Mutumwinka M, Talmor DS, Fowler RA. Hospital Incidence and Outcomes of the Acute Respiratory Distress Syndrome Using the Kigali Modification of the Berlin Definition. Am J Respir Crit Care Med. 2016 Jan 1;193(1):52-9. doi: 10.1164/rccm.201503-0584OC. PMID: 26352116.
• 13. Branson RD, Hess DR, Chatbum RL. Respiratory care equipment. Philadelphia: J.B. Lippincott Company; 1995. p. 55–62
• 14. Guy T, Créac’hcadec A, Ricordel C, et al. High-flow nasal oxygen: a safe, efficient treatment for COVID-19 patients not in an ICU. Eur Respir J 2020; 56: 2001154 [https://doi.org/10.1183/ 13993003.01154-2020].
• 15. Colombo SM, Scaravilli V, Cortegiani A, et al. Use of high flow nasal cannula in patients with acute respiratory failure in general wards under intensivists supervision: a single center observational study. Respir Res. 2022;23(1):171. Published 2022 Jun 26. doi:10.1186/s12931-022-02090-x
• 16. Issa I, Söderberg M. High-flow nasal oxygen (HFNO) for patients with Covid-19 outside intensive care units. Respir Med. 2021;187:106554. doi:10.1016/j.rmed.2021.106554
• 17. Calligaro GL, Lalla U, Audley G, et al. The utility of high-flow nasal oxygen for severe COVID-19 pneumonia in a resource-constrained setting: A multi-centre prospective observational study. EClinicalMedicine. 2020;28:100570. doi:10.1016/j.eclinm.2020.100570
• 18. Xia J, Zhang Y, Ni L, et al. High-Flow Nasal Oxygen in Coronavirus Disease 2019 Patients With Acute Hypoxemic Respiratory Failure: A Multicenter, Retrospective Cohort Study. Crit Care Med. 2020;48(11):e1079-e1086. doi:10.1097/CCM.0000000000004558
• 19. Garner O, Dongarwar D, Salihu HM, et al. Predictors of failure of high flow nasal cannula failure in acute hypoxemic respiratory failure due to COVID-19. Respir Med. 2021;185:106474. doi:10.1016/j.rmed.2021.106474
• 20. Ma XH, An MM, Yin F, et al. Factors associated with failure of high-flow nasal cannula oxygen therapy in patients with severe COVID-19: a retrospective case series. J Int Med Res. 2022;50(5):3000605221103525. doi:10.1177/03000605221103525
• 21. Küçük M, Ergan B, Yakar MN, et al. The Predictive Values of Respiratory Rate Oxygenation Index and Chest Computed Tomography Severity Score for High-Flow Nasal Oxygen Failure in Critically Ill Patients with Coronavirus Disease-2019. Balkan Med J. 2022;39(2):140-147. doi:10.4274/balkanmedj.galenos.2021.2021-7-32
• 22. Roca O, Caralt B, Messika J, et al. An Index Combining Respiratory Rate and Oxygenation to Predict Outcome of Nasal High-Flow Therapy. Am J Respir Crit Care Med. 2019;199(11):1368-1376. doi:10.1164/rccm.201803-0589OC
• 23. Mellado-Artigas R, Mujica LE, Ruiz ML, et al. Predictors of failure with high-flow nasal oxygen therapy in COVID-19 patients with acute respiratory failure: a multicenter observational study. J Intensive Care. 2021;9(1):23. Published 2021 Mar 5. doi:10.1186/s40560-021-00538-8
• 24. Zucman N, Mullaert J, Roux D, Roca O, Ricard JD; Contributors. Prediction of outcome of nasal high flow use during COVID-19-related acute hypoxemic respiratory failure. Intensive Care Med. 2020 Oct;46(10):1924-1926. doi: 10.1007/s00134-020-06177-1. Epub 2020 Jul 15. PMID: 32671470; PMCID: PMC7362315.
• 25. Prakash J, Bhattacharya PK, Yadav AK, Kumar A, Tudu LC, Prasad K. ROX index as a good predictor of high flow nasal cannula failure in COVID-19 patients with acute hypoxemic respiratory failure: A systematic review and meta-analysis. J Crit Care. 2021 Dec;66:102-108. doi: 10.1016/j.jcrc.2021.08.012. Epub 2021 Sep 8. PMID: 34507079; PMCID: PMC8424061.
• 26. Chandel A, Patolia S, Brown AW, Collins AC, Sahjwani D, Khangoora V, Cameron PC, Desai M, Kasarabada A, Kilcullen JK, Nathan SD, King CS. High-Flow Nasal Cannula Therapy in COVID-19: Using the ROX Index to Predict Success. Respir Care. 2021 Jun;66(6):909-919. doi: 10.4187/respcare.08631. Epub 2020 Dec 16. PMID: 33328179.
• 27. Hu M, Zhou Q, Zheng R, Li X, Ling J, Chen Y, Jia J, Xie C. Application of high-flow nasal cannula in hypoxemic patients with COVID-19: a retrospective cohort study. BMC Pulm Med. 2020 Dec 24;20(1):324. doi: 10.1186/s12890-020-01354-w. PMID: 33357219; PMCID: PMC7758183.
• 28. Gattinoni L, Gattarello S, Steinberg I, Busana M, Palermo P, Lazzari S, Romitti F, Quintel M, Meissner K, Marini JJ, Chiumello D, Camporota L. COVID-19 pneumonia: pathophysiology and management. Eur Respir Rev. 2021 Oct 20;30(162):210138. doi: 10.1183/16000617.0138-2021. PMID: 34670808; PMCID: PMC8527244.
• 29. Brochard L, Slutsky A, Pesenti A. Mechanical Ventilation to Minimize Progression of Lung Injury in Acute Respiratory Failure. Am J Respir Crit Care Med. 2017 Feb 15;195(4):438-442. doi: 10.1164/rccm.201605-1081CP. PMID: 27626833.
• 30. Grieco DL, Menga LS, Eleuteri D, Antonelli M. Patient self-inflicted lung injury: implications for acute hypoxemic respiratory failure and ARDS patients on non-invasive support. Minerva Anestesiol. 2019 Sep;85(9):1014-1023. doi: 10.23736/S0375-9393.19.13418-9. Epub 2019 Mar 12. PMID: 30871304.
• 31. Kang BJ, Koh Y, Lim CM, et al. Failure of high-flow nasal cannula therapy may delay intubation and increase mortality. Intensive Care Med. 2015;41(4):623-632. doi:10.1007/s00134-015-3693-5
• 32. Ragab D, Salah Eldin H, Taeimah M, Khattab R, Salem R. The COVID-19 Cytokine Storm; What We Know So Far. Front Immunol. 2020;11:1446.