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Clin Respir J
. 2022 Dec 30.
doi: 10.1111/crj.13573. Online ahead of print.
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
- PMID: 36584670
- DOI: 10.1111/crj.13573
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 and which 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.