tetano
Editor, Senior Moderator
Respir Med Res
. 2021 Jun 4;80:100834.
doi: 10.1016/j.resmer.2021.100834. Online ahead of print.
Covid-19 severe hypoxemic pneumonia: A clinical experience using high-flow nasal oxygen therapy as first-line management
G Beduneau[SUP] 1 [/SUP], D Boyer[SUP] 2 [/SUP], P-G Guitard[SUP] 3 [/SUP], P Gouin[SUP] 3 [/SUP], D Carpentier[SUP] 2 [/SUP], S Grangé[SUP] 2 [/SUP], B Veber[SUP] 3 [/SUP], C Girault[SUP] 4 [/SUP], F Tamion[SUP] 5 [/SUP]
Affiliations
Abstract
Purpose: To report a French experience in patients admitted to Intensive Care Unit (ICU) for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) requiring high fractional concentration of inspired oxygen supported by high flow nasal cannula (HFNC) as first-line therapy.
Methods: Retrospective cohort study conducted in two ICUs of a French university hospital. All consecutive patients admitted during 28-days after the first admission for SARS-CoV-2 pneumonia were screened. Demographic, clinical, respiratory support, specific therapeutics, ICU length-of-stay and survival data were collected.
Results: Data of 43 patients were analyzed: mainly men (72%), median age 61 (51-69) years, median body mass index of 28 (25-31) kg/m[SUP]2[/SUP], median simplified acute physiology score (SAPS II) of 29 (22-37) and median PaO[SUB]2[/SUB]/fraction of inspired oxygen (FiO[SUB]2[/SUB]) (P/F) ratio of 146 (100-189) mmHg. HFNC was initiated at ICU admission in 76% of patients. Median flow was 50 (45-50) L/min and median FiO2 was 0.6 (0.5-0.8). 79% of patients presented at least one comorbidity, mainly hypertension (58%). At day (D) 28, 32% of patients required invasive mechanical ventilation, 3 patients died in ICU. Risk factors for intubation were diabetes (10% vs. 43%, P=0.04) and extensive lesions on chest computed tomography (CT) (P=0.023). Patients with more than 25% of lesions on chest CT were more frequently intubated during ICU stay (P=0.012). At ICU admission (D1), patients with higher SAPS II and Sequential Organ Failure Assessment (SOFA) scores (respectively 39 (28-50) vs. 27 (22-31), P=0.0031 and 5 (2-8) vs. 2 (2-2.2), P=0.0019), and a lower P/F ratio (98 (63-109) vs. 178 (126-206), P=0.0005) were more frequently intubated. Among non-intubated patients, the median lowest P/F was 131 (85-180) mmHg. Four caregivers had to stop working following coronavirus 2 contamination, but did not require hospitalization.
Conclusion: Our clinical experience supports the use of HFNC as first line-therapy in patients with SARS-COV-2 pneumonia for whom face mask oxygen does not provide adequate respiratory support.
Keywords: High flow oxygen therapy; Hypoxemia; Mechanical ventilation; Outcomes; SARS-COV-2 pneumonia.
. 2021 Jun 4;80:100834.
doi: 10.1016/j.resmer.2021.100834. Online ahead of print.
Covid-19 severe hypoxemic pneumonia: A clinical experience using high-flow nasal oxygen therapy as first-line management
G Beduneau[SUP] 1 [/SUP], D Boyer[SUP] 2 [/SUP], P-G Guitard[SUP] 3 [/SUP], P Gouin[SUP] 3 [/SUP], D Carpentier[SUP] 2 [/SUP], S Grangé[SUP] 2 [/SUP], B Veber[SUP] 3 [/SUP], C Girault[SUP] 4 [/SUP], F Tamion[SUP] 5 [/SUP]
Affiliations
- PMID: 34153702
- DOI: 10.1016/j.resmer.2021.100834
Abstract
Purpose: To report a French experience in patients admitted to Intensive Care Unit (ICU) for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) requiring high fractional concentration of inspired oxygen supported by high flow nasal cannula (HFNC) as first-line therapy.
Methods: Retrospective cohort study conducted in two ICUs of a French university hospital. All consecutive patients admitted during 28-days after the first admission for SARS-CoV-2 pneumonia were screened. Demographic, clinical, respiratory support, specific therapeutics, ICU length-of-stay and survival data were collected.
Results: Data of 43 patients were analyzed: mainly men (72%), median age 61 (51-69) years, median body mass index of 28 (25-31) kg/m[SUP]2[/SUP], median simplified acute physiology score (SAPS II) of 29 (22-37) and median PaO[SUB]2[/SUB]/fraction of inspired oxygen (FiO[SUB]2[/SUB]) (P/F) ratio of 146 (100-189) mmHg. HFNC was initiated at ICU admission in 76% of patients. Median flow was 50 (45-50) L/min and median FiO2 was 0.6 (0.5-0.8). 79% of patients presented at least one comorbidity, mainly hypertension (58%). At day (D) 28, 32% of patients required invasive mechanical ventilation, 3 patients died in ICU. Risk factors for intubation were diabetes (10% vs. 43%, P=0.04) and extensive lesions on chest computed tomography (CT) (P=0.023). Patients with more than 25% of lesions on chest CT were more frequently intubated during ICU stay (P=0.012). At ICU admission (D1), patients with higher SAPS II and Sequential Organ Failure Assessment (SOFA) scores (respectively 39 (28-50) vs. 27 (22-31), P=0.0031 and 5 (2-8) vs. 2 (2-2.2), P=0.0019), and a lower P/F ratio (98 (63-109) vs. 178 (126-206), P=0.0005) were more frequently intubated. Among non-intubated patients, the median lowest P/F was 131 (85-180) mmHg. Four caregivers had to stop working following coronavirus 2 contamination, but did not require hospitalization.
Conclusion: Our clinical experience supports the use of HFNC as first line-therapy in patients with SARS-COV-2 pneumonia for whom face mask oxygen does not provide adequate respiratory support.
Keywords: High flow oxygen therapy; Hypoxemia; Mechanical ventilation; Outcomes; SARS-COV-2 pneumonia.