Article de journal
High-Flow nasal cannula treatment in patients with COVID-19 acute hypoxemic respiratory failure: A prospective cohort study


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Liste des auteurs: Mohammed S Alshahrani1, Hassan M Alshaqaq2, Jehan Alhumaid3, Ammar A Binammar2, Khalid H AlSalem4, Abdulazez Alghamdi5, Ahmed Abdulhady6, Moamen Yehia7, Amal AlSulaibikh8, Mohammed Al Jumaan8, Waleed H Albuli9, Talal Ibrahim10, Abdullah A Yousef9, Yousef Almubarak10, Waleed Alhazzani11
Editeur: Medknow Publications
Année de publication: 2021
Journal: Saudi Journal of Medicine and Medical Sciences
Lexique des acronymes: SJMMS
ISSN: 1658-631X
Web of Science ID:
PubMed-ID:
Scopus ID:
eISSN: 2321-4856


Background: Early use of high-flow nasal cannula (HFNC) decreases the need for endotracheal intubation (EI) in different respiratory failure causes. While HFNC is used in coronavirus disease 2019 (COVID-19)-related acute hypoxemic respiratory failure (AHRF) under weak recommendations, its efficacy remains to be investigated.
Objectives: The primary objective was to examine HFNC efficacy in preventing EI among COVID-19 patients with AHRF. Secondary objectives were to determine predictors of HFNC success/failure, mortality rate, and length of hospital and intensive care unit (ICU) stay.
Patients and Methods: This is a prospective cohort study conducted at a single tertiary care centre in Saudi Arabia from April to August 2020. Adult patients admitted to the ICU with AHRF secondary to COVID-19 pneumonia and managed with HFNC were included. We excluded patients who were intubated or managed with non-invasive ventilation before HFNC.
Results: Forty-four patients received HFNC for a median duration of 3 days (interquartile range, 1–5 days). The mean age was 57 ± 14 years, and 86% were men. HFNC failure and EI occurred in 29 (66%) patients. Patients in whom HNFC treatment failed had a higher risk of death (52% versus 0%; P = 0.001). After adjusting for confounding factors, a high SOFA score and a low ROX index were significantly associated with HFNC failure (hazard ratio [HR], 1.42; 95% confidence interval [CI], 1.04–1.93; P = 0.025; and HR, 0.61; 95% CI, 0.42–0.88; P = 0.008, respectively).
Conclusions: One-third of hypoxemic COVID-19 patients who received HFNC did not require intubation. High SOFA score and low ROX index were associated with HFNC failure.

Keywords: Acute hypoxemic respiratory failure, COVID-19, endotracheal intubation, high-flow nasal cannula, oxygen therapy, SARS-CoV-2


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Dernière mise à jour le 2021-19-10 à 11:04