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High-flow nasal cannula therapy in a predominantly African American population with COVID-19 associated acute respiratory failure
IMPORTANCE: Use of non-invasive respiratory modalities in COVID-19 has the potential to reduce rates of intubation and mortality in severe disease however data regarding the use of high-flow nasal cannula (HFNC) in this population is limited. OBJECTIVE: To interrogate clinical and laboratory feature...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8457999/ https://www.ncbi.nlm.nih.gov/pubmed/34551962 http://dx.doi.org/10.1136/bmjresp-2021-000875 |
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author | Nguyen, Paul L Osman, Heba Watza, Donovan Khicher, Suman Sharma, Aditi Dyson, Greg Saydain, Ghulam Soubani, Ayman |
author_facet | Nguyen, Paul L Osman, Heba Watza, Donovan Khicher, Suman Sharma, Aditi Dyson, Greg Saydain, Ghulam Soubani, Ayman |
author_sort | Nguyen, Paul L |
collection | PubMed |
description | IMPORTANCE: Use of non-invasive respiratory modalities in COVID-19 has the potential to reduce rates of intubation and mortality in severe disease however data regarding the use of high-flow nasal cannula (HFNC) in this population is limited. OBJECTIVE: To interrogate clinical and laboratory features of SARS-CoV-2 infection associated with high-flow failure. DESIGN: We conducted a retrospective cohort study to evaluate characteristics of high-flow therapy use early in the pandemic and interrogate factors associated with respiratory therapy failure. SETTING: Multisite single centre hospital system within the metropolitan Detroit region. PARTICIPANTS: Patients from within the Detroit Medical Center (n=104, 89% African American) who received HFNC therapy during a COVID-19 admission between March and May of 2020. PRIMARY OUTCOME: HFNC failure is defined as death or intubation while on therapy. RESULTS: Therapy failure occurred in 57% of the patient population, factors significantly associated with failure centred around markers of multiorgan failure including hepatic dysfunction/transaminitis (OR=6.1, 95% CI 1.9 to 19.4, p<0.01), kidney injury (OR=7.0, 95% CI 2.7 to 17.8, p<0.01) and coagulation dysfunction (OR=4.5, 95% CI 1.2 to 17.1, p=0.03). Conversely, comorbidities, admission characteristics, early oxygen requirements and evaluation just prior to HFNC therapy initiation were not significantly associated with success or failure of therapy. CONCLUSIONS: In a population disproportionately affected by COVID-19, we present key indicators of likely HFNC failure and highlight a patient population in which aggressive monitoring and intervention are warranted. |
format | Online Article Text |
id | pubmed-8457999 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-84579992021-09-24 High-flow nasal cannula therapy in a predominantly African American population with COVID-19 associated acute respiratory failure Nguyen, Paul L Osman, Heba Watza, Donovan Khicher, Suman Sharma, Aditi Dyson, Greg Saydain, Ghulam Soubani, Ayman BMJ Open Respir Res Critical Care IMPORTANCE: Use of non-invasive respiratory modalities in COVID-19 has the potential to reduce rates of intubation and mortality in severe disease however data regarding the use of high-flow nasal cannula (HFNC) in this population is limited. OBJECTIVE: To interrogate clinical and laboratory features of SARS-CoV-2 infection associated with high-flow failure. DESIGN: We conducted a retrospective cohort study to evaluate characteristics of high-flow therapy use early in the pandemic and interrogate factors associated with respiratory therapy failure. SETTING: Multisite single centre hospital system within the metropolitan Detroit region. PARTICIPANTS: Patients from within the Detroit Medical Center (n=104, 89% African American) who received HFNC therapy during a COVID-19 admission between March and May of 2020. PRIMARY OUTCOME: HFNC failure is defined as death or intubation while on therapy. RESULTS: Therapy failure occurred in 57% of the patient population, factors significantly associated with failure centred around markers of multiorgan failure including hepatic dysfunction/transaminitis (OR=6.1, 95% CI 1.9 to 19.4, p<0.01), kidney injury (OR=7.0, 95% CI 2.7 to 17.8, p<0.01) and coagulation dysfunction (OR=4.5, 95% CI 1.2 to 17.1, p=0.03). Conversely, comorbidities, admission characteristics, early oxygen requirements and evaluation just prior to HFNC therapy initiation were not significantly associated with success or failure of therapy. CONCLUSIONS: In a population disproportionately affected by COVID-19, we present key indicators of likely HFNC failure and highlight a patient population in which aggressive monitoring and intervention are warranted. BMJ Publishing Group 2021-09-21 /pmc/articles/PMC8457999/ /pubmed/34551962 http://dx.doi.org/10.1136/bmjresp-2021-000875 Text en © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) . |
spellingShingle | Critical Care Nguyen, Paul L Osman, Heba Watza, Donovan Khicher, Suman Sharma, Aditi Dyson, Greg Saydain, Ghulam Soubani, Ayman High-flow nasal cannula therapy in a predominantly African American population with COVID-19 associated acute respiratory failure |
title | High-flow nasal cannula therapy in a predominantly African American population with COVID-19 associated acute respiratory failure |
title_full | High-flow nasal cannula therapy in a predominantly African American population with COVID-19 associated acute respiratory failure |
title_fullStr | High-flow nasal cannula therapy in a predominantly African American population with COVID-19 associated acute respiratory failure |
title_full_unstemmed | High-flow nasal cannula therapy in a predominantly African American population with COVID-19 associated acute respiratory failure |
title_short | High-flow nasal cannula therapy in a predominantly African American population with COVID-19 associated acute respiratory failure |
title_sort | high-flow nasal cannula therapy in a predominantly african american population with covid-19 associated acute respiratory failure |
topic | Critical Care |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8457999/ https://www.ncbi.nlm.nih.gov/pubmed/34551962 http://dx.doi.org/10.1136/bmjresp-2021-000875 |
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