High-flow nasal cannula for Acute Respiratory Distress Syndrome (ARDS) due to COVID-19

  • Carolina Panadero | karolapa@hotmail.com Pulmonology Department, Hospital Universitario de Getafe, Madrid , Spain. https://orcid.org/0000-0001-6810-0436
  • Araceli Abad-Fernández Pulmonology Department, Hospital Universitario de Getafe, Madrid , Spain.
  • Mª Teresa Rio-Ramírez Pulmonology Department, Hospital Universitario de Getafe, Madrid , Spain.
  • Carmen Maria Acosta Gutiérrez Pulmonology Department, Hospital Universitario de Getafe, Madrid , Spain. https://orcid.org/0000-0002-8538-6584
  • Mariara Calderón-Alcalá Pulmonology Department, Hospital Universitario de Getafe, Madrid , Spain.
  • Cristina López-Riolobos Pulmonology Department, Hospital Universitario de Getafe, Madrid , Spain. https://orcid.org/0000-0003-2202-5914
  • Cristina Matesanz-López Pulmonology Department, Hospital Universitario de Getafe, Madrid , Spain.
  • Fernando Garcia-Prieto Pulmonology Department, Hospital Universitario de Getafe, Madrid , Spain.
  • Jose Maria Diaz-Garcia Pulmonology Department, Hospital Universitario de Getafe, Madrid , Spain.
  • Beatriz Raboso-Moreno Pulmonology Department, Hospital Universitario de Getafe, Madrid , Spain. https://orcid.org/0000-0002-4502-9099
  • Zully Vasquez-Gambasica Pulmonology Department, Hospital Universitario de Getafe, Madrid , Spain.
  • Pilar Andres-Ruzafa Pulmonology Department, Hospital Universitario de Getafe, Madrid , Spain.
  • Jose Luis García-Satué Pulmonology Department, Hospital Universitario de Getafe, Madrid , Spain.
  • Sara Calero-Pardo Pulmonology Department, Hospital Universitario de Getafe, Madrid , Spain.
  • Belen Sagastizabal Department of Pediatrics, Hospital Universitario de Getafe, Madrid, Spain. https://orcid.org/0000-0002-5123-6983
  • Diego Bautista Department of Pediatrics, Hospital Universitario de Getafe, Madrid, Spain. https://orcid.org/0000-0003-1236-7777
  • Alfonso Campos Department of Pediatrics, Hospital Universitario de Getafe, Madrid, Spain. https://orcid.org/0000-0002-0286-9215
  • Marina Gonzalez Department of Pediatrics, Hospital Universitario de Getafe, Madrid, Spain. https://orcid.org/0000-0002-0760-7484
  • Luis Grande Department of Pediatrics, Hospital Universitario de Getafe, Madrid, Spain. https://orcid.org/0000-0001-9122-3522
  • Marta Jimenez Fernandez Thoracic Surgery Department, Hospital Universitario de Getafe, Madrid, Spain. https://orcid.org/0000-0002-2828-2615
  • Jose L. Santiago-Ruiz Cardiology Department, Hospital Universitario de Getafe, Madrid, Spain. https://orcid.org/0000-0001-6546-1885
  • Pedro Caravaca Perez Cardiology Department, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), CIBERCV, Madrid, Spain. https://orcid.org/0000-0001-9362-8371
  • Andres Jose Alcaraz Department of Pediatrics, Hospital Universitario de Getafe, Madrid, Spain. https://orcid.org/0000-0003-3554-0253

Abstract

Background: High-flow nasal cannula oxygen therapy (HFNC) has been shown to be a useful therapy in the treatment of patients with Acute Respiratory Distress Syndrome (ARDS), but its efficacy is still unknown in patients with COVID-19. Our objective is to describe its utility as therapy for the treatment of ARDS caused by SARS-CoV-2. 
Methods: A retrospective, observational study was performed at a single centre, evaluating patients with ARDS secondary to COVID-19 treated with HFNC. The main outcome was the intubation rate at day 30, which defined failure of therapy. We also analysed the role of the ROX index to predict the need for intubation.
Results: In the study period, 196 patients with bilateral pneumonia were admitted to our pulmonology unit, 40 of whom were treated with HFNC due to the presence of ARDS. The intubation rate at day 30 was 52.5%, and overall mortality was 22.5%. After initiating HFNC, the SpO2/FiO2 ratio was significantly better in the group that did not require intubation (113.4±6.6 vs 93.7±6.7, p=0.020), as was the ROX index (5.0±1.6 vs 4.0±1.0, p=0.018). A ROX index less than 4.94 measured 2 to 6 h after the start of therapy was associated with increased risk of intubation (HR 4.03 [95% CI 1.18 – 13.7]; p=0.026).
Conclusion: High-flow therapy is a useful treatment in ARDS in order to avoid intubation or as a bridge therapy, and no increased mortality was observed secondary to the delay in intubation. After initiating HFNC, a ROX index below 4.94 predicts the need for intubation.

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Published
2020-09-16
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Original Research Articles
Keywords:
COVID-19, high-flow nasal cannula, acute respiratory distress syndrome, coronavirus
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How to Cite
Panadero, C., Abad-Fernández, A., Rio-Ramírez , M. T., Acosta Gutiérrez, C. M., Calderón-Alcalá , M., López-Riolobos, C., Matesanz-López , C., Garcia-Prieto , F., Diaz-Garcia, J. M., Raboso-Moreno, B., Vasquez-Gambasica, Z., Andres-Ruzafa, P., García-Satué , J. L., Calero-Pardo , S., Sagastizabal, B., Bautista, D., Campos, A., Gonzalez, M., Grande, L., Jimenez Fernandez, M., Santiago-Ruiz, J. L., Caravaca Perez, P., & Alcaraz, A. J. (2020). High-flow nasal cannula for Acute Respiratory Distress Syndrome (ARDS) due to COVID-19. Multidisciplinary Respiratory Medicine, 15. https://doi.org/10.4081/mrm.2020.693