Nasal High Flow oxygen therapy (NHF) is commonly used as first line ventilatory support in patients with acute hypoxemic respiratory failure (AHRF). It's use has been initially limited in Covid-19 patients presenting with AHRF. The aim of the study is to describe the use of NHF in Covid-19-related AHRF and report the changes in the respiratory-oxygenation index (termed ROX index) over time in these patients.
Nasal High Flow oxygen therapy (NHF) is one of the newer methods of oxygenation commonly used in critical care during acute hypoxemic respiratory failure (AHRF). For various reasons (fear of a putative risk of viral dispersion; initial recommendations for rapid intubation due to the rapid deterioration of patients), NHF seems to have been seldomly used during the current Covid-19 epidemic in France. However, the World Health Organization, and other scientific societies list NHF among the possible options for ventilatory support. One of the risks however, identified with NHF is to delay an intubation that would have become necessary. This delay seems to be associated with a poorer prognosis for patients. The respiratory-oxygenation index (termed ROX index) (defined as the ratio of pulse oximetry (SpO2) over inspired fraction in oxygen (FiO2) over respiratory rate (RR); SpO2/FiO2/RR) is used - along with other criteria - to assist the clinician in deciding whether or not to intubate patients on NHF for AHRF. In investigators'ICU, NHF is used in patients admitted for AHRFrelated to Covid-19 and the ROX index is measured and monitoring in investigators' patients. Investigators' initial experience - consistent with feedback from other ICUs - suggests that the respiratory rate of patients with Covid-19-related AHRF is sometimes lower than would be expected given the depth of the hypoxemia. In this case, the ROX index thresholds previously identified for predicting the success or failure of NHF could be different in the case of Covid-19-associated AHRF. The purpose of this work is to describe the use of NHF in Covid-19 patients with AHRF and the evolution of the ROX score over time in patients initially treated with NHF.
Study Type
OBSERVATIONAL
Enrollment
62
patients admitted to the ICU for Covid-19-related acute hypoxemic respiratory failure treated with nasal high flow
Hôpital Louis Mourier, Assistance Publique - Hôpitaux de Paris
Colombes, France
Changes in ROX index
values of ROX index during ICU stay
Time frame: from date of NHF initiation until date of weaning from NHF or date of intubation whichever came first, assessed up to 2 months
NHF failure
percentage of patients requiring intubation
Time frame: from date of NHF initiation until date of weaning from NHF or date of intubation whichever came first, assessed up to 2 months
NHF flow
level of flow used with NHF
Time frame: from date of NHF initiation until date of weaning from NHF or date of intubation whichever came first, assessed up to 2 months
NHF inspired fraction in oxygen
level of inspired fraction in oxygen used with NHF
Time frame: from date of NHF initiation until date of weaning from NHF or date of intubation whichever came first, assessed up to 2 months
oxygenation
level of pulse oxymetry during NHF therapy
Time frame: from date of NHF initiation until date of weaning from NHF or date of intubation whichever came first, assessed up to 2 months
respiratory status
respiratory rate during NHF therapy
Time frame: from date of NHF initiation until date of weaning from NHF or date of intubation whichever came first, assessed up to 2 months
prediction of intubation
defining the values of ROX index associated with intubation
Time frame: from date of NHF initiation until date of weaning from NHF or date of intubation whichever came first, assessed up to 2 months
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prediction of NHF success
defining the values of ROX index associated with NHF success (no intubation required)
Time frame: from date of NHF initiation until date of weaning from NHF or date of intubation whichever came first, assessed up to 2 months