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Anaesthesiology Intensive Therapy
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1/2022
vol. 54
 
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abstract:
Original article

Predicting the effectiveness of high-flow oxygen therapy in COVID-19 patients: a single-centre observational study

Felicitas M. Schmidt
1
,
Lorenz Nowak
1
,
Florian Obereisenbuchler
2
,
Justin Hetrodt
2
,
Marion Heiß-Neumann
2
,
Anna Schönlebe
1
,
Katharina Heinig-Menhard
1
,
Wolfgang Gesierich
2
,
Jürgen Behr
2, 3, 4
,
Rudolf A. Hatz
5, 6
,
Julien Dinkel
5, 6, 7
,
Mircea-Gabriel Stoleriu
4, 5, 6

  1. Department of Intensive Care Medicine, Asklepios Lung Clinic Munich-Gauting, Gauting, Germany
  2. Department of Pneumology, Asklepios Lung Clinic Munich-Gauting, Gauting, Germany; member of the German Centre for Lung Research
  3. Department of Internal Medicine V, Ludwig-Maximilians-University Munich (LMU), Munich, Germany; member of the German Centre for Lung Research
  4. Comprehensive Pneumology Centre, Helmholtz Center Munich, Munich, Germany; member of the German Centre for Lung Research
  5. Center for Thoracic Surgery Munich, Ludwig-Maximilians-University Munich (LMU), Munich, Germany
  6. Asklepios Lung Clinic Munich-Gauting, Gauting, Germany
  7. Department of Radiology, Ludwig-Maximilians-University of Munich (LMU) Munich, Germany
Anaesthesiol Intensive Ther 2022; 54, 1: 12–17
DOI: https://doi.org/10.5114/ait.2022.113738
Online publish date: 2022/03/16
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Background
High-flow nasal cannula (HFNC) therapy is a helpful tool in the treatment of hypoxaemic respiratory failure. However, the clinical parameters predicting the effectiveness of HFNC in coronavirus-19 disease (COVID-19) patients remain unclear.

Methods
Sixteen COVID-19 patients undergoing HFNC in the Asklepios Lung Clinic Munich-Gauting, Germany between 16 March and 3 June 2020 were retrospectively included into the study. Seven patients successfully recovered after HFNC (Group 1), while 9 patients required intubation upon HFNC failure (Group 2). Relevant predictors for an effective HFNC therapy were analysed on day 0 and 4 after HFNC initiation via receiver operating characteristics.

Results
The groups did not differ significantly in terms of age, sex, body mass index, and comorbidities. Five patients died in Group 2 upon disease progression and HFNC failure. Group 1 required a lower oxygen supplementation (FiO2 0.46 [0.31–0.54] vs. 0.72 [0.54–0.76], P = 0.022) and displayed a higher PaO2/FiO2 ratio (115 [111–201] vs. 93.3 [67.2–145], P = 0.042) on day 0. In Group 2, fever persisted on day 4 (38.5 [38.0–39.4]°C vs. 36.5 [31.1–37.1]°C, P = 0.010). Serum C-reactive protein (CRP) levels > 108 mg L–1 (day 0) and persistent oxygen saturation < 89% and PaO2/FiO2 ratio < 91 (day 4) were identified as significant predictors for HFNC failure (area under curve 0.929, 0.933, and 0.893).

Conclusions
Elevated oxygen saturation, decreased FiO2 and reduced serum CRP on day 4 significantly predict HFNC effectiveness in COVID-19 patients. Based on these parameters, larger prospective studies are necessary to further investigate the effectiveness of HFNC in the treatment of COVID-19-associated hypoxaemic respiratory failure.

keywords:

COVID-19, SARS-CoV-2, high-flow therapy, intensive care
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