Prediction of High Flow Nasal Cannula Failure In Patients With COVID-19 Pneumonia Suffering from Acute Hypoxemic Respiratory Failure

Abstract

Background: High flow nasal cannula (HFNC) is one of the most often employed methods of oxygen therapy for COVID-19 pneumonia and respiratory failure patients. Since the causes of HFNC failure and success are still undetermined, the goal of this study was to identify potential predictors of HFNC failure in COVID-19 pneumonia given that early detection of HFNC failure during episodes of acute hypoxemic respiratory failure (AHRF) can improve clinical treatment and accurately categorize patients for the best ventilation maneuver. Patients and Methods: This observational trial was conducted on 100 COVID-19 pneumonia cases with acute hypoxemic respiratory failure who were referred to our COVID-19 intensive care units from 1 August 2020 to 31 December 2022 and required HFNC therapy as rescue therapy. In patients who were finally weaned from this modality and have not been intubated, HFNC was considered successful; while patients who were intubated or put on continuous positive airway pressure (CPAP) were considered as failures. Results: there was a significant association between HFNC failure and obesity, high levels of inflammatory markers, and/or Sequential Organ Failure Assessment (SOFA) score. ROX score of less than 3.91 after 24 h of HFNC application and Procalcitonin were significant predictors of HFNC failure. Conclusions: In COVID-19 pneumonia, HFNC therapy can be a convenient tool to avoid invasive mechanical ventilation, however, patient selection is very crucial.

Keywords: Acute hypoxemic respiratory failure; COVID-19; High flow nasal cannula