The Outcome Impact of Early vs Late HFNC Oxygen Therapy in Elderly Patients with COVID-19 and ARDS

  1. Liehua Deng
  2. Shaoqing Lei
  3. Fang Jiang
  4. David A. Lubarsky
  5. Liangqing Zhang
  6. Danyong Liu
  7. Conghua Han
  8. Dunrong Zhou
  9. Zheng Wang
  10. Xiaocong Sun
  11. Yuanli Zhang
  12. Chi Wai Cheung
  13. Sheng Wang
  14. Zhong-yuan Xia
  15. Richard L Applegate
  16. Hong Liu
  17. Jing Tang
  18. Zhengyuan Xia

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Abstract

Coronavirus disease-2019 (COVID-19) has rapidly spread worldwide. High-flow nasal cannula therapy (HFNC) is a major oxygen supporting therapy for severely ill patients, but information regarding the timing of HFNC application is scarce, especially in elderly patients. We retrospectively analyzed the clinical data of 110 elderly patients (≥65 years) who received HFNC from Renmin Hospital of Wuhan University, People’s Hospital of Xiantao City and Chinese Medicine Hospital of Shishou City in Hubei Province, China, and from Affiliated Hospital of Guangdong Medical University, People’s Hospital of Yangjiang City, People’s Hospital of Maoming City in Guangdong Province, China.

Of the 110 patients, the median age was 71 years (IQR, 68-78) and 59.1% was male. Thirty-eight patients received HFNC when 200 mmHg < PO 2 /FiO 2 ≤ 300 mmHg (early HFNC group), and 72 patients received HFNC treatment when 100 mmHg < PaO 2 /FiO 2 ≤ 200 mmHg (late HFNC group). Compared with the late HFNC group, patients in the early HFNC group had a lower likelihood of developing severe ARDS, longer time from illness onset to severe ARDS and shorter duration of viral shedding after illness onset, as well as shorter lengths of ICU and hospital stay. Twenty-four patients died during hospitalization, of whom 22 deaths (30.6%) were in the late HFNC group and 2(5.3%) in the early HFNC group. It is concluded that the Prognosis was better in severely ill elderly patients with COVID-19 receiving early compared to late HFNC. This suggests HFNC could be considered early in this disease process.

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    SciScore for 10.1101/2020.05.23.20111450: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIRB: The goal of oxygen therapy was to maintain the oxygen saturation (SpO2) at 93%-96%, which is in keeping with the recent guideline recommendation of a reasonable SpO2 range of 92-96% for patients receiving oxygen.[12] This study was reviewed and approved by the Medical Ethical Committee of participating institutes (PJ2020-005), and the informed consent was waived by the Medical Ethical Committee.
    Consent: The goal of oxygen therapy was to maintain the oxygen saturation (SpO2) at 93%-96%, which is in keeping with the recent guideline recommendation of a reasonable SpO2 range of 92-96% for patients receiving oxygen.[12] This study was reviewed and approved by the Medical Ethical Committee of participating institutes (PJ2020-005), and the informed consent was waived by the Medical Ethical Committee.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    All statistical analyses were performed with the SPSS (version 25) software.
    SPSS
    suggested: (SPSS, RRID:SCR_002865)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: An explicit section about the limitations of the techniques employed in this study was not found. We encourage authors to address study limitations.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  2. Version published to 10.1101/2020.05.23.20111450 on medRxiv