Clinical observation of high-flow nasal cannula with non-rebreather mask use on severe or critically ill COVID-19 diabetic patients

  1. AFM Tareq Bhuiyan
  2. Sudipta Deb Nath
  3. Md Jakir Hossain
  4. Shuva Das
  5. Moumita Das
  6. Moinul Ahsan
  7. Md. Iftekher-E-Alam Ziad
  8. Fahmida Khatun Padma
  9. Rana Dey
  10. AKM Shamsul Alam
  11. Farial Hoque Zehan
  12. Ayan Saha

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Abstract

Background and aims

Prevalence of diabetes is a vital factor in COVID-19’s clinical prognosis. This study aimed to investigate and compare the efficacy of High-flow Nasal Cannula (HFNC) with/without non-rebreather mask (NRM) use on critical COVID-19 patients with/without diabetes.

Methods

For analysis and comparison, epidemiological, biochemical, and clinical data were collected from 240 HFNC (±NRM) treated severe and critical COVID-19 patients (diabetic = 136; non-diabetic = 104) admitted into ICUs of five hospitals in Chattogram, Bangladesh.

Results

59.1% of patients with fever had diabetes (p=0.012). ICU stay was longer for diabetic patients (9.06±5.70) than non-diabetic patients (7.41±5.11) (p=0.020). Majority of the hypertensive patients were diabetic (68.3%; p<0.001). Majority of diabetic patients (70.4%; p<0.005) had elevated creatinine levels. Partial pressure of oxygen (mmHg) after HFNC (only) administration was significantly (p=0.031) higher in non-diabetic patients (69.30±23.56) than in diabetic patients (61.50±14.49). Diabetic (62.64±13.05) and non-diabetic patients (59.40±13.22) had almost similar partial pressure of oxygen (mmHg) from HFNC with NRM. Patients with elevated RBS required NRM with HFNC five times (AOR=5.1, 1.2-20.8) higher than others. Besides age, and hypertension were significantly associated with the HFNC+NRM treated diabetic patients. Factors those affected the HFNC only treated patients were fever and impaired glucose tolerance.

Conclusions

The results of this study imply that oxygen supply with HFNC and NRM may be beneficial for the elderly/hypertensive diabetic patients with COVID-19 associated AHRF; and that increased blood glucose level could be a determinant for the need of HFNC + NRM treatment.

Highlights

  • Elderly diabetic patients required both HFNC and NRM to increase oxygen saturation.

  • Hypertension may be a factor for diabetic patients with COVID-19 requiring HFNC and NRM together.

  • ‘HFNC + NRM’-combination therapy might be needed when blood glucose levels rise.

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    1. Version published to 10.1101/2021.10.13.21264946v3 on medRxiv
    2. Version published to 10.1101/2021.10.13.21264946v2 on medRxiv
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      SciScore for 10.1101/2021.10.13.21264946: (What is this?)

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

      Table 1: Rigor

      EthicsIRB: Ethical approval: This research and its protocol were approved by the 250 Bedded Chattogram General Hospital’s Institutional Review Board (Approval No.: 1724). 2.3.
      Sex as a biological variablenot detected.
      Randomizationnot detected.
      Blindingnot detected.
      Power Analysisnot detected.

      Table 2: Resources

      Software and Algorithms
      SentencesResources
      All data analysis tests were performed in IBM SPSS version-25.
      SPSS
      suggested: (SPSS, RRID:SCR_002865)

      Results from OddPub: Thank you for sharing your data.

      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.

      Results from scite Reference Check: We found no unreliable references.

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    4. Version published to 10.1101/2021.10.13.21264946v1 on medRxiv