Retrospective analysis of high flow nasal therapy in COVID-19-related moderate-to-severe hypoxaemic respiratory failure

  1. Maulin Patel
  2. Andrew Gangemi
  3. Robert Marron
  4. Junad Chowdhury
  5. Ibraheem Yousef
  6. Matthew Zheng
  7. Nicole Mills
  8. Lauren Tragesser
  9. Julie Giurintano
  10. Rohit Gupta
  11. Matthew Gordon
  12. Parth Rali
  13. Gilbert D'Alonso
  14. David Fleece
  15. Huaqing Zhao
  16. Nicole Patlakh
  17. Gerard Criner

Reviewed by

Read the full article See related articles

Listed in

Log in to save this article

Abstract

Invasive mechanical has been associated with high mortality in COVID-19. Alternative therapy of high flow nasal therapy (HFNT) has been greatly debated around the world for use in COVID-19 pandemic due to concern for increased healthcare worker transmission.This was a retrospective analysis of consecutive patients admitted to Temple University Hospital in Philadelphia, Pennsylvania, from 10 March 2020 to 24 April 2020 with moderate-to-severe respiratory failure treated with HFNT. Primary outcome was prevention of intubation. Of the 445 patients with COVID-19, 104 met our inclusion criteria. The average age was 60.66 (+13.50) years, 49 (47.12 %) were female, 53 (50.96%) were African-American, 23 (22.12%) Hispanic. Forty-three patients (43.43%) were smokers. Saturation to fraction ratio and chest X-ray scores had a statistically significant improvement from day 1 to day 7. 67 of 104 (64.42%) were able to avoid invasive mechanical ventilation in our cohort. Incidence of hospital-associated/ventilator-associated pneumonia was 2.9%. Overall, mortality was 14.44% (n=15) in our cohort with 13 (34.4%) in the progressed to intubation group and 2 (2.9%) in the non-intubation group. Mortality and incidence of pneumonia was statistically higher in the progressed to intubation group.

HFNT use is associated with a reduction in the rate of invasive mechanical ventilation and overall mortality in patients with COVID-19 infection.

Article activity feed

  1. Version published to 10.1136/bmjresp-2020-000650
  2. ScreenIT

    SciScore for 10.1101/2020.05.22.20109355: (What is this?)

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

    Table 1: Rigor

    Institutional Review Board StatementIRB: The study was approved by the Temple University Institutional Review Board (TUIRB protocol number: 27051).
    Consent: A waiver of consent was granted due to the acknowledged minimal risk to the patients.
    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 use of Stata 14.0 (StataCorp LP, College Station, TX).
    StataCorp
    suggested: (Stata, RRID:SCR_012763)

    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: We detected the following sentences addressing limitations in the study:
    An in-vitro study mimicking clinical scenarios including HFNT with mannequins only revealed proximal dispersion of secretions to the face and nasal cannula itself.(43, 44) A recent study with healthy volunteers wearing high-flow nasal cannulas at both 30 L/min and 60 L/min of gas flow did not report variable aerosolization of particles between 10-10,000 nm, regardless of coughing, when compared with patients on room air or oxygen via regular nasal cannula.(45) This study has several limitations. First, it was retrospective in nature as developing a prospective trial on the initial management of acute hypoxemic respiratory failure in the face of an evolving public health crisis is difficult. Second, we could not reasonably analyze a control arm as our endpoint was prevention of mechanical ventilation. Developing a prospective study during a pandemic situation is impractical without first determining clinical equipoise. Third, we do not report on arterial pH or partial pressure of carbon dioxide (PaCO2) as many patients did not have baseline or follow up arterial blood gas measurements prior to initiation of HFNT. We recognize that in many clinical trials an elevated PaCO2 was an exclusion criterion for enrollment. (7, 10) Fourth, our data on hospital length of stay was limited since several patients were still hospitalized at the time data was collected. Institutions around the world have been skeptical about the use of HFNT in CVOID-19 patients. However, based on our findings...

    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.

  3. Version published to 10.1101/2020.05.22.20109355v1 on medRxiv