Retrospective analysis of high flow nasal therapy in COVID-19-related moderate-to-severe hypoxaemic respiratory failure
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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.
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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 Statement IRB: 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.Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable not detected. Table 2: Resources
Software and Algorithms Sentences Resources All statistical analyses were performed with the use of Stata 14.0 (StataCorp LP, College Station, TX). StataCorpsuggested: (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 …
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 Statement IRB: 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.Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable not detected. Table 2: Resources
Software and Algorithms Sentences Resources All statistical analyses were performed with the use of Stata 14.0 (StataCorp LP, College Station, TX). StataCorpsuggested: (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.
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