High flow nasal oxygen in frail COVID-19 patients hospitalized in intermediate care units and non-eligible to invasive mechanical ventilation - 19/09/23
, Emmanuel Grolleau a, b, Nathalie Freymond b, Florent Wallet c, Thomas Gilbert d, Myriam Locatelli-Sanchez b, Laurence Gérinière b, Emilie Perrot b, Pierre-Jean Souquet b, Clara Fontaine-Delaruelle b, Jean-Stéphane David c, Sébastien Couraud b, e
Bienvenue sur EM-consulte, la référence des professionnels de santé.
Article gratuit.
Connectez-vous pour en bénéficier!
Abstract |
Background |
In COVID-19 patients, older age (sixty or older), comorbidities, and frailty are associated with a higher risk for mortality and invasive mechanical ventilation (IMV) failure. It therefore seems appropriate to suggest limitations of care to older and vulnerable patients with severe COVID-19 pneumonia and a poor expected outcome, who would not benefit from invasive treatment. HFNO (high flow nasal oxygen) is a non-invasive respiratory support device already used in de novo acute respiratory failure. The main objective of this study was to evaluate the survival of patients treated with HFNO outside the ICU (intensive care unit) for a severe COVID-19 pneumonia, otherwise presenting limitations of care making them non-eligible for IMV. Secondary objectives were the description of our cohort and the identification of prognostic factors for HFNO failure.
Methods |
We conducted a retrospective cohort study. We included all patients with limitations of care making them non-eligible for IMV and treated with HFNO for a severe COVID-19 pneumonia, hospitalized in a COVID-19 unit of the pulmonology department of Lyon Sud University Hospital, France, from March 2020 to March 2021. Primary outcome was the description of the vital status at day-30 after HFNO initiation, using the WHO (World Health Organization) 7-points ordinal scale.
Results |
Fifty-six patients were included. Median age was 83 years [76.3–87.0], mean duration for HFNO was 7.5 days, 53% had a CFS score (Clinical Frailty Scale) >4. At day-30, 73% of patients were deceased, one patient (2%) was undergoing HFNO, 9% of patients were discharged from hospital. HFNO failure occurred in 66% of patients. Clinical signs of respiratory failure before HFNO initiation (respiratory rate >30/min, retractions, and abdominal paradoxical breathing pattern) were associated with mortality (p = 0.001).
Conclusions |
We suggest that HFNO is an option in non-ICU skilled units for older and frail patients with a severe COVID-19 pneumonia, otherwise non-suitable for intensive care and mechanical ventilation. Observation of clinical signs of respiratory failure before HFNO initiation was associated with mortality.
Le texte complet de cet article est disponible en PDF.Keywords : COVID-19, High flow nasal oxygen, HFNO, Frailty
Abbreviations : ARDS, ARF, BMI, CFS, CPAP, CT-scan, DNI, ECMO, FiO2, HFNO, IADL, ICU, IMV, LCAS, NIV, PEEP, RR, RT-PCR, SO, SpO2
Plan
Vol 84
Article 101026- novembre 2023 Retour au numéro
Article précédent
- Association of forced oscillation technique measurements with respiratory system compliance and resistance in a 2-compartment physical model
- Valentin Cerfeuillet, Laurine Allimonnier, Sandrine Le Guellec, Luke Ménard, Plamen Bokov, Laurent Plantier
- Insight into the relationship between forced vital capacity and transfer of the lungs for carbon monoxide in patients with idiopathic pulmonary fibrosis
- Thibaud Soumagne, Sébastien Quétant, Alicia Guillien, Loïc Falque, David Hess, Bernard Aguilaniu, Bruno Degano
Bienvenue sur EM-consulte, la référence des professionnels de santé.