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Research article
Risk factors associated with failure of high-flow nasal cannula oxygen therapy in patients with severe COVID-19 in Wuhan, China
Ping Gong
First Affiliated Hospital of Dalian Medical University
Corresponding Author
ORCiD: https://orcid.org/0000-0001-9910-7948
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background: Acute hypoxemic respiratory failure is prevalent in severe Coronavirus Disease 2019 (COVID-19). High-flow nasal canula oxygen therapy (HFNC) is currently one of the most common ventilation strategies for COVID-19 patients with respiratory failure. This study is to analyze the risk factors associated with HFNC failure in patients with severe COVID-19.
Methods: In this single-center, retrospective, observational study, we enrolled patients with confirmed severe COVID-19 admitted to Renmin Hospital of Wuhan university (Wuhan, China) from 1 February 2020 to 26 March 26 2020. Epidemiological, clinical, and laboratory data, and treatments and outcomes upon hospital admission, were obtained from electronic medical records. Sequential organ failure assessment (SOFA) scores were calculated.
Results: Of 54 patients with severe COVID-19, HFNC was successful in 28 (51.9%) and unsuccessful in 26 (48.1%). HFNC failure was seen more commonly in patients aged ≥60 years and in men. In addition, compared with patients successfully treated with HFNC, patients with HFNC failure had the following characteristics: higher percentage of fatigue and anorexia as well as cardiovascular disease; increased time from onset to diagnosis and SOFA scores; elevated body temperature, respiratory rate, and heart rate; more complications including ARDS, septic shock, myocardial damage, and acute kidney injury; increased C-reactive protein, neutrophil counts and prothrombin time; and decreased arterial partial pressure of oxygen/fraction of inspired oxygen (PaO2/FiO2) (all P < 0.05). However, binary logistic regression analysis showed that only male, PaO2/FiO2 and SOFA scores were independent risk factors significantly associated with HFNC failure (all P < 0.05).
Conclusion: Patients with severe COVID-19 had a high HFNC treatment failure rate. Male, low PaO2/FiO2 and SOFA scores were independent risk factors associated with HFNC failure in severe COVID-19 patients. However, studies with larger sample sizes or multi-center studies are warranted.
Keywords
COVID-19, High-flow nasal cannula therapy, Risk factor, Patient
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CURRENT STATUS: Under Review
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Posted 13 Jan, 2021
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Reviewer #2 agreed
On 05 Jan, 2021
Reviewers invited
Invitations sent on 04 Jan, 2021
Reviewer #1 agreed
On 04 Jan, 2021
Editor assigned
On 03 Jan, 2021
Submission checks complete
On 03 Jan, 2021
Editor invited
On 03 Jan, 2021
No comments provided
Review #2 received
Received 13 Dec, 2020
Editorial decision: Major revision
On 13 Dec, 2020
Review #1 received
Received 06 Sep, 2020
Reviewer #2 agreed
On 29 Aug, 2020
Reviewer #1 agreed
On 11 Aug, 2020
Reviewers invited
Invitations sent on 28 Jul, 2020
First submitted
On 02 Jul, 2020
Editor assigned
On 02 Jul, 2020
Submission checks complete
On 01 Jul, 2020
Editor invited
On 01 Jul, 2020
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Subject Areas
Infectious Diseases
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This preprint is under consideration at BMC Infectious Diseases. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Risk factors associated with failure of high-flow nasal cannula oxygen therapy in patients with severe COVID-19 in Wuhan, China
Ping Gong
First Affiliated Hospital of Dalian Medical University
Corresponding Author
ORCiD: https://orcid.org/0000-0001-9910-7948
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Review
Version 2
Posted 13 Jan, 2021
No community comments so far
Reviewer #2 agreed
On 05 Jan, 2021
Reviewers invited
Invitations sent on 04 Jan, 2021
Reviewer #1 agreed
On 04 Jan, 2021
Editor assigned
On 03 Jan, 2021
Submission checks complete
On 03 Jan, 2021
Editor invited
On 03 Jan, 2021
No comments provided
Review #2 received
Received 13 Dec, 2020
Editorial decision: Major revision
On 13 Dec, 2020
Review #1 received
Received 06 Sep, 2020
Reviewer #2 agreed
On 29 Aug, 2020
Reviewer #1 agreed
On 11 Aug, 2020
Reviewers invited
Invitations sent on 28 Jul, 2020
First submitted
On 02 Jul, 2020
Editor assigned
On 02 Jul, 2020
Submission checks complete
On 01 Jul, 2020
Editor invited
On 01 Jul, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Infectious Diseases
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background: Acute hypoxemic respiratory failure is prevalent in severe Coronavirus Disease 2019 (COVID-19). High-flow nasal canula oxygen therapy (HFNC) is currently one of the most common ventilation strategies for COVID-19 patients with respiratory failure. This study is to analyze the risk factors associated with HFNC failure in patients with severe COVID-19.
Methods: In this single-center, retrospective, observational study, we enrolled patients with confirmed severe COVID-19 admitted to Renmin Hospital of Wuhan university (Wuhan, China) from 1 February 2020 to 26 March 26 2020. Epidemiological, clinical, and laboratory data, and treatments and outcomes upon hospital admission, were obtained from electronic medical records. Sequential organ failure assessment (SOFA) scores were calculated.
Results: Of 54 patients with severe COVID-19, HFNC was successful in 28 (51.9%) and unsuccessful in 26 (48.1%). HFNC failure was seen more commonly in patients aged ≥60 years and in men. In addition, compared with patients successfully treated with HFNC, patients with HFNC failure had the following characteristics: higher percentage of fatigue and anorexia as well as cardiovascular disease; increased time from onset to diagnosis and SOFA scores; elevated body temperature, respiratory rate, and heart rate; more complications including ARDS, septic shock, myocardial damage, and acute kidney injury; increased C-reactive protein, neutrophil counts and prothrombin time; and decreased arterial partial pressure of oxygen/fraction of inspired oxygen (PaO2/FiO2) (all P < 0.05). However, binary logistic regression analysis showed that only male, PaO2/FiO2 and SOFA scores were independent risk factors significantly associated with HFNC failure (all P < 0.05).
Conclusion: Patients with severe COVID-19 had a high HFNC treatment failure rate. Male, low PaO2/FiO2 and SOFA scores were independent risk factors associated with HFNC failure in severe COVID-19 patients. However, studies with larger sample sizes or multi-center studies are warranted.
Figure 1