Predictors of failure with high-flow nasal cannula oxygen in COVID-19 patients
Predictores de fracaso con cánula nasal de alto flujo de oxígeno en pacientes COVID-19.
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Introduction: COVID-19 has generated challenges due to the high demand for health care services, making it necessary to seek ventilatory support alternatives that allow us to fulfill the needs of the population. It is important to have tools that allow to detect the failure of non-invasive ventilatory strategies early and to identify the need for intubation on time.
Objective: Identify the variables associated with failure of high-flow nasal cannula treatment (HFNC) on COVID-19 patients.
Materials and Methods: Analytical observational, cross-sectional study of 68 patients in the intensive care unit with COVID-19, who received treatment with HFNC. The variables of the study were evaluated at three time points, at 24, 48 and 72 hours. A bivariate and multivariate analysis was performed between those who failed and those who were successful.
Results: In the bivariate analysis, the variables that presented a statistically significant relationship at 24h were: No increase in work of breathing (WOB) (p=0.000), normal oxygen saturation (SatO2) (p=0.006). At 48h: No increase in WOB (p=0.014), normal SatO2 (p=0.005), mild to moderate partial pressure arterial oxygen/fraction inspired oxygen ratio (P/F ratio) (p=0.039). At 72h failed: severe P/F ratio (p=0.000), Increased WOB (p=0.001) and ROX index less than 4.88 (p=0.023). According to multivariate analysis the predictive variables for the therapeutic failure at 24h were: FIO2, SatO2, WOB; at 48h: FIO2 and SatO2.
Conclusions: Increased FIO2>70%, increased WOB and SpO2 less than 88% are variables associated with failure of HFNC, and facilitate clinical decisions on whether or not to progress with invasive ventilatory support.
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