High-Flow Nasal Oxygen for Severe COVID-19 Pneumonia in Greek Patients: A Prospective Observational Study
Introduction: High-flow nasal oxygen (HFNO) and prone positioning may improve outcomes of coronavirus disease 2019 (COVID-19) patients treated in the intensive care unit (ICU). The aim of this study was to describe outcomes following the timely application of HFNO and prone positioning in COVID-19 p...
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| Published in | Kurume medical journal Vol. 69; no. 1.2; pp. 53 - 63 |
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| Main Authors | , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
Kurume University School of Medicine
30.06.2022
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0023-5679 1881-2090 1881-2090 |
| DOI | 10.2739/kurumemedj.MS69120013 |
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| Abstract | Introduction: High-flow nasal oxygen (HFNO) and prone positioning may improve outcomes of coronavirus disease 2019 (COVID-19) patients treated in the intensive care unit (ICU). The aim of this study was to describe outcomes following the timely application of HFNO and prone positioning in COVID-19 patients treated in a ward setting. Methods: The study included 89 prospectively recruited subjects at the COVID-19 ward unit of the University Hospital of Heraklion, Greece, between March and December 2020. Results: Seventy-four (83%) of the 89 subjects in the study had severe COVID-19. Of those, 33 (45%) required HFNO treatment and prone positioning and 15 (45%) were transferred to the ICU, with 4 of them being intubated. Severe COVID-19 and HFNO needs were associated with an increased pneumonia severity index (PSI) score on admission and a worse PaO2/FiO2 ratio. In multivariate analysis, PSI was the only independent predictor of subsequent HFNO needs (OR=1.022). Overall intubation and mortality rates were 5.6% and 3.4%, respectively. Conclusion: This study shows that for patients with severe COVID-19 hospitalized in medical wards, standard COVID-19 treatment, along with the timely utilization of HFNO and prone positioning, resulted in excellent outcomes with fewer ICU admission rates. |
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| AbstractList | Introduction: High-flow nasal oxygen (HFNO) and prone positioning may improve outcomes of coronavirus disease 2019 (COVID-19) patients treated in the intensive care unit (ICU). The aim of this study was to describe outcomes following the timely application of HFNO and prone positioning in COVID-19 patients treated in a ward setting. Methods: The study included 89 prospectively recruited subjects at the COVID-19 ward unit of the University Hospital of Heraklion, Greece, between March and December 2020. Results: Seventy-four (83%) of the 89 subjects in the study had severe COVID-19. Of those, 33 (45%) required HFNO treatment and prone positioning and 15 (45%) were transferred to the ICU, with 4 of them being intubated. Severe COVID-19 and HFNO needs were associated with an increased pneumonia severity index (PSI) score on admission and a worse PaO2/FiO2 ratio. In multivariate analysis, PSI was the only independent predictor of subsequent HFNO needs (OR=1.022). Overall intubation and mortality rates were 5.6% and 3.4%, respectively. Conclusion: This study shows that for patients with severe COVID-19 hospitalized in medical wards, standard COVID-19 treatment, along with the timely utilization of HFNO and prone positioning, resulted in excellent outcomes with fewer ICU admission rates. High-flow nasal oxygen (HFNO) and prone positioning may improve outcomes of coronavirus disease 2019 (COVID-19) patients treated in the intensive care unit (ICU). The aim of this study was to describe outcomes following the timely application of HFNO and prone positioning in COVID-19 patients treated in a ward setting.INTRODUCTIONHigh-flow nasal oxygen (HFNO) and prone positioning may improve outcomes of coronavirus disease 2019 (COVID-19) patients treated in the intensive care unit (ICU). The aim of this study was to describe outcomes following the timely application of HFNO and prone positioning in COVID-19 patients treated in a ward setting.The study included 89 prospectively recruited subjects at the COVID-19 ward unit of the University Hospital of Heraklion, Greece, between March and December 2020.METHODSThe study included 89 prospectively recruited subjects at the COVID-19 ward unit of the University Hospital of Heraklion, Greece, between March and December 2020.Seventy-four (83%) of the 89 subjects in the study had severe COVID-19. Of those, 33 (45%) required HFNO treatment and prone positioning and 15 (45%) were transferred to the ICU, with 4 of them being intubated. Severe COVID-19 and HFNO needs were associated with an increased pneumonia severity index (PSI) score on admission and a worse PaO2/FiO2 ratio. In multivariate analysis, PSI was the only independent predictor of subsequent HFNO needs (OR=1.022). Overall intubation and mortality rates were 5.6% and 3.4%, respectively.RESULTSSeventy-four (83%) of the 89 subjects in the study had severe COVID-19. Of those, 33 (45%) required HFNO treatment and prone positioning and 15 (45%) were transferred to the ICU, with 4 of them being intubated. Severe COVID-19 and HFNO needs were associated with an increased pneumonia severity index (PSI) score on admission and a worse PaO2/FiO2 ratio. In multivariate analysis, PSI was the only independent predictor of subsequent HFNO needs (OR=1.022). Overall intubation and mortality rates were 5.6% and 3.4%, respectively.This study shows that for patients with severe COVID-19 hospitalized in medical wards, standard COVID-19 treatment, along with the timely utilization of HFNO and prone positioning, resulted in excellent outcomes with fewer ICU admission rates.CONCLUSIONThis study shows that for patients with severe COVID-19 hospitalized in medical wards, standard COVID-19 treatment, along with the timely utilization of HFNO and prone positioning, resulted in excellent outcomes with fewer ICU admission rates. |
| ArticleNumber | MS69120013 |
| Author | FILIPPATOS, THEODOSIOS D IOANNOU, PETROS CHAMILOS, GEORGIOS KOFTERIDIS, DIAMANTIS P AKOUMIANAKI, EVANGELIA AKOUMIANAKIS, IOANNIS ON BEHALF OF THE UNIVERSITY HOSPITAL OF HERAKLION COVID-19 STUDY GROUP |
| Author_xml | – sequence: 1 fullname: CHAMILOS, GEORGIOS organization: Clinical Microbiology and Microbial Pathogenesis, University Hospital of Heraklion – sequence: 1 fullname: KOFTERIDIS, DIAMANTIS P organization: Internal Medicine & Infectious Diseases, University Hospital of Heraklion – sequence: 1 fullname: ON BEHALF OF THE UNIVERSITY HOSPITAL OF HERAKLION COVID-19 STUDY GROUP – sequence: 1 fullname: FILIPPATOS, THEODOSIOS D organization: Internal Medicine & Infectious Diseases, University Hospital of Heraklion – sequence: 1 fullname: AKOUMIANAKI, EVANGELIA organization: Intensive Care Unit, University Hospital of Heraklion – sequence: 1 fullname: AKOUMIANAKIS, IOANNIS organization: Internal Medicine & Infectious Diseases, University Hospital of Heraklion – sequence: 1 fullname: IOANNOU, PETROS organization: Internal Medicine & Infectious Diseases, University Hospital of Heraklion |
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| References_xml | – reference: 37. Bertolini A, Peppel IP, Bodewes FAJA, Moshage H, Fantin A et al. Abnormal Liver Function Tests in Patients With COVID-19 : Relevance and Potential Pathogenesis. Hepatology 2020; 72:1864-1872. – reference: 48. Dickson RP, Schultz MJ, van der Poll T, Schouten LR, Falkowski NR et al. Lung Microbiota Predict Clinical Outcomes in Critically Ill Patients. Am J Respir Crit Care Med 2020; 201:555-563. – reference: 29. Cheng L, Li H, Li L, Liu C, Yan S et al. Ferritin in the coronavirus disease 2019 (COVID-19): A systematic review and meta-analysis. J Clin Lab Anal 2020; 34:e23618. – reference: 22. Mellado-Artigas R, Ferreyro BL, Angriman F, Hernández-Sanz M, Arruti E, Torres A et al. High-flow nasal oxygen in patients with COVID-19-associated acute respiratory failure. Crit Care 2021; 25:58. – reference: 18. Calligaro GL, Lalla U, Audley G, Gina P, Miller MG, Mendelson M, et al. 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| Title | High-Flow Nasal Oxygen for Severe COVID-19 Pneumonia in Greek Patients: A Prospective Observational Study |
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