Predictors Of HFNO Failure In Patients With COVID-19

This study aims to describe the use of HFNO in adult patients with acute respiratory failure by COVID-19 and to identify factors associated with an increased risk of intubation

Keywords: High-flow nasal oxygen therapy; COVID-19; Invasive mechanical ventilation; Hypoxemic respiratory failure.


– Of the 259 patients, 54% (140) required respiratory support by intubation.

– The main predictors of intubation were the SOFA (Sequential Organ Failure Assessment) indices, which assess the occurrence and evolution of multi-organ failure in ICU patients, and ROX, which combines information on respiratory parameters and patient oxygenation.

– In contrast to other studies in non-COVID-19 patients, low oxygenation on admission was not a reliable marker for intubation.

Description of the Study:

  • Title Predictors of failure with high-flow nasal oxygen therapy in COVID-19 patients with acute respiratory failure: a multicenter observational study.
  • Principal Investigators: Ricard Mellado-Artigas, Luis Eduardo Mujica, Magda Liliana Ruiz, Bruno Leonel Ferreyro, Federico Angriman, Egoitz Arruti, Antoni Torres, Enric Barbeta, Jesús Villar and Carlos Ferrando.
  • Centres of Implementation: 36 hospitals in Spain and Andorra, promoted by the Spanish Society of Anaesthesiology and Resuscitation (SEDAR).
  • Study Population: Prospectively collected database of 259 patients over 18 years of age, admitted to the ICU with a diagnosis of acute respiratory failure related to COVID-19, confirmatory nasopharyngeal or pulmonary sample positive for COVID-19.
  • Study Type: Prospective, multicentre cohort study.
  • Design: Patients received HFNO on admission to the ICU during a 22-week period (12 March to 13 August 2020). Outcomes of interest were factors on the day of ICU admission associated with the need for endotracheal intubation.
  • Methods:
    – Multivariable logistic regression and mixed-effects models were used.
    – A predictive model for endotracheal intubation in patients treated with HFNO was derived and internally validated.

Objectives of the Study:

Principal Objective: To describe the use of high-flow nasal oxygen (HFNO) in patients with acute respiratory failure due to COVID-19 and factors associated with a switch to invasive mechanical ventilation.

More about this Study:

Scientific Context: High-flow nasal oxygen (HFNO) reduces the need for endotracheal intubation in patients with acute respiratory failure. In the last few months, several studies have reported experiences with HFNO therapy in patients with COVID-19. Also, a recent publication suggested that HFNO compared to oxygen therapy could decrease the requirements for invasive mechanical ventilation in these patients. If validated, the use of HFNO would not only be beneficial for individual patients treated noninvasively but also to those planned for invasive mechanical ventilation through the rational allocation of resources. Conversely, delaying intubation by choosing a non-invasive approach may be associated with worse outcomes in patients with the acute respiratory distress syndrome (ARDS). Therefore, identifying those at higher risk of failure could be highly valuable for avoiding delays in choosing the best management approach.


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CIBERES UCI COVID is a fundamental study that will improve care of critical patients infected by COVID-19.