An observational study on the timing of intubation and outcome in COVID-19 ARDS patients who were treated with high flow nasal oxygen prior to invasive mechanical ventilation: A time series analysis (InOutHFNO trial)
Background and Aims: Prolonged high flow nasal oxygen (HFNO) application might delay intubation and increase mortality in acute hypoxemic respiratory failure (AHRF) patients. Intubation in coronavirus disease 2019 (COVID-19) AHRF (CAHRF) patients 24 to 48 hours after HFNO initiation has been associ...
| Main Authors: | , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wolters Kluwer Medknow Publications
2023-01-01
|
| Series: | Indian Journal of Anaesthesia |
| Subjects: | |
| Online Access: | http://www.ijaweb.org/article.asp?issn=0019-5049;year=2023;volume=67;issue=5;spage=439;epage=444;aulast=Kundu |
| _version_ | 1797775201986936832 |
|---|---|
| author | Rupak Kundu Sounak Ghosh Subhash Todi |
| author_facet | Rupak Kundu Sounak Ghosh Subhash Todi |
| author_sort | Rupak Kundu |
| collection | DOAJ |
| description | Background and Aims: Prolonged high flow nasal oxygen (HFNO) application might delay intubation and increase mortality in acute hypoxemic respiratory failure (AHRF) patients. Intubation in coronavirus disease 2019 (COVID-19) AHRF (CAHRF) patients 24 to 48 hours after HFNO initiation has been associated with increased mortality in previous studies. This cut-off period is variable in previous studies. A time series analysis could reflect more robust data on outcome in relation to HFNO duration before intubation in CAHRF. Methods: A retrospective study was conducted at 30-bedded ICU of a tertiary care teaching hospital from July 2020 to August 2021. The study cohort comprised 116 patients who required HFNO and were subsequently intubated following HFNO failure. A time series analysis of patient outcomes on each day of HFNO application prior to invasive mechanical ventilation (IMV) was done. Results: ICU and hospital mortality was 67.2%. Beyond day 4 of HFNO application, there was a trend towards increased risk-adjusted ICU and hospital mortality for each day delay in intubation of CAHRF patients on HFNO [OR 2.718; 95% CI 0.957–7.721; P 0.061]. This trend was maintained till day 8 of HFNO application, after which there was 100% mortality. Taking day four as a cut-off in the timeline of HFNO application, we have observed an absolute mortality benefit of 15% with early intubation despite a higher APACHE-IV score than the late intubation group. Conclusion: IMV beyond the 4th day of HFNO initiation in CAHRF patients increases mortality. |
| first_indexed | 2024-03-12T22:32:19Z |
| format | Article |
| id | doaj.art-25319c511a7f454d9f0973d50bf7230e |
| institution | Directory Open Access Journal |
| issn | 0019-5049 0976-2817 |
| language | English |
| last_indexed | 2024-03-12T22:32:19Z |
| publishDate | 2023-01-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Indian Journal of Anaesthesia |
| spelling | doaj.art-25319c511a7f454d9f0973d50bf7230e2023-07-21T14:50:43ZengWolters Kluwer Medknow PublicationsIndian Journal of Anaesthesia0019-50490976-28172023-01-0167543944410.4103/ija.ija_672_22An observational study on the timing of intubation and outcome in COVID-19 ARDS patients who were treated with high flow nasal oxygen prior to invasive mechanical ventilation: A time series analysis (InOutHFNO trial)Rupak KunduSounak GhoshSubhash TodiBackground and Aims: Prolonged high flow nasal oxygen (HFNO) application might delay intubation and increase mortality in acute hypoxemic respiratory failure (AHRF) patients. Intubation in coronavirus disease 2019 (COVID-19) AHRF (CAHRF) patients 24 to 48 hours after HFNO initiation has been associated with increased mortality in previous studies. This cut-off period is variable in previous studies. A time series analysis could reflect more robust data on outcome in relation to HFNO duration before intubation in CAHRF. Methods: A retrospective study was conducted at 30-bedded ICU of a tertiary care teaching hospital from July 2020 to August 2021. The study cohort comprised 116 patients who required HFNO and were subsequently intubated following HFNO failure. A time series analysis of patient outcomes on each day of HFNO application prior to invasive mechanical ventilation (IMV) was done. Results: ICU and hospital mortality was 67.2%. Beyond day 4 of HFNO application, there was a trend towards increased risk-adjusted ICU and hospital mortality for each day delay in intubation of CAHRF patients on HFNO [OR 2.718; 95% CI 0.957–7.721; P 0.061]. This trend was maintained till day 8 of HFNO application, after which there was 100% mortality. Taking day four as a cut-off in the timeline of HFNO application, we have observed an absolute mortality benefit of 15% with early intubation despite a higher APACHE-IV score than the late intubation group. Conclusion: IMV beyond the 4th day of HFNO initiation in CAHRF patients increases mortality.http://www.ijaweb.org/article.asp?issn=0019-5049;year=2023;volume=67;issue=5;spage=439;epage=444;aulast=Kunducovid-19hfno failuremechanical ventilation |
| spellingShingle | Rupak Kundu Sounak Ghosh Subhash Todi An observational study on the timing of intubation and outcome in COVID-19 ARDS patients who were treated with high flow nasal oxygen prior to invasive mechanical ventilation: A time series analysis (InOutHFNO trial) Indian Journal of Anaesthesia covid-19 hfno failure mechanical ventilation |
| title | An observational study on the timing of intubation and outcome in COVID-19 ARDS patients who were treated with high flow nasal oxygen prior to invasive mechanical ventilation: A time series analysis (InOutHFNO trial) |
| title_full | An observational study on the timing of intubation and outcome in COVID-19 ARDS patients who were treated with high flow nasal oxygen prior to invasive mechanical ventilation: A time series analysis (InOutHFNO trial) |
| title_fullStr | An observational study on the timing of intubation and outcome in COVID-19 ARDS patients who were treated with high flow nasal oxygen prior to invasive mechanical ventilation: A time series analysis (InOutHFNO trial) |
| title_full_unstemmed | An observational study on the timing of intubation and outcome in COVID-19 ARDS patients who were treated with high flow nasal oxygen prior to invasive mechanical ventilation: A time series analysis (InOutHFNO trial) |
| title_short | An observational study on the timing of intubation and outcome in COVID-19 ARDS patients who were treated with high flow nasal oxygen prior to invasive mechanical ventilation: A time series analysis (InOutHFNO trial) |
| title_sort | observational study on the timing of intubation and outcome in covid 19 ards patients who were treated with high flow nasal oxygen prior to invasive mechanical ventilation a time series analysis inouthfno trial |
| topic | covid-19 hfno failure mechanical ventilation |
| url | http://www.ijaweb.org/article.asp?issn=0019-5049;year=2023;volume=67;issue=5;spage=439;epage=444;aulast=Kundu |
| work_keys_str_mv | AT rupakkundu anobservationalstudyonthetimingofintubationandoutcomeincovid19ardspatientswhoweretreatedwithhighflownasaloxygenpriortoinvasivemechanicalventilationatimeseriesanalysisinouthfnotrial AT sounakghosh anobservationalstudyonthetimingofintubationandoutcomeincovid19ardspatientswhoweretreatedwithhighflownasaloxygenpriortoinvasivemechanicalventilationatimeseriesanalysisinouthfnotrial AT subhashtodi anobservationalstudyonthetimingofintubationandoutcomeincovid19ardspatientswhoweretreatedwithhighflownasaloxygenpriortoinvasivemechanicalventilationatimeseriesanalysisinouthfnotrial AT rupakkundu observationalstudyonthetimingofintubationandoutcomeincovid19ardspatientswhoweretreatedwithhighflownasaloxygenpriortoinvasivemechanicalventilationatimeseriesanalysisinouthfnotrial AT sounakghosh observationalstudyonthetimingofintubationandoutcomeincovid19ardspatientswhoweretreatedwithhighflownasaloxygenpriortoinvasivemechanicalventilationatimeseriesanalysisinouthfnotrial AT subhashtodi observationalstudyonthetimingofintubationandoutcomeincovid19ardspatientswhoweretreatedwithhighflownasaloxygenpriortoinvasivemechanicalventilationatimeseriesanalysisinouthfnotrial |