Effectiveness of the use of a high-flow nasal cannula to treat COVID-19 patients and risk factors for failure: a meta-analysis
Background: Coronavirus disease 2019 (COVID-19) has spread globally, and many patients with severe cases have received oxygen therapy through a high-flow nasal cannula (HFNC). Objectives: We assessed the efficacy of HFNC for treating patients with COVID-19 and risk factors for HFNC failure. Methods:...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
SAGE Publishing
2022-04-01
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| Series: | Therapeutic Advances in Respiratory Disease |
| Online Access: | https://doi.org/10.1177/17534666221091931 |
| _version_ | 1797853332138622976 |
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| author | Dong-yang Xu Bing Dai Wei Tan Hong-wen Zhao Wei Wang Jian Kang |
| author_facet | Dong-yang Xu Bing Dai Wei Tan Hong-wen Zhao Wei Wang Jian Kang |
| author_sort | Dong-yang Xu |
| collection | DOAJ |
| description | Background: Coronavirus disease 2019 (COVID-19) has spread globally, and many patients with severe cases have received oxygen therapy through a high-flow nasal cannula (HFNC). Objectives: We assessed the efficacy of HFNC for treating patients with COVID-19 and risk factors for HFNC failure. Methods: We searched PubMed, Embase, and the Cochrane Central Register of randomized controlled trials (RCTs) and observational studies of HFNC in patients with COVID-19 published in English from January 1st, 2020 to August 15th, 2021. The primary aim was to assess intubation, mortality, and failure rates in COVID-19 patients supported by HFNC. Secondary aims were to compare HFNC success and failure groups and to describe the risk factors for HFNC failure. Results: A total of 25 studies fulfilled selection criteria and included 2851 patients. The intubation, mortality, and failure rates were 0.44 (95% confidence interval (CI): 0.38–0.51, I 2 = 84%), 0.23 (95% CI: 0.19–0.29, I 2 = 88%), and 0.47 (95% CI: 0.42–0.51, I 2 = 56%), respectively. Compared to the success group, age, body mass index (BMI), Sequential Organ Failure Assessment (SOFA) score, Acute Physiology and Chronic Health Evaluation (APACHE) II score, D-dimer, lactate, heart rate, and respiratory rate were higher and PaO 2 , PaO 2 /FiO 2 , ROX index (the ratio of SpO 2 /FiO 2 to respiratory rate), ROX index after the initiation of HFNC, and duration of HFNC were lower in the failure group (all Ps < 0.05). There were also more smokers and more comorbidities in the failure group (all Ps < 0.05). Pooled odds ratios (ORs) revealed that older age (OR: 1.04, 95% CI: 1.01–1.07, P = 0.02, I 2 = 88%), a higher white blood cell (WBC) count (OR: 1.06, 95% CI: 1.01–1.12, P = 0.02, I 2 = 0%), a higher heart rate (OR: 1.42, 95% CI: 1.15–1.76, P < 0.01, I 2 = 0%), and a lower ROX index(OR: 0.61, 95% CI: 0.39–0.95, P = 0.03, I 2 = 93%) after the initiation of HFNC were all significant risk factors for HFNC failure. Conclusions: HFNC is an effective way of providing respiratory support in the treatment of COVID-19 patients. Older age, a higher WBC count, a higher heart rate, and a lower ROX index after the initiation of HFNC are associated with an increased risk of HFNC failure. |
| first_indexed | 2024-04-09T19:47:49Z |
| format | Article |
| id | doaj.art-9c19bc9ce77b4ce5acef7b339ec2b678 |
| institution | Directory Open Access Journal |
| issn | 1753-4666 |
| language | English |
| last_indexed | 2024-04-09T19:47:49Z |
| publishDate | 2022-04-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Therapeutic Advances in Respiratory Disease |
| spelling | doaj.art-9c19bc9ce77b4ce5acef7b339ec2b6782023-04-03T13:05:38ZengSAGE PublishingTherapeutic Advances in Respiratory Disease1753-46662022-04-011610.1177/17534666221091931Effectiveness of the use of a high-flow nasal cannula to treat COVID-19 patients and risk factors for failure: a meta-analysisDong-yang XuBing DaiWei TanHong-wen ZhaoWei WangJian KangBackground: Coronavirus disease 2019 (COVID-19) has spread globally, and many patients with severe cases have received oxygen therapy through a high-flow nasal cannula (HFNC). Objectives: We assessed the efficacy of HFNC for treating patients with COVID-19 and risk factors for HFNC failure. Methods: We searched PubMed, Embase, and the Cochrane Central Register of randomized controlled trials (RCTs) and observational studies of HFNC in patients with COVID-19 published in English from January 1st, 2020 to August 15th, 2021. The primary aim was to assess intubation, mortality, and failure rates in COVID-19 patients supported by HFNC. Secondary aims were to compare HFNC success and failure groups and to describe the risk factors for HFNC failure. Results: A total of 25 studies fulfilled selection criteria and included 2851 patients. The intubation, mortality, and failure rates were 0.44 (95% confidence interval (CI): 0.38–0.51, I 2 = 84%), 0.23 (95% CI: 0.19–0.29, I 2 = 88%), and 0.47 (95% CI: 0.42–0.51, I 2 = 56%), respectively. Compared to the success group, age, body mass index (BMI), Sequential Organ Failure Assessment (SOFA) score, Acute Physiology and Chronic Health Evaluation (APACHE) II score, D-dimer, lactate, heart rate, and respiratory rate were higher and PaO 2 , PaO 2 /FiO 2 , ROX index (the ratio of SpO 2 /FiO 2 to respiratory rate), ROX index after the initiation of HFNC, and duration of HFNC were lower in the failure group (all Ps < 0.05). There were also more smokers and more comorbidities in the failure group (all Ps < 0.05). Pooled odds ratios (ORs) revealed that older age (OR: 1.04, 95% CI: 1.01–1.07, P = 0.02, I 2 = 88%), a higher white blood cell (WBC) count (OR: 1.06, 95% CI: 1.01–1.12, P = 0.02, I 2 = 0%), a higher heart rate (OR: 1.42, 95% CI: 1.15–1.76, P < 0.01, I 2 = 0%), and a lower ROX index(OR: 0.61, 95% CI: 0.39–0.95, P = 0.03, I 2 = 93%) after the initiation of HFNC were all significant risk factors for HFNC failure. Conclusions: HFNC is an effective way of providing respiratory support in the treatment of COVID-19 patients. Older age, a higher WBC count, a higher heart rate, and a lower ROX index after the initiation of HFNC are associated with an increased risk of HFNC failure.https://doi.org/10.1177/17534666221091931 |
| spellingShingle | Dong-yang Xu Bing Dai Wei Tan Hong-wen Zhao Wei Wang Jian Kang Effectiveness of the use of a high-flow nasal cannula to treat COVID-19 patients and risk factors for failure: a meta-analysis Therapeutic Advances in Respiratory Disease |
| title | Effectiveness of the use of a high-flow nasal cannula to treat COVID-19 patients and risk factors for failure: a meta-analysis |
| title_full | Effectiveness of the use of a high-flow nasal cannula to treat COVID-19 patients and risk factors for failure: a meta-analysis |
| title_fullStr | Effectiveness of the use of a high-flow nasal cannula to treat COVID-19 patients and risk factors for failure: a meta-analysis |
| title_full_unstemmed | Effectiveness of the use of a high-flow nasal cannula to treat COVID-19 patients and risk factors for failure: a meta-analysis |
| title_short | Effectiveness of the use of a high-flow nasal cannula to treat COVID-19 patients and risk factors for failure: a meta-analysis |
| title_sort | effectiveness of the use of a high flow nasal cannula to treat covid 19 patients and risk factors for failure a meta analysis |
| url | https://doi.org/10.1177/17534666221091931 |
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