• Carolina Panadero, Araceli Abad-Fernández, Mª Teresa Rio-Ramirez, Carmen Maria Acosta Gutierrez, Mariara Calderon-Alcala, Cristina Lopez-Riolobos, Cristina Matesanz-Lopez, Fernando Garcia-Prieto, Jose Maria Diaz-Garcia, Beatriz Raboso-Moreno, Zully Vasquez-Gambasica, Pilar Andres-Ruzafa, Jose Luis Garcia-Satue, Sara Calero-Pardo, Belen Sagastizabal, Diego Bautista, Alfonso Campos, Marina González, Luis Grande, Marta Jimenez Fernandez, Jose L Santiago-Ruiz, Pedro Caravaca Perez, and Andres Jose Alcaraz.
• Pulmonology Department, Hospital Universitario de Getafe, Madrid.
• Multidiscip Resp Med. 2020 Jan 28; 15 (1): 693.

IntroductionHigh-flow nasal cannula oxygen therapy (HFNC) has been shown to be a useful therapy in the treatment of patients with Acute Respiratory Distress Syndrome (ARDS), but its efficacy is still unknown in patients with COVID-19. Our objective is to describe its utility as therapy for the treatment of ARDS caused by SARS-CoV-2.MethodsA retrospective, observational study was performed at a single centre, evaluating patients with ARDS secondary to COVID-19 treated with HFNC. The main outcome was the intubation rate at day 30, which defined failure of therapy. We also analysed the role of the ROX index to predict the need for intubation.ResultsIn the study period, 196 patients with bilateral pneumonia were admitted to our pulmonology unit, 40 of whom were treated with HFNC due to the presence of ARDS. The intubation rate at day 30 was 52.5%, and overall mortality was 22.5%. After initiating HFNC, the SpO2/FiO2 ratio was significantly better in the group that did not require intubation (113.4±6.6 vs 93.7±6.7, p=0.020), as was the ROX index (5.0±1.6 vs 4.0±1.0, p=0.018). A ROX index less than 4.94 measured 2 to 6 h after the start of therapy was associated with increased risk of intubation (HR 4.03 [95% CI 1.18 - 13.7]; p=0.026).ConclusionHigh-flow therapy is a useful treatment in ARDS in order to avoid intubation or as a bridge therapy, and no increased mortality was observed secondary to the delay in intubation. After initiating HFNC, a ROX index below 4.94 predicts the need for intubation.©Copyright: the Author(s).

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