KẾT QUẢ THỞ OXY LƯU LƯỢNG CAO (HFNC) TRONG ĐIỀU TRỊ SUY HÔ HẤP NGUY KỊCH DO COVID-19 TẠI BỆNH VIỆN BỆNH NHIỆT ĐỚI TRUNG ƯƠNG

Abstract

Objective: To describe the outcomes of high-flow nasal cannula (HFNC) oxygen therapy in COVID-19 patients with critical respiratory failure. Methods: A retrospective descriptive study was conducted on critically respiratory failure COVID-19 patients treated with HFNC in the Intensive Care Unit of the National Hospital for Tropical Diseases, Vietnam, from May 2021 to April 2023. Results: There were 147 critically ill COVID-19 patients on HFNC treatment screened during the study period. Of which, 118 patients fulfilled the eligibility criteria were included. The mean age was 63.8 ± 19.6; 72% were male, and 69.5% had comorbidities. HFNC was successful in 65 patients (55.1%), while 53 patients (44.9%) failed HFNC requiring invasive mechanical ventilation. The median (IQR) HFNC duration in succeful group and failure group was 120 (80–173) hours and 30 (10–79) hours, respectively. Most HFNC failed patients occurred within the first 48 hours (31 patients, 59.5%), especially within the first 6 hours (10 patients accounted for 18.9% of the HFNC failures). In univariable analyses, risk factors for HFNC failure included female, ROX index < 4.88 and heart rate > 100 beats/min while on HFNC, absolute lymphocyte count ≤ 0.50 × 10^9/L, increased FiO₂ requirement after 2 hours on HFNC, and having complications during HFNC period. In multivariable analysis, only absolute lymphocyte count ≤ 0.50 × 10^9/L and complications during HFNC were independent risk factors associated with increased failure, with adjusted odds ratios (95% CI) of 2.92 (1.21–7.03) and 3.86 (1.57–9.47), respectively. Conclusions: HFNC is an effective therapy in treatment of COVID-19 patients with critically respiratory failure, more than a half of patients excluded from invasive mechanical ventilation. However, the failure rate was still high with most failures occurred within the first 48 hours on HFNC.