High-flow nasal cannula therapy for hypoxemic respiratory failure in patients with COVID-19

Purpose High-flow nasal cannula (HFNC) therapy in patients with hypoxemic respiratory failure due to COVID-19 is poorly understood and remains controversial. Methods We designed a prospective observational study of a large cohort of patients with COVID-19-related hypoxaemic respiratory failure at the Temporary COVID-19 Hospital in Mexico City. The primary outcome was the success rate of HFNC to prevent the progression to invasive mechanical ventilation (IMV). We also evaluated the risk factors associated with HFNC success or failure. Results This study included 378 patients who were admitted to the Temporary COVID-19 Hospital with a confirmed diagnosis of COVID-19 and hypoxemic respiratory failure. HFNC therapy effectively prevented IMV in 71.4% of patients (n = 270; 95% confidence interval [CI] 66.6–75.8%). Factors that were significantly different between patients who were only treated with HFNC therapy and those who progressed to IMV included age, the presence of hypertension, and the Charlson comorbidity index. Predictors of therapy failure included the CALL score at admission (adjusted hazard ratio [HR] 1.27; 95% CI 1.09–1.47; p p = 0.02), and no prior treatment with steroids (adjusted HR 0.34; 95% CI 0.19–0.62; p