Importance Use of non-invasive respiratory modalities in COVID-19 has the potential to reduce rates of intubation and mortality in severe disease however data regarding the use of high-flow nasal cannula (HFNC) in this population is limited. Objective To interrogate clinical and laboratory features of SARS-CoV-2 infection associated with high-flow failure. Design We conducted a retrospective cohort study to evaluate characteristics of high-flow therapy use early in the pandemic and interrogate factors associated with respiratory therapy failure. Setting Multisite single centre hospital system within the metropolitan Detroit region. Participants Patients from within the Detroit Medical Center (n=104, 89% African American) who received HFNC therapy during a COVID-19 admission between March and May of 2020. Primary outcome HFNC failure is defined as death or intubation while on therapy. Results Therapy failure occurred in 57% of the patient population, factors significantly associated with failure centred around markers of multiorgan failure including hepatic dysfunction/transaminitis (OR=6.1, 95% CI 1.9 to 19.4, p<0.01), kidney injury (OR=7.0, 95% CI 2.7 to 17.8, p<0.01) and coagulation dysfunction (OR=4.5, 95% CI 1.2 to 17.1, p=0.03). Conversely, comorbidities, admission characteristics, early oxygen requirements and evaluation just prior to HFNC therapy initiation were not significantly associated with success or failure of therapy. Conclusions In a population disproportionately affected by COVID-19, we present key indicators of likely HFNC failure and highlight a patient population in which aggressive monitoring and intervention are warranted. Data are available upon reasonable request and upon approvable from our institutional IRB.

中文翻译：

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以非裔美国人为主的 COVID-19 相关急性呼吸衰竭人群的高流量鼻插管治疗

重要性 在 COVID-19 中使用无创呼吸方式有可能降低严重疾病的插管率和死亡率，但有关在该人群中使用高流量鼻插管 (HFNC) 的数据有限。目的探讨与高流量衰竭相关的 SARS-CoV-2 感染的临床和实验室特征。设计 我们进行了一项回顾性队列研究，以评估大流行早期使用高流量治疗的特征并询问与呼吸治疗失败相关的因素。在底特律大都市地区设置多站点单中心医院系统。参与者 来自底特律医疗中心的患者（n=104，89% 为非裔美国人），他们在 2020 年 3 月至 5 月期间 COVID-19 入院期间接受了 HFNC 治疗。主要结果 HFNC 失败定义为治疗期间死亡或插管。结果 57% 的患者群体发生治疗失败，与失败显着相关的因素主要围绕多器官衰竭的标志物，包括肝功能障碍/转氨酶 (OR=6.1, 95% CI 1.9 至 19.4, p<0.01)、肾损伤 (OR= 7.0，95% CI 2.7 至 17.8，p<0.01）和凝血功能障碍（OR=4.5，95% CI 1.2 至 17.1，p=0.03）。相反，合并症、入院特征、早期氧气需求和 HFNC 治疗开始前的评估与治疗的成功或失败没有显着相关性。结论 在受 COVID-19 影响不成比例的人群中，我们提出了可能 HFNC 失败的关键指标，并强调了需要积极监测和干预的患者群体。数据可应合理要求并经我们的机构 IRB 批准后提供。