Outcomes in COVID-19 Patients Who Escalate to Mechanical Ventilation After Prolonged High Flow Oxygen With Additional Oxygen Flow Administration

Abstract

Background:

During the COVID-19 pandemic mortality outcome for mechanically ventilated patients can exceed 50%. Based on this data, aggressive attempts to prevent endotracheal intubation and thus mechanical ventilation have been instituted. Self-proning, noninvasive ventilation, and high-flow oxygen administration had been utilized. Even adding addition oxygen flow via a non-rebreathing mask when high-flow oxygen is maximized at 100% and 60 L/min. There are conflicting data that this additional oxygenation administration prevents intubation in a large percentage of patients who receive it. Another question that arises if the patients fail this hyper-oxygenation strategy and require mechanical ventilation is what is the morality of this subset of patients?

Methods:

We retrospectively assessed 52 patients from February 1, 2021 to April 15, 2021 who either had additional flow (10-15 L/min) added to the high flow device or a non-rebreathing placed on the patient’s face for a minimum of 7 days who then went on to require mechanical ventilation

Results:

Thirty-two of the fifty-two patients who required mechanical ventilation (62%) expired during their ICU stay. Twenty patients were liberated from mechanical ventilation via extubation or post tracheostomy. The mean duration of high-flow oxygen was 7.2 days in the survivor group and 8.7 days in the expired group. Age, BMI, and existing comorbidities were similar in both groups. SpO₂ increased by 2-3% and respiratory rate reduced by 2-6 breaths/min in both groups after additional oxygen was placed, but these improvements were not universally sustained after 24-36 hours.

Conclusions:

In our 52 patients who received additional oxygen administration when maximized on high flow settings, who then escalated to mechanical ventilation, had a mortality rate of 62%. This is little higher than our current mechanical ventilation mortality rate of COVID-19 patients of 52%. Further research needs to be conducted to determine the role of prolonged additional oxygen administration on the outcomes of the COVID-19 patient population.