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{ "pk": 14615, "title": "Emergency Department-initiated High-flow Nasal Cannula for COVID-19 Respiratory Distress", "subtitle": null, "abstract": "Introduction:\n Patients with coronavirus disease 2019 (COVID-19) can develop rapidly progressive respiratory failure. Ventilation strategies during the COVID-19 pandemic seek to minimize patient mortality. In this study we examine associations between the availability of emergency department (ED)-initiated high-flow nasal cannula (HFNC) for patients presenting with COVID-19 respiratory distress and outcomes, including rates of endotracheal intubation (ETT), mortality, and hospital length of stay. \nMethods:\n We performed a retrospective, non-concurrent cohort study of patients with COVID-19 respiratory distress presenting to the ED who required HFNC or ETT in the ED or within 24 hours following ED departure. Comparisons were made between patients presenting before and after the introduction of an ED-HFNC protocol.\nResults:\n Use of HFNC was associated with a reduced rate of ETT in the ED (46.4% vs 26.3%, P <0.001) and decreased the cumulative proportion of patients who required ETT within 24 hours of ED departure (85.7% vs 32.6%, P <0.001) or during their entire hospitalization (89.3% vs 48.4%, P <0.001). Using HFNC was also associated with a trend toward increased survival to hospital discharge; however, this was not statistically significant (50.0% vs 68.4%, P = 0.115). There was no impact on intensive care unit or hospital length of stay. Demographics, comorbidities, and illness severity were similar in both cohorts.\nConclusions:\n The institution of an ED-HFNC protocol for patients with COVID-19 respiratory distress was associated with reductions in the rate of ETT. Early initiation of HFNC is a promising strategy for avoiding ETT and improving outcomes in patients with COVID-19.", "language": "en", "license": { "name": "Creative Commons Attribution 4.0", "short_name": "CC BY 4.0", "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.", "url": "https://creativecommons.org/licenses/by/4.0" }, "keywords": [ { "word": "COVID-19, airway, high flow, intubation, ventilation, respiratory, HFNC" } ], "section": "Endemic Infections", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/6917m7c9", "frozenauthors": [ { "first_name": "Zachary", "middle_name": "J.", "last_name": "Jarou", "name_suffix": "", "institution": "University of Chicago, Section of Emergency Medicine, Department of Medicine, Chicago, Illinois", "department": "None" }, { "first_name": "David", "middle_name": "G.", "last_name": "Beiser", "name_suffix": "", "institution": "University of Chicago, Section of Emergency Medicine, Department of Medicine, Chicago, Illinois", "department": "None" }, { "first_name": "Willard", "middle_name": "W.", "last_name": "Sharp", "name_suffix": "", "institution": "University of Chicago, Section of Emergency Medicine, Department of Medicine, Chicago, Illinois", "department": "None" }, { "first_name": "Ravi", "middle_name": "", "last_name": "Chacko", "name_suffix": "", "institution": "University of Chicago, Section of Emergency Medicine, Department of Medicine, Chicago, Illinois", "department": "None" }, { "first_name": "Deirdre", "middle_name": "", "last_name": "Goode", "name_suffix": "", "institution": "University of Chicago, Section of Emergency Medicine, Department of Medicine, Chicago, Illinois", "department": "None" }, { "first_name": "Daniel", "middle_name": "S.", "last_name": "Rubin", "name_suffix": "", "institution": "University of Chicago, Department of Anesthesia and Critical Care, Chicago, Illinois", "department": "None" }, { "first_name": "Dinesh", "middle_name": "", "last_name": "Kurian", "name_suffix": "", "institution": "University of Chicago, Department of Anesthesia and Critical Care, Chicago, Illinois", "department": "None" }, { "first_name": "Allison", "middle_name": "", "last_name": "Dalton", "name_suffix": "", "institution": "University of Chicago, Department of Anesthesia and Critical Care, Chicago, Illinois", "department": "None" }, { "first_name": "Stephen", "middle_name": "R.", "last_name": "Estime", "name_suffix": "", "institution": "University of Chicago, Department of Anesthesia and Critical Care, Chicago, Illinois", "department": "None" }, { "first_name": "Michael", "middle_name": "", "last_name": "O'Connor", "name_suffix": "", "institution": "University of Chicago, Department of Anesthesia and Critical Care, Chicago, Illinois", "department": "None" }, { "first_name": "Bhakti", "middle_name": "K.", "last_name": "Patel", "name_suffix": "", "institution": "University of Chicago, Section of Pulmonary and Critical Care Medicine, Department of Medicine, Chicago, Illinois", "department": "None" }, { "first_name": "John", "middle_name": "P.", "last_name": "Kress", "name_suffix": "", "institution": "University of Chicago, Section of Pulmonary and Critical Care Medicine, Department of Medicine, Chicago, Illinois", "department": "None" }, { "first_name": "Thomas", "middle_name": "F.", "last_name": "Spiegel", "name_suffix": "", "institution": "University of Chicago, Section of Emergency Medicine, Department of Medicine, Chicago, Illinois", "department": "None" } ], "date_submitted": "2020-10-03T12:51:02Z", "date_accepted": "2020-10-03T12:51:02Z", "date_published": "2021-07-20T18:25:24Z", "render_galley": null, "galleys": [ { "label": "", "type": "pdf", "path": "https://journalpub.escholarship.org/westjem/article/14615/galley/7456/download/" } ] }