PROGNOSIS OF PATIENTS SUFFERING FROM SARS-COV-2 PNEUMONIA REQUIRING HIGH-FLOW OXYGEN THERAPY AS THE HIGHEST THERAPEUTIC SCALE (PATIENTS WITH A "DO NOT INTUBATE" STATUS). A MONOCENTRIC RETROSPECTIVE STUDY

Résumé

Background: The severe acute respiratory failure and hypoxemia induced by the COVID-19 disease has led to a widespread need for mechanical ventilation by orotracheal intubation. However, the choice of a do not intubate (DNI) order is recommended in some cases. This makes non-invasive respiratory support interventions such as high-flow oxygen therapy (HFOT) a possible alternative to invasive ventilation as the highest therapeutic scale in patients with severe COVID-19 infection and a DNI order. There is however a paucity of data on the prognosis of patients requiring HFOT with a DNI. As HFOT is also a limited resource, such data are useful for resource allocation, particularly in a situation of pandemic. Aims: This study aimed to assess the vital prognosis of patients admitted in tertiary care hospital for acute respiratory failure due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection who were offered HFOT as the highest therapeutic scale because of a DNI order. Moreover, other aims are to assess characteristics or comorbidities of these patients associated with mortality and to compare the vital prognosis of these patients to that of patients who were offered HFOT for a SARS-CoV-2 infection but without a DNI order. Methods: We performed a retrospective monocentric cohort study by reviewing the medical charts of patients admitted at the CHU-UCL-Namur-Site Godinne hospital for a SARS-CoV-2 infection who were offered HFOT with a DNI order to assess their prognosis. Prognostic factors are related to patient’s demographic data namely: age, gender, weight, height, living in a health facility, COVID-19 vaccination status; as well as clinical data, in particular comorbidities. Groups comparison followed by multivariate cox regression and ROC analysis were performed to identify predictors of mortality. Results: The results of the comparative analysis in the group of DNI patients indicated, at first a mortality rate of 76.2%. Only age (p = 0.001; r2 change: 0.22) and D-dimers levels (p = 0.0015; r2 change: 0.14) on admission were significantly associated with a higher mortality rate in DNI patients. Furthermore, mortality rate was significantly higher in patients in the DNI group than in those eligible for intubation (76.2% vs. 13%; p

la date de réponse	1 sept. 2023
langue originale	Anglais
L'institution diplômante	Universite de Namur
Superviseur	Eric Marchand (Promoteur)