TY - JOUR T1 - Survival rates among COVID-19 patients treated with high flow nasal oxygen therapy with a do-not-intubate-order: an observational study JF - European Respiratory Journal JO - Eur Respir J DO - 10.1183/13993003.congress-2021.PA1762 VL - 58 IS - suppl 65 SP - PA1762 AU - Illaa Smesseim AU - Burak Atasever AU - Lisa Hessels AU - Daniel Korevaar AU - Lieuwe Bos AU - Bram Goorhuis AU - Esther Nossent AU - Kirsten Mooij-Kalverda AU - Peter Bonta Y1 - 2021/09/05 UR - http://erj.ersjournals.com/content/58/suppl_65/PA1762.abstract N2 - Introduction: High-flow nasal oxygen (HFNO) therapy for acute hypoxic failure in COVID-19 patients might avoid the need for intubation. Little is known about the outcomes of HFNO in COVID-19 patients with a do-not-intubate (DNI) order.Aims and objectives: To evaluate the survival rate of COVID-19 patients with a DNI order in whom HFNO was initiated for hypoxic failure.Methods: Multicentre, retrospective, observational study in the Netherlands. Inclusion: COVID-19 patients with a DNI order in whom HFNO for hypoxic failure was initiated between March 2020 and January 2021. 30 day post discharge survival rate and variables associated with survival were assessed, including respiratory rate oxygenation (ROX) index.Results: 56 patients were assessed (median age: 78.0 years (IQR 72,0-81,0), 82.1% male). 16 patients (28.6%) were alive 30 days after discharge. Preliminary univariate analysis showed that median days from admission to start HFNO was shorter among survivors vs non-survivors (2.0 (IQR 0.25-3.75) vs 4.0 (1.0-9.0) days; p<0.05), and showed a better median WHO performance score at admission (0.0 (IQR 0.0-1.0) vs 1.0 (0.5-2.0); p<0.05). Median ROX on day 0 was similar in both groups, but significantly lower in the non-survival group from day 2 onwards. ROX diverted between both groups at day 4, with further decline in non-survivors as opposed to an increase in survivors.Conclusion: This is the first study to describe outcomes of HFNO in COVID-19 patients with a DNI order. Survival rates were moderate. Timing of HFNO initiation, WHO performance score, and failure to increase in ROX after 4 days may help in patient selection and feedback towards treatment.FootnotesCite this article as: European Respiratory Journal 2021; 58: Suppl. 65, PA1762.This abstract was presented at the 2021 ERS International Congress, in session “Prediction of exacerbations in patients with COPD”.This is an ERS International Congress abstract. No full-text version is available. Further material to accompany this abstract may be available at www.ers-education.org (ERS member access only). ER -