Effect on comfort of administering bubble-humidified or dry oxygen: the Oxyrea non-inferiority randomized study

Abstract

BackgroundThe clinical interest of using bubble humidification of oxygen remains controversial. This study was designed to further explore whether delivering dry oxygen instead of bubble-moistened oxygen had an impact on discomfort of ICU patients.MethodsThis randomized multicenter non-inferiority open trial included patients admitted in intensive care unit and receiving oxygen. Any patient receiving non-humidified oxygen (between 0 and 15 L/min) for less than 2 h could participate in the study. Randomization was stratified based on the flow rate at inclusion (less or more than 4 L/min). Discomfort was assessed 6–8 and 24 h after inclusion using a dedicated 15-item scale (quoted from 0 to 150).ResultsThree hundred and fifty-four ICU patients receiving non-humidified oxygen were randomized either in the humidified (HO) (n = 172), using bubble humidifiers, or in the non-humidified (NHO) (n = 182) arms. In modified intention-to-treat analysis at H6–H8, the 15-item score was 26.6 ± 19.4 and 29.8 ± 23.4 in the HO and NHO groups, respectively. The absolute difference between scores in both groups was 3.2 [90% CI 0.0; + 6.5] for a non-inferiority margin of 5.3, meaning that the non-inferiority analysis was not conclusive. This was also true for the subgroups of patients receiving either less or more than 4 L/min of oxygen. At H24, using NHO was not inferior compared to HO in the general population and in the subgroup of patients receiving 4 L/min or less of oxygen. However, for patients receiving more than 4 L/min, a post hoc superiority analysis suggested that patients receiving dry oxygen were less comfortable.ConclusionsOxygen therapy-related discomfort was low. Dry oxygen could not be demonstrated as non-inferior compared to bubble-moistened oxygen after 6–8 h of oxygen administration. At 24 h, dry oxygen was non-inferior compared to bubble-humidified oxygen for flows below 4 L/min.Electronic supplementary materialThe online version of this article (10.1186/s13613-018-0472-9) contains supplementary material, which is available to authorized users.

A Report of Unprovoked Bilateral Epistaxis in Patient with Covid-19: Our Experience

“…Furthermore, the patient had no history of use of anticoagulants or antiplatelet drugs before the onset of the sudden epistaxis, this reports contrast the observation from another study were most of the patients who had spontaneous epistaxis reported taking anticoagulants or antiplatelet prior to the onset of COVID-19 [16]. Also of note, all the patient in the aforementioned study had a risk factor of use of non-humidified oxygen therapy during their stay in the hospital, this factors have been implicated as a major cause of spontaneous epistaxis in other studies [17][18][19]. This report further adds to the fact that COVID-19 is a novel disease that still needs further population survey to clearly highlight all its clinical features.…”

Epistaxis in hospitalized patients with COVID-19

“…All of our patients were receiving non-humidified oxygen either via a low-flow nasal cannula or continuous positive expiratory pressure via a helmet. Such treatments are known risk factors for nasal dryness, 6 – 8 and prolonged oxygenation will increase the risk of crust formation, which will then weaken the nasal mucosa and expose the patient to an increased risk of nasal bleeding. A second risk factor in this specific population is the use of anticoagulant drugs.…”

AARC Clinical Practice Guideline: Management of Adult Patients With Oxygen in the Acute Care Setting

“…Poiroux et al, 2018 67 Standard oxygen via NC or simple face mask with humidification Mortality, escalation of care, and subjects complications were not statistically different between humidified and nonhumidified cohorts.…”

“…Even given the above evidence, studies have not been able to determine that nonhumidified supplemental oxygen is inferior to humidified supplemental oxygen. Poiroux et al 67 studied humidified and nonhumidified oxygen delivered via nasal cannula at various flows. They reported that nonhumidified oxygen at flows > 4 L/min may be associated with higher levels of discomfort but, overall, oxygen therapy-related discomfort was low.…”