High-flow nasal oxygen in patients with COVID-19-associated acute respiratory failure

Abstract

Purpose Whether the use of high-flow nasal oxygen in adult patients with COVID-19 associated acute respiratory failure improves clinically relevant outcomes remains unclear. We thus sought to assess the effect of high-flow nasal oxygen on ventilator-free days, compared to early initiation of invasive mechanical ventilation, on adult patients with COVID-19. Methods We conducted a multicentre cohort study using a prospectively collected database of patients with COVID-19 associated acute respiratory failure admitted to 36 Spanish and Andorran intensive care units (ICUs). Main exposure was the use of high-flow nasal oxygen (conservative group), while early invasive mechanical ventilation (within the first day of ICU admission; early intubation group) served as the comparator. The primary outcome was ventilator-free days at 28 days. ICU length of stay and all-cause in-hospital mortality served as secondary outcomes. We used propensity score matching to adjust for measured confounding. Results Out of 468 eligible patients, a total of 122 matched patients were included in the present analysis (61 for each group). When compared to early intubation, the use of high-flow nasal oxygen was associated with an increase in ventilator-free days (mean difference: 8.0 days; 95% confidence interval (CI): 4.4 to 11.7 days) and a reduction in ICU length of stay (mean difference: − 8.2 days; 95% CI − 12.7 to − 3.6 days). No difference was observed in all-cause in-hospital mortality between groups (odds ratio: 0.64; 95% CI: 0.25 to 1.64). Conclusions The use of high-flow nasal oxygen upon ICU admission in adult patients with COVID-19 related acute hypoxemic respiratory failure may lead to an increase in ventilator-free days and a reduction in ICU length of stay, when compared to early initiation of invasive mechanical ventilation. Future studies should confirm our findings.

Effect of Helmet Noninvasive Ventilation vs High-Flow Nasal Oxygen on Days Free of Respiratory Support in Patients With COVID-19 and Moderate to Severe Hypoxemic Respiratory Failure

“…Monitoring of patients receiving noninvasive support during acute hypoxemic respiratory failure remains of paramount importance not to delay endotracheal intubation and protective ventilation. 9 The study has several strengths: the randomized multicenter design with reproducible enrollment criteria, welldefined treatment protocols that can be applied in other intensive care units, strict prespecified criteria for defining the need for endotracheal intubation, and a process of external vali-dation by 3 independent experts to verify the adherence to such criteria for intubated patients.…”

Predictors of failure of high flow nasal cannula failure in acute hypoxemic respiratory failure due to COVID-19

“…Mellado-Artigas’ et al, demonstrated that HFNC might decrease ventilator days, ICU length of days and all-cause-hospital mortality but their cohort had lower SOFA scores, BMIs and utilized higher flows. 18 A systematic review done found that HFNC may reduce the need for IMV but there was no difference in mortality or length of stay and the studies included did not pertain exclusively to COVID-19. 19 …”

Clinical characteristics and outcomes of hospitalized COVID-19 patients with COPD

“…SARS-CoV-2 can cause serious damage to the respiratory system, particularly with the development of pneumonia. Severe hypoxemia affected most of the patients with COVID-19 who were admitted to critical care, which makes it an important predictor of mortality in critically ill patients [ 28 ]. Therefore, clinicians should be more cautious in initially hypoxemic patients infected with SARS-CoV-2, particularly those with preexisting chronic lung disease, owing to the possibility of a poor prognosis.…”