Variation in Use of High-Flow Nasal Cannula and Noninvasive Ventilation Among Patients With COVID-19

High-flow nasal oxygen versus conventional oxygen therapy and noninvasive ventilation in COVID-19 respiratory failure: a systematic review and network meta-analysis of randomised controlled trials

“…Of the remaining 34 studies, 26 studies were excluded after full review, leaving eight studies. Among the studies excluded after full-text review, 19 were not RCTs, 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 two were conference abstracts, 27 , 28 and five did not meet inclusion criteria. 29 , 30 , 31 , 32 , 33 The Helmet-COVID RCT, comparing helmet-NIV vs usual respiratory support did not meet inclusion criteria because it included facemask-NIV as part of usual respiratory support.…”

Variation in Sedative and Analgesic Use During the COVID-19 Pandemic and Associated Outcomes

“…Separately, exclusion of hospitals for limited site-level data reporting and fewer than 10 patients meeting inclusion criteria may have affected hospital clustering, primary findings, or both, although these approaches have been applied in prior work within the VIRUS database. 19 , 36 We removed hospitals with very low percentage (< 5%) of mechanically ventilated patients receiving any opioid, which could affect our characterization of sedation practices. However, prior studies among patients with COVID-19 receiving MV demonstrated that opioid analgesia is administered widely (80% of patients received opioid infusions), 8 suggesting that such a low percentage of opioid use could represent a limitation in data collection, rather than a description of true practice.…”

Use of Inhaled Epoprostenol in Patients With COVID-19 Receiving Humidified, High-Flow Nasal Oxygen Is Associated With Progressive Respiratory Failure

“…Finally, although the time to mechanical ventilation may be a factor associated with poor outcomes, trials of HHFNC therapy before invasive mechanical ventilation have been shown to be safe, and in this study, the time to mechanical ventilation was the same between treatment groups, suggesting that optimal therapy was not delayed preferentially between treatment groups. 11 , 12 , 29 …”

“…During the COVID-19 pandemic, use of oxygen delivered by humidified high-flow nasal cannula (HHFNC) for SARS-CoV-2-induced ARDS has increased. 11 , 12 As a result, many clinicians have considered extending the diagnostic criteria of ARDS to include the use of HHFNC in an attempt to identify patients earlier and to facilitate enrollment in research studies. 13 , 14 Use of inhaled pulmonary vasodilators through the HHFNC circuit also has proven to be technically feasible and safe, although with inconsistent effects on gas exchange.…”