High-flow nasal oxygen in patients with COVID-19-associated acute respiratory failure
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.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2021 |
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| Erschienen: |
2021 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:25 |
|---|---|
| Enthalten in: |
Critical care (London, England) - 25(2021), 1 vom: 11. Feb., Seite 58 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Mellado-Artigas, Ricard [VerfasserIn] |
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| Links: |
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| Themen: |
Acute hypoxemic respiratory failure |
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| Anmerkungen: |
Date Completed 17.02.2021 Date Revised 10.11.2023 published: Electronic Citation Status MEDLINE |
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| doi: |
10.1186/s13054-021-03469-w |
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| funding: |
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| Förderinstitution / Projekttitel: |
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NLM321337018 |
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| 245 | 1 | 0 | |a High-flow nasal oxygen in patients with COVID-19-associated acute respiratory failure |
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| 500 | |a Date Revised 10.11.2023 | ||
| 500 | |a published: Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 520 | |a 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) | ||
| 520 | |a 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 | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Multicenter Study | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 650 | 4 | |a Acute hypoxemic respiratory failure | |
| 650 | 4 | |a COVID-19 | |
| 650 | 4 | |a High-flow nasal oxygen | |
| 650 | 4 | |a Ventilator-free days | |
| 700 | 1 | |a Ferreyro, Bruno L |e verfasserin |4 aut | |
| 700 | 1 | |a Angriman, Federico |e verfasserin |4 aut | |
| 700 | 1 | |a Hernández-Sanz, María |e verfasserin |4 aut | |
| 700 | 1 | |a Arruti, Egoitz |e verfasserin |4 aut | |
| 700 | 1 | |a Torres, Antoni |e verfasserin |4 aut | |
| 700 | 1 | |a Villar, Jesús |e verfasserin |4 aut | |
| 700 | 1 | |a Brochard, Laurent |e verfasserin |4 aut | |
| 700 | 1 | |a Ferrando, Carlos |e verfasserin |4 aut | |
| 700 | 0 | |a COVID-19 Spanish ICU Network |e verfasserin |4 aut | |
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| 700 | 1 | |a Hernández-Sanz, María |e investigator |4 oth | |
| 700 | 1 | |a Ferrando, Carlos |e investigator |4 oth | |
| 700 | 1 | |a Vendrell, Marina |e investigator |4 oth | |
| 700 | 1 | |a Sánchez-Etayo, Gerard |e investigator |4 oth | |
| 700 | 1 | |a Alcón, Amalia |e investigator |4 oth | |
| 700 | 1 | |a Belda, Isabel |e investigator |4 oth | |
| 700 | 1 | |a Agustí, Mercé |e investigator |4 oth | |
| 700 | 1 | |a Carramiñana, Albert |e investigator |4 oth | |
| 700 | 1 | |a Gracia, Isabel |e investigator |4 oth | |
| 700 | 1 | |a Panzeri, Miriam |e investigator |4 oth | |
| 700 | 1 | |a León, Irene |e investigator |4 oth | |
| 700 | 1 | |a Balust, Jaume |e investigator |4 oth | |
| 700 | 1 | |a Navarro, Ricard |e investigator |4 oth | |
| 700 | 1 | |a Arguís, María José |e investigator |4 oth | |
| 700 | 1 | |a Carretero, María José |e investigator |4 oth | |
| 700 | 1 | |a Ibáñez, Cristina |e investigator |4 oth | |
| 700 | 1 | |a Perdomo, Juan |e investigator |4 oth | |
| 700 | 1 | |a López, Antonio |e investigator |4 oth | |
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| 700 | 1 | |a Martín, Nuria |e investigator |4 oth | |
| 700 | 1 | |a Tercero, Javier |e investigator |4 oth | |
| 700 | 1 | |a Sanahuja, Pepe |e investigator |4 oth | |
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| 700 | 1 | |a Del Rio, Elena |e investigator |4 oth | |
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