High-flow nasal oxygen in patients with COVID-19-associated acute respiratory failure.
Crit Care
; 25(1): 58, 2021 02 11.
Article
in English
| MEDLINE | ID: covidwho-1082883
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.Keywords
Full text:
Available
Collection:
International databases
Database:
MEDLINE
Main subject:
Oxygen Inhalation Therapy
/
Respiratory Distress Syndrome
/
Noninvasive Ventilation
/
COVID-19
Type of study:
Cohort study
/
Experimental Studies
/
Observational study
/
Prognostic study
/
Randomized controlled trials
Topics:
Long Covid
Limits:
Aged
/
Female
/
Humans
/
Male
/
Middle aged
Language:
English
Journal:
Crit Care
Year:
2021
Document Type:
Article
Affiliation country:
S13054-021-03469-w
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