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High-flow nasal oxygen in patients with COVID-19-associated acute respiratory failure.
Mellado-Artigas, Ricard; Ferreyro, Bruno L; Angriman, Federico; Hernández-Sanz, María; Arruti, Egoitz; Torres, Antoni; Villar, Jesús; Brochard, Laurent; Ferrando, Carlos.
  • Mellado-Artigas R; Department of Anesthesiology and Critical Care, Institut D'investigació August Pi I Sunyer, Hospital Clínic, Villarroel 170, 08025, Barcelona, Spain. rmartigas@gmail.com.
  • Ferreyro BL; Department of Medicine, Sinai Health System and University Health Network, Toronto, Canada.
  • Angriman F; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada.
  • Hernández-Sanz M; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada.
  • Arruti E; Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada.
  • Torres A; Department of Anesthesiology and Critical Care, Hospital de Cruces, Vizcaya, Spain.
  • Villar J; Ubikare Technology, Vizcaya, Spain.
  • Brochard L; Department of Respirology, Hospital Clínic, Institut D'investigació August Pi i Sunyer, Barcelona, Spain.
  • Ferrando C; CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain.
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.
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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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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