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- Title
High-flow nasal oxygen in patients with COVID-19-associated acute respiratory failure.
- Authors
Mellado-Artigas, Ricard; Ferreyro, Bruno L.; Angriman, Federico; Hernández-Sanz, María; Arruti, Egoitz; Torres, Antoni; Villar, Jesús; Brochard, Laurent; Ferrando, Carlos; for the COVID-19 Spanish ICU Network; Vendrell, Marina; Sánchez-Etayo, Gerard; Alcón, Amalia; Belda, Isabel; Agustí, Mercé; Carramiñana, Albert; Gracia, Isabel; Panzeri, Miriam; León, Irene; Balust, Jaume
- Abstract
<bold>Purpose: </bold>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.<bold>Methods: </bold>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.<bold>Results: </bold>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).<bold>Conclusions: </bold>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.
- Publication
Critical Care, 2021, Vol 25, Issue 1, p1
- ISSN
1364-8535
- Publication type
journal article
- DOI
10.1186/s13054-021-03469-w