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Open Access 01-12-2021 | COVID-19 | Research

High-flow nasal oxygen in patients with COVID-19-associated acute respiratory failure

Authors: Ricard Mellado-Artigas, Bruno L. Ferreyro, Federico Angriman, María Hernández-Sanz, Egoitz Arruti, Antoni Torres, Jesús Villar, Laurent Brochard, Carlos Ferrando, for the COVID-19 Spanish ICU Network

Published in: Critical Care | Issue 1/2021

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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Title: High-flow nasal oxygen in patients with COVID-19-associated acute respiratory failure
Authors: Ricard Mellado-Artigas
Bruno L. Ferreyro
Federico Angriman
María Hernández-Sanz
Egoitz Arruti
Antoni Torres
Jesús Villar
Laurent Brochard
Carlos Ferrando
for the COVID-19 Spanish ICU Network
Publication date: 01-12-2021
Publisher: BioMed Central
Keyword: COVID-19
Published in: Critical Care / Issue 1/2021
Electronic ISSN: 1364-8535
DOI: https://doi.org/10.1186/s13054-021-03469-w

At a glance: The STEP trials

Springer Medicine

High-flow nasal oxygen in patients with COVID-19-associated acute respiratory failure

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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