Abstract
RationalTo evaluate the respective impact of standard oxygen, high-flow nasal cannula (HFNC) and noninvasive ventilation (NIV) on oxygenation failure rate and mortality in COVID-19 patients admitted to intensive care units (ICUs).MethodsMulticenter, prospective cohort study (COVID-ICU) in 137 hospitals in France, Belgium, and Switzerland. Demographic, clinical, respiratory support, oxygenation failure, and survival data were collected. Oxygenation failure was defined as either intubation or death in the ICU without intubation. Variables independently associated with oxygenation failure and Day-90 mortality were assessed using multivariate logistic regression.ResultsFrom February 25 to May 4, 2020, 4754 patients were admitted in ICU. Of these, 1491 patients were not intubated on the day of ICU admission and received standard oxygen therapy (51%), HFNC (38%), or NIV (11%) (P < 0.001). Oxygenation failure occurred in 739 (50%) patients (678 intubation and 61 death). For standard oxygen, HFNC, and NIV, oxygenation failure rate was 49%, 48%, and 60% (P < 0.001). By multivariate analysis, HFNC (odds ratio [OR] 0.60, 95% confidence interval [CI] 0.36–0.99, P = 0.013) but not NIV (OR 1.57, 95% CI 0.78–3.21) was associated with a reduction in oxygenation failure). Overall 90-day mortality was 21%. By multivariable analysis, HFNC was not associated with a change in mortality (OR 0.90, 95% CI 0.61–1.33), while NIV was associated with increased mortality (OR 2.75, 95% CI 1.79–4.21, P < 0.001).ConclusionIn patients with COVID-19, HFNC was associated with a reduction in oxygenation failure without improvement in 90-day mortality, whereas NIV was associated with a higher mortality in these patients. Randomized controlled trials are needed.
Highlights
Severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) is the causative agent of the ongoing coronavirus disease 2019 (COVID-19) pandemic
high-flow nasal cannula oxygen (HFNC) was not associated with a change in mortality, but noninvasive mechanical ventilation (NIV) was associated with an increased mortality
In patients with acute respiratory failure due to COVID19 and who were not intubated on the day of intensive care unit (ICU) admission, the results of our study showed, for each specific objective, the following: (1) HFNC and NIV, respectively, were used in 38% and 11% of patients, (2) HFNC but not NIV was independently associated with a reduction in oxygenation failure, and (3) HFNC was not associated with a reduction in 90-day mortality, and NIV was associated with increased 90-day mortality
Summary
Severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) is the causative agent of the ongoing coronavirus disease 2019 (COVID-19) pandemic. In patients with de novo acute respiratory failure admitted to the intensive care unit (ICU), high-flow nasal cannula oxygen (HFNC) and noninvasive mechanical ventilation (NIV) improve oxygenation and reduce inspiratory effort and the work of breathing [1,2,3]. Highflow nasal cannula oxygen has shown clinical benefit by reducing the intubation rate [4], and its use is recommended in de novo acute respiratory failure [5]. Noninvasive ventilation decreases the intubation rate [6], but NIV failure and subsequent intubation is associated with higher mortality compared to first-line intubation [7], and NIV is not recommended in de novo acute respiratory failure [6]
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