Abstract
We aimed to compare the mortality and comfort associated with high-flow nasal cannula oxygenation (HFNCO) and high-concentration mask (HCM) in older SARS-CoV-2 infected patients who were hospitalized in non-intensive care units. In this retrospective cohort study, we included all consecutive patients aged 75 years and older who were hospitalized for acute respiratory failure (ARF) in either an acute geriatric unit or an acute pulmonary care unit, and tested positive for SARS-CoV-2. We compared the in-hospital prognosis between patients treated with HFNCO and patients treated with HCM. To account for confounders, we created a propensity score for HFNCO, and stabilizing inverse probability of treatment weighting (SIPTW) was applied. From March 2020 to January 2021, 67 patients (median age 87 years, 41 men) were hospitalized with SARS-CoV-2-related ARF, of whom 41 (61%) received HFNCO and 26 (39%) did not. Age and comorbidities did not significantly differ in the two groups, whereas clinical presentation was more severe in the HFNCO group (NEW2 score: 8 (5–11) vs. 7 (5–8), p = 0.02, and Sp02/Fi02: 88 (98–120) vs. 117 (114–148), p = 0.03). Seven (17%) vs. two (5%) patients survived at 30 days in the HFNCO and HCM group, respectively. Overall, after SIPTW, HFNCO was significantly associated with greater survival (adjusted hazard ratio (AHR) 0.57, 95% CI 0.33–0.99; p = 0.04). HFNCO use was associated with a lower need for morphine (AHR 0.39, 95% CI 0.21–0.71; p = 0.005), but not for midazolam (AHR 0.66, 95% CI 0.37–1.19; p = 0.17). In conclusion, HFNCO use in non-intensive care units may reduce mortality and discomfort in older inpatients with SARS-CoV-2-related ARF.
Highlights
SARS-CoV-2 has infected millions of individuals worldwide, but its burden has been heavy in the older population
We aimed to investigate the impact of high-flow nasal cannula oxygenation (HFNCO) compared to highconcentration mask (HCM) oxygen therapy on the survival and comfort of patients hospitalized for SARS-CoV-2-related acute respiratory failure (ARF) outside the intensive care units (ICUs)
Morphine is used to relieve the symptoms of dyspnea and enhance comfort in ARF [12]; we aimed to evaluate the impact on dyspnea by comparing the morphine prescription between the two groups
Summary
SARS-CoV-2 has infected millions of individuals worldwide, but its burden has been heavy in the older population. Most deaths are the result of acute respiratory failure (ARF) linked to viral pneumonia, for which optimal therapeutic management is still a matter of debate. Many of these patients are admitted to intensive care units (ICUs) because they require mechanical ventilation. Older patients with ARF are frequently hospitalized outside the ICU, requiring alternatives to tracheal intubation. In this context, aside from drug therapies, high-flow nasal cannula oxygenation (HFNCO) was suggested as a promising non-invasive tool for SARS-CoV-2-related ARF [4]
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