Abstract
PurposeWhether 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.MethodsWe 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.ResultsOut 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).ConclusionsThe 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.
Highlights
High-flow nasal oxygen (HFNO) reduces the need for intubation in adult patients with acute respiratory failure [1,2,3,4]
Several studies have shown that the use of invasive mechanical ventilation remains high in this population, and patients usually receive it for prolonged periods of time [14,15,16]
Study outcomes When compared to an early intubation strategy, the use of HFNO was associated with an increase in Ventilator-free day (VFD), and a reduction in intensive care unit (ICU) length of stay
Summary
High-flow nasal oxygen (HFNO) reduces the need for intubation in adult patients with acute respiratory failure [1,2,3,4]. This may in turn help to avoid the associated risks. Ill patients with COVID-19 often have profound hypoxemia which may partially explain the extremely high use of invasive ventilatory support in this patient population. This scenario, combined with the sharp rise in the incidence of COVID-19, has led to an unprecedented pressure on healthcare systems [14, 15, 21,22,23]
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