Abstract
BackgroundThe efficacy of high flow nasal canula oxygen therapy (HFNO) to prevent invasive mechanical ventilation (IMV) is not well established in severe coronavirus disease 2019 (COVID-19). The aim of this study was to compare the risk of IMV between two strategies of oxygenation (conventional oxygenation and HFNO) in critically ill COVID 19 patients.MethodsThis was a bicenter retrospective study which took place in two intensive care units (ICU) of tertiary hospitals in the Paris region from March 11, to May 3, 2020. We enrolled consecutive patients hospitalized for COVID-19 and acute respiratory failure (ARF) who did not receive IMV at ICU admission. The primary outcome was the rate of IMV after ICU admission. Secondary outcomes were death at day 28 and day 60, length of ICU stay and ventilator-free days at day 28. Data from the HFNO group were compared with those from the standard oxygen therapy (SOT) group using weighted propensity score.ResultsAmong 138 patients who met the inclusion criteria, 62 (45%) were treated with SOT alone, and 76 (55%) with HFNO. In HFNO group, 39/76 (51%) patients received IMV and 46/62 (74%) in SOT group (OR 0.37 [95% CI, 0.18–0.76] p = 0.007). After weighted propensity score, HFNO was still associated with a lower rate of IMV (OR 0.31 [95% CI, 0.14–0.66] p = 0.002). Length of ICU stay and mortality at day 28 and day 60 did not significantly differ between HFNO and SOT groups after weighted propensity score. Ventilator-free days at days 28 was higher in HNFO group (21 days vs 10 days, p = 0.005). In the HFNO group, predictive factors associated with IMV were SAPS2 score (OR 1.13 [95%CI, 1.06–1.20] p = 0.0002) and ROX index > 4.88 (OR 0.23 [95%CI, 0.008–0.64] p = 0.006).ConclusionsHigh flow nasal canula oxygen for ARF due to COVID-19 is associated with a lower rate of invasive mechanical ventilation.
Highlights
The efficacy of high flow nasal canula oxygen therapy (HFNO) to prevent invasive mechanical ventila‐ tion (IMV) is not well established in severe coronavirus disease 2019 (COVID-19)
COVID-19 patients are hospitalized in intensive care unit (ICU) and may require invasive mechanical ventilation (IMV)
A total of 155 COVID-19 patients were admitted in the participating ICUs for COVID-19
Summary
The efficacy of high flow nasal canula oxygen therapy (HFNO) to prevent invasive mechanical ventila‐ tion (IMV) is not well established in severe coronavirus disease 2019 (COVID-19). COVID-19 patients are hospitalized in intensive care unit (ICU) and may require invasive mechanical ventilation (IMV). High flow nasal oxygen (HFNO) is increasingly used for adults hospitalized with ARF. This non-invasive technic delivers warmed, humidified oxygen with a fraction of inspired oxygen (FiO2) up to 1.0 and a maximum flow rate of 60 L/min. In a post hoc subgroup analysis of the Florali study, the use of HFNO reduced the need for IMV in most hypoxemic patients [3]. A recent retrospective study, which deserves to be confirmed, suggested the same benefit in COVID-19 patients [4]
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