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

• Published in: Critical Care 2021, Vol.25 (1)
• Main Authors: Brochard, Laurent, Sánchez-Etayo, Gerard, Navarro, Ricard, Perdomo, Juan, López-Baamonde, Manuel, Ojeda, Antonio, Tercero, Javier, Magaldi, Marta, Martínez-Ocon, Julia, Risco, Raquel, Gómez, Lidia, de Lacy, Francisco Borja de Borja, Martín-Barreda, Daniel, Aliaga, Jorge, Angelès, Gerard Sergi, Arias, Marilyn, Batiste, Guillem, Forné, Daniel, Leyes, Pere, Martínez, José Antonio, Pérez, Manuel, Ãlvarez, Covadonga Peralta, Labrador, Gemma O, Larraéaga, Mireia Pérez, Campos, Alberto Sánchez, Reta, Mikel Celorrio, Aspiazu, Iéaki Ituarte, Núéez, María, Román, Lorena, Albert, Mireia Chanzá, de Heredia, Sandra Beltrán, Contreras, Sergio Marcos, de la Fuente, Ane Martín, Hernando, Alvar Santa Cruz, Rodriguez, Eva Patiéo, Muéoz, Enrique Alday, Serrano, Patricia Ma, Paz, María Luisa Meilan, Candela, Ãngel, Balvis, Alberto José, Martín, María Beltrán, del Mar Carbonell Soto, María, Zaballos, Cristina Cerro, Forero, Ingrid P. Cortes, Triviéo, Javier Felices, Pozuelo, Natalia Ferreiro, Mayo, Diego Gil, Khonsari, Sassan, Herrera, Lisset Miguel, Carbajo, María Montiel, Moradas, Javier Moya, Murias, Mónica Nuéez, Roux, Diego Parise, Rodrigo, Marian Prieto, Esteban, David Rodriguez, Saiz, Ãlvaro Ruigómez, Palero, Noemí Samaranch, Romero, Ana Belén Serrano, de la Torre Concostrina, Marta, Mesa, Eva María Ureta, Ovejero, Soraya Gholamian, Herradon, Patricia Lloreda, Martín, Sonsoles, Bainac, Albert, Lara, Andrea, Baines, Ãéigo Rubio, Trull, Carmen Sala, López, Pablo Montero, Pitarch, Juan Vicente Llau, Alcóver, Fernando Rauer, Martín, Cyntia Sánchez, Moruno, Marta Navas, Coco, Laura Fuentes, Romar, Adrián García, Rodríguez, Eva Mosquera, Castro-Ceoane, Francisco, Gil, Belén Albericio, López, Diego Loscos, Zubizarreta, Ion, Ramos, Jon, Piéeiro, Matilde, cedeéo, Jamil, Garcia-Bernalt, Cristina Cobaleda, Orejuela, Laura Pardo Pinzon, Sira Garcia Aranda Carlos Briones, Malagon, Sara Espejo, Alcaide, María Sanabra Loewe, Laura Grau Torradeflo Lourdes Blanco, Serra, Arantxa Mas, Escoda, Norma Aracil, Peéa, Alicia Ruiz Escobar, Maria Laura Pelegrina López Marina Valenzuela, Abad-Gurumeta, Alfredo, Ruiz, Elena Sáez, de Borja Bau González, Cesar Morcillo Serra Jessica Souto Higueras, Rosario Vicente Raquel Ferrandis, Francisco, Moncho, Azucena Pajares, Puigdollers, Ignacio Moreno, Carlín, Raquel Rey, Aragunde, Sarra Barreiro, Galiana, María, del Rio, Antoni Margarit Válerie Mourre, Muxella, Eva Heras, Vidal, Anna
• Format: Report
• Language: English
• Subjects: Acute respiratory distress syndrome; Care and treatment; Oxygen therapy; Patient outcomes
• ISSN: 1364-8535
• DOI: 10.1186/s13054-021-03469-w

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. Keywords: COVID-19, Acute hypoxemic respiratory failure, High-flow nasal oxygen, Ventilator-free days