A randomised controlled trial of high-flow nasal oxygen versus non-rebreathing oxygen face mask therapy in acute hypoxaemic respiratory failure

Background and Aims: A major limitation to providing oxygen therapy by high flow nasal oxygen (HFNO) delivery devices is its availability and therefore as an alternative many clinicians use a standard non rebreathing face mask (NRBM) in order to oxygenate their patients where low-flow nasal oxygen o...

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Bibliographic Details
Published in:Indian journal of anaesthesia 2022-09, Vol.66 (9), p.644-650
Main Authors: Thota, Bhargavi, Samantaray, Aloka, B, Vengamma, Mangu, Hanumantha Rao, Alladi, Mohan, Kalawat, Usha
Format: Article
Language:English
Subjects:
Care and treatment
Clinical trials
Comparative analysis
Coronaviruses
COVID-19
Epidemics
Health aspects
India
Medical research
Medicine, Experimental
Methods
Mortality
Original
Oxygen equipment (Medical care)
Oxygen therapy
Patient outcomes
Respiratory failure
Respiratory insufficiency
Social aspects
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Summary:Background and Aims: A major limitation to providing oxygen therapy by high flow nasal oxygen (HFNO) delivery devices is its availability and therefore as an alternative many clinicians use a standard non rebreathing face mask (NRBM) in order to oxygenate their patients where low-flow nasal oxygen or simple facemask oxygen is not providing adequate respiratory support to achieve the target peripheral oxygen saturation (SpO[sub.2]). We aimed to determine the clinical effectiveness of HFNO versus NRBM in terms of improving patient outcome among patients admitted to our intensive care unit (ICU) during coronavirus disease-2019 (COVID-19) outbreak. Methods: In this prospective open labelled study, 122 COVID-19 patients presenting with acute hypoxaemic respiratory failure (AHRF) were randomised to receive either HFNO or NRBM to achieve the target SpO[sub.2]. The primary clinical outcome measured was device failure rate and secondary outcome was all-cause 28-day mortality rate. Results: The device failure rate was significantly higher in HFNO group (39 versus 21, P = 0.030). Oxygen support with NRBM resulted in a reduced all mortality rate over HFNO (26.2 versus 45) but the mortality rate after treatment failure in either group (HFNO or NRBM) remained high (91 versus 92). Conclusion: Oxygen support with NRBM results in both reduced device failure rate and higher survival among patients of COVID-19 with AHRF. Keywords: Acute hypoxaemic respiratory failure, COVID-19, high flow nasal oxygen, mortality, non-rebreathing mask, treatment failure
ISSN:0019-5049
0976-2817
DOI:10.4103/ija.ija_507_22