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

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  • dc.contributor.author Mellado Artigas, Ricard
  • dc.contributor.author Ferreyro, Bruno Leonel
  • dc.contributor.author Angriman, Federico
  • dc.contributor.author Hernández Sanz, María L.
  • dc.contributor.author Arruti, Egoitz
  • dc.contributor.author Torres, Antoni
  • dc.contributor.author Villar, Jesús
  • dc.contributor.author Brochard, Laurent
  • dc.contributor.author Ferrando, Carlos
  • dc.contributor.author COVID-19 Spanish ICU Network
  • dc.date.accessioned 2022-08-31T07:43:37Z
  • dc.date.available 2022-08-31T07:43:37Z
  • dc.date.issued 2021
  • dc.description.abstract 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.
  • dc.format.mimetype application/pdf
  • dc.identifier.citation Mellado-Artigas R, Ferreyro BL, Angriman F, Hernández-Sanz M, Arruti E, Torres A, Villar J, Brochard L, Ferrando C; COVID-19 Spanish ICU Network. High-flow nasal oxygen in patients with COVID-19-associated acute respiratory failure. Crit Care. 2021 Feb 11;25(1):58. DOI: 10.1186/s13054-021-03469-w
  • dc.identifier.doi http://dx.doi.org/10.1186/s13054-021-03469-w
  • dc.identifier.issn 1364-8535
  • dc.identifier.uri http://hdl.handle.net/10230/53960
  • dc.language.iso eng
  • dc.publisher BioMed Central
  • dc.relation.ispartof Crit Care. 2021 Feb 11;25(1):58
  • dc.rights © The Author(s) 2021. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
  • dc.rights.accessRights info:eu-repo/semantics/openAccess
  • dc.rights.uri http://creativecommons.org/licenses/by/4.0/
  • dc.subject.keyword Acute hypoxemic respiratory failure
  • dc.subject.keyword COVID-19
  • dc.subject.keyword High-flow nasal oxygen
  • dc.subject.keyword Ventilator-free days
  • dc.title High-flow nasal oxygen in patients with COVID-19-associated acute respiratory failure
  • dc.type info:eu-repo/semantics/article
  • dc.type.version info:eu-repo/semantics/publishedVersion

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Articles (Hospital del Mar Research Institute)