tetano
Editor, Senior Moderator
Crit Care
. 2022 Feb 8;26(1):37.
doi: 10.1186/s13054-022-03905-5.
Non-invasive oxygenation support in acutely hypoxemic COVID-19 patients admitted to the ICU: a multicenter observational retrospective study
Pedro David Wendel-Garcia[SUP] #[/SUP][SUP] 1 [/SUP], Arantxa Mas[SUP] 2 [/SUP], Cristina González-Isern[SUP] 3 [/SUP], Ricard Ferrer[SUP] 4 [/SUP], Rafael Máñez[SUP] 5 [/SUP], Joan-Ramon Masclans[SUP] 6 [/SUP], Elena Sandoval[SUP] 7 [/SUP], Paula Vera[SUP] 8 [/SUP], Josep Trenado[SUP] 9 [/SUP], Rafael Fernández[SUP] 10 [/SUP], Josep-Maria Sirvent[SUP] 11 [/SUP], Melcior Martínez[SUP] 12 [/SUP], Mercedes Ibarz[SUP] 13 [/SUP], Pau Garro[SUP] 14 [/SUP], José Luis Lopera[SUP] 15 [/SUP], María Bodí[SUP] 16 [/SUP], Joan Carles Yébenes-Reyes[SUP] 17 [/SUP], Carles Triginer[SUP] 18 [/SUP], Imma Vallverdú[SUP] 19 [/SUP], Anna Baró[SUP] 20 [/SUP], Fernanda Bodí[SUP] 21 [/SUP], Paula Saludes[SUP] 22 [/SUP], Mauricio Valencia[SUP] 23 [/SUP], Ferran Roche-Campo[SUP] 24 [/SUP], Arturo Huerta[SUP] 25 [/SUP], Francisco José Cambra[SUP] 26 [/SUP], Carme Barberà[SUP] 27 [/SUP], Jorge Echevarria[SUP] 28 [/SUP], Óscar Peñuelas[SUP] 29 [/SUP], Jordi Mancebo[SUP] #[/SUP][SUP] 30 31 [/SUP], UCIsCAT study group
Collaborators, Affiliations
Abstract
Background: Non-invasive oxygenation strategies have a prominent role in the treatment of acute hypoxemic respiratory failure during the coronavirus disease 2019 (COVID-19). While the efficacy of these therapies has been studied in hospitalized patients with COVID-19, the clinical outcomes associated with oxygen masks, high-flow oxygen therapy by nasal cannula and non-invasive mechanical ventilation in critically ill intensive care unit (ICU) patients remain unclear.
Methods: In this retrospective study, we used the best of nine covariate balancing algorithms on all baseline covariates in critically ill COVID-19 patients supported with > 10 L of supplemental oxygen at one of the 26 participating ICUs in Catalonia, Spain, between March 14 and April 15, 2020.
Results: Of the 1093 non-invasively oxygenated patients at ICU admission treated with one of the three stand-alone non-invasive oxygenation strategies, 897 (82%) required endotracheal intubation and 310 (28%) died during the ICU stay. High-flow oxygen therapy by nasal cannula (n = 439) and non-invasive mechanical ventilation (n = 101) were associated with a lower rate of endotracheal intubation (70% and 88%, respectively) than oxygen masks (n = 553 and 91% intubated), p < 0.001. Compared to oxygen masks, high-flow oxygen therapy by nasal cannula was associated with lower ICU mortality (hazard ratio 0.75 [95% CI 0.58-0.98), and the hazard ratio for ICU mortality was 1.21 [95% CI 0.80-1.83] for non-invasive mechanical ventilation.
Conclusion: In critically ill COVID-19 ICU patients and, in the absence of conclusive data, high-flow oxygen therapy by nasal cannula may be the approach of choice as the primary non-invasive oxygenation support strategy.
Keywords: Acute hypoxemic respiratory failure; COVID-19; Intensive care; Non-invasive oxygenation.
. 2022 Feb 8;26(1):37.
doi: 10.1186/s13054-022-03905-5.
Non-invasive oxygenation support in acutely hypoxemic COVID-19 patients admitted to the ICU: a multicenter observational retrospective study
Pedro David Wendel-Garcia[SUP] #[/SUP][SUP] 1 [/SUP], Arantxa Mas[SUP] 2 [/SUP], Cristina González-Isern[SUP] 3 [/SUP], Ricard Ferrer[SUP] 4 [/SUP], Rafael Máñez[SUP] 5 [/SUP], Joan-Ramon Masclans[SUP] 6 [/SUP], Elena Sandoval[SUP] 7 [/SUP], Paula Vera[SUP] 8 [/SUP], Josep Trenado[SUP] 9 [/SUP], Rafael Fernández[SUP] 10 [/SUP], Josep-Maria Sirvent[SUP] 11 [/SUP], Melcior Martínez[SUP] 12 [/SUP], Mercedes Ibarz[SUP] 13 [/SUP], Pau Garro[SUP] 14 [/SUP], José Luis Lopera[SUP] 15 [/SUP], María Bodí[SUP] 16 [/SUP], Joan Carles Yébenes-Reyes[SUP] 17 [/SUP], Carles Triginer[SUP] 18 [/SUP], Imma Vallverdú[SUP] 19 [/SUP], Anna Baró[SUP] 20 [/SUP], Fernanda Bodí[SUP] 21 [/SUP], Paula Saludes[SUP] 22 [/SUP], Mauricio Valencia[SUP] 23 [/SUP], Ferran Roche-Campo[SUP] 24 [/SUP], Arturo Huerta[SUP] 25 [/SUP], Francisco José Cambra[SUP] 26 [/SUP], Carme Barberà[SUP] 27 [/SUP], Jorge Echevarria[SUP] 28 [/SUP], Óscar Peñuelas[SUP] 29 [/SUP], Jordi Mancebo[SUP] #[/SUP][SUP] 30 31 [/SUP], UCIsCAT study group
Collaborators, Affiliations
- PMID: 35135588
- DOI: 10.1186/s13054-022-03905-5
Abstract
Background: Non-invasive oxygenation strategies have a prominent role in the treatment of acute hypoxemic respiratory failure during the coronavirus disease 2019 (COVID-19). While the efficacy of these therapies has been studied in hospitalized patients with COVID-19, the clinical outcomes associated with oxygen masks, high-flow oxygen therapy by nasal cannula and non-invasive mechanical ventilation in critically ill intensive care unit (ICU) patients remain unclear.
Methods: In this retrospective study, we used the best of nine covariate balancing algorithms on all baseline covariates in critically ill COVID-19 patients supported with > 10 L of supplemental oxygen at one of the 26 participating ICUs in Catalonia, Spain, between March 14 and April 15, 2020.
Results: Of the 1093 non-invasively oxygenated patients at ICU admission treated with one of the three stand-alone non-invasive oxygenation strategies, 897 (82%) required endotracheal intubation and 310 (28%) died during the ICU stay. High-flow oxygen therapy by nasal cannula (n = 439) and non-invasive mechanical ventilation (n = 101) were associated with a lower rate of endotracheal intubation (70% and 88%, respectively) than oxygen masks (n = 553 and 91% intubated), p < 0.001. Compared to oxygen masks, high-flow oxygen therapy by nasal cannula was associated with lower ICU mortality (hazard ratio 0.75 [95% CI 0.58-0.98), and the hazard ratio for ICU mortality was 1.21 [95% CI 0.80-1.83] for non-invasive mechanical ventilation.
Conclusion: In critically ill COVID-19 ICU patients and, in the absence of conclusive data, high-flow oxygen therapy by nasal cannula may be the approach of choice as the primary non-invasive oxygenation support strategy.
Keywords: Acute hypoxemic respiratory failure; COVID-19; Intensive care; Non-invasive oxygenation.