tetano
Editor, Senior Moderator
Respir Care
. 2021 Sep 28;respcare.09130.
doi: 10.4187/respcare.09130. Online ahead of print.
Comparison of High-Flow Nasal Cannula and Noninvasive Ventilation in Acute Hypoxemic Respiratory Failure Due to Severe COVID-19 Pneumonia
Parvathy Ramachandran Nair[SUP] 1 [/SUP], Damarla Haritha[SUP] 1 [/SUP], Srikant Behera[SUP] 1 [/SUP], Choro Athiphro Kayina[SUP] 1 [/SUP], Souvik Maitra[SUP] 1 [/SUP], Rahul Kumar Anand[SUP] 1 [/SUP], Bikash Ranjan Ray[SUP] 1 [/SUP], Manish Soneja[SUP] 1 [/SUP], Rajeshwari Subramaniam[SUP] 1 [/SUP], Dalim Kumar Baidya[SUP] 2 [/SUP]
Affiliations
Abstract
Background: Efficacy of high-flow nasal cannula (HFNC) over noninvasive ventilation (NIV) in severe coronavirus disease 2019 (COVID-19) pneumonia is not known. We aimed to assess the incidence of invasive mechanical ventilation in patients with acute hypoxemic respiratory failure due to COVID-19 treated with either HFNC or NIV.
Methods: This was a single-center randomized controlled trial performed in the COVID-19 ICU of a tertiary care teaching hospital in New Delhi, India. One hundred and nine subjects with severe COVID-19 pneumonia presenting with acute hypoxemic respiratory failure were recruited and allocated to either HFNC (n = 55) or NIV (n = 54) arm. Primary outcome was intubation by 48 h. Secondary outcomes were improvement in oxygenation by 48 h, intubation rate at day 7, and in-hospital mortality.
Results: Baseline characteristics and P[SUB]aO[SUB]2[/SUB][/SUB] /F[SUB]IO[SUB]2[/SUB][/SUB] ratio were similar in both the groups. Intubation rate at 48 h was similar between the groups (33% NIV vs 20% HFNC, relative risk 0.6, 95% CI 0.31-1.15, P = .12). Intubation rate at day 7 was lower in the HFNC (27.27%) compared to the NIV group (46.29%) (relative risk 0.59, 95% CI 0.35-0.99, P = .045), and this difference remained significant after adjustment for the incidence of chronic kidney disease and the arterial pH (adjusted OR 0.40, 95% CI 0.17-0.93, P = .03). Hospital mortality was similar between HFNC (29.1%) and NIV (46.2%) group (relative risk 0.6, 95% CI 0.38-1.04, P = .06).
Conclusions: We were not able to demonstrate a statistically significant improvement of oxygenation parameters nor of the intubation rate at 48 h between NIV and HFNC. These findings should be further tested in a larger randomized controlled trial.The study was registered at the Clinical Trials Registry of India (www.ctri.nic.in; reference number: CTRI/2020/07/026835) on July 27, 2020.
Keywords: high-flow nasal cannula; HFNC; NIV; acute respiratory failure; coronavirus disease 2019; noninvasive ventilation.
. 2021 Sep 28;respcare.09130.
doi: 10.4187/respcare.09130. Online ahead of print.
Comparison of High-Flow Nasal Cannula and Noninvasive Ventilation in Acute Hypoxemic Respiratory Failure Due to Severe COVID-19 Pneumonia
Parvathy Ramachandran Nair[SUP] 1 [/SUP], Damarla Haritha[SUP] 1 [/SUP], Srikant Behera[SUP] 1 [/SUP], Choro Athiphro Kayina[SUP] 1 [/SUP], Souvik Maitra[SUP] 1 [/SUP], Rahul Kumar Anand[SUP] 1 [/SUP], Bikash Ranjan Ray[SUP] 1 [/SUP], Manish Soneja[SUP] 1 [/SUP], Rajeshwari Subramaniam[SUP] 1 [/SUP], Dalim Kumar Baidya[SUP] 2 [/SUP]
Affiliations
- PMID: 34584010
- DOI: 10.4187/respcare.09130
Abstract
Background: Efficacy of high-flow nasal cannula (HFNC) over noninvasive ventilation (NIV) in severe coronavirus disease 2019 (COVID-19) pneumonia is not known. We aimed to assess the incidence of invasive mechanical ventilation in patients with acute hypoxemic respiratory failure due to COVID-19 treated with either HFNC or NIV.
Methods: This was a single-center randomized controlled trial performed in the COVID-19 ICU of a tertiary care teaching hospital in New Delhi, India. One hundred and nine subjects with severe COVID-19 pneumonia presenting with acute hypoxemic respiratory failure were recruited and allocated to either HFNC (n = 55) or NIV (n = 54) arm. Primary outcome was intubation by 48 h. Secondary outcomes were improvement in oxygenation by 48 h, intubation rate at day 7, and in-hospital mortality.
Results: Baseline characteristics and P[SUB]aO[SUB]2[/SUB][/SUB] /F[SUB]IO[SUB]2[/SUB][/SUB] ratio were similar in both the groups. Intubation rate at 48 h was similar between the groups (33% NIV vs 20% HFNC, relative risk 0.6, 95% CI 0.31-1.15, P = .12). Intubation rate at day 7 was lower in the HFNC (27.27%) compared to the NIV group (46.29%) (relative risk 0.59, 95% CI 0.35-0.99, P = .045), and this difference remained significant after adjustment for the incidence of chronic kidney disease and the arterial pH (adjusted OR 0.40, 95% CI 0.17-0.93, P = .03). Hospital mortality was similar between HFNC (29.1%) and NIV (46.2%) group (relative risk 0.6, 95% CI 0.38-1.04, P = .06).
Conclusions: We were not able to demonstrate a statistically significant improvement of oxygenation parameters nor of the intubation rate at 48 h between NIV and HFNC. These findings should be further tested in a larger randomized controlled trial.The study was registered at the Clinical Trials Registry of India (www.ctri.nic.in; reference number: CTRI/2020/07/026835) on July 27, 2020.
Keywords: high-flow nasal cannula; HFNC; NIV; acute respiratory failure; coronavirus disease 2019; noninvasive ventilation.