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Observational Study
. 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 #  1 , Arantxa Mas  2 , Cristina González-Isern  3 , Ricard Ferrer  4 , Rafael Máñez  5 , Joan-Ramon Masclans  6 , Elena Sandoval  7 , Paula Vera  8 , Josep Trenado  9 , Rafael Fernández  10 , Josep-Maria Sirvent  11 , Melcior Martínez  12 , Mercedes Ibarz  13 , Pau Garro  14 , José Luis Lopera  15 , María Bodí  16 , Joan Carles Yébenes-Reyes  17 , Carles Triginer  18 , Imma Vallverdú  19 , Anna Baró  20 , Fernanda Bodí  21 , Paula Saludes  22 , Mauricio Valencia  23 , Ferran Roche-Campo  24 , Arturo Huerta  25 , Francisco José Cambra  26 , Carme Barberà  27 , Jorge Echevarria  28 , Óscar Peñuelas  29 , Jordi Mancebo #  30   31 ; UCIsCAT study group
Collaborators, Affiliations
Observational Study

Non-invasive oxygenation support in acutely hypoxemic COVID-19 patients admitted to the ICU: a multicenter observational retrospective study

Pedro David Wendel-Garcia et al. Crit Care. .

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.

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Conflict of interest statement

P.D Wendel-Garcia has nothing to disclose. A. Mas declares teaching fees from Fundació Parc Tauli, outside the submitted work. C. González-Isern has nothing to disclose. R. Ferrer declares personal fees from MSD, GSK, Alexion, Pfizer, Shionogi, Menarini and Gilead, outside the submitted work. R. Máñez has nothing to disclose. J.R. Masclans declares grants and research support from Fisher&Paykel and fees from Dextro payed to his Institution, outside the submitted work. E. Sandoval, P. Vera, J. Trenado, R. Fernández, J.M. Sirvent, M. Martínez, M. Ibarz, P. Garro, J.L. Lopera, M. Bodí, J.C. Yébenes-Reyes, C. Triginer, I. Vallverdú, A. Baró, F. Bodí, P. Saludes, M. Valencia, F. Roche-Campo, A. Huerta, F.J. Cambra, C. Barberá, J. Echeverria, and O. Peñuelas have nothing to disclose. J. Mancebo declares personal fees from Medtronic and Janssen, a research grant from Covidien/Medtronic and the Canadian Institutes of Health Research and he is consultant for Vyaire, all outside the submitted work.

Figures

Fig. 1
Fig. 1
Study flowchart
Fig. 2
Fig. 2
Kaplan–Meier plot of the cumulative proportion of intubation. Kaplan–Meier curve of the cumulative proportion of intubation stratified according to the initial oxygenation support strategy at ICU admission. Oxygen mask, high-flow oxygen therapy and non-invasive ventilation are plotted in red, blue, and green, respectively. p values were calculated by means of the log-rank test. Hazard ratios (HR) were computed using a Cox proportional hazard model and the risk of intubation in the high-flow oxygen therapy and non-invasive ventilation groups was assessed using the oxygen mask group as reference; 95% confidence intervals (CI) are given in parentheses. Table at the bottom presents the patients at risk per time point
Fig. 3
Fig. 3
Kaplan–Meier plot of the cumulative survival in the intensive care unit. Kaplan–Meier curve of the cumulative intensive care survival was stratified according to the initial oxygenation support strategy at admission to the intensive care unit. Subplot (a) refers to all patients included in the analysis. Subplot (b) considers only patients pending probably intubation and invasive mechanical ventilation. Oxygen mask, high-flow oxygen therapy and non-invasive ventilation are plotted in red, blue, and green, respectively. p values were calculated by means of the log-rank test. Hazard ratios (HR) were computed by means of a Cox proportional hazard model. The risk of intensive care unit mortality in the high-flow oxygen therapy and non-invasive ventilation groups was assessed using the oxygen mask group as reference; 95% confidence intervals (CI) are given in parentheses. Table at the bottom shows the patients at risk per time point
See this image and copyright information in PMC

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