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Observational Study
. 2023 Mar 27;108(5):1035-1041.
doi: 10.4269/ajtmh.22-0793. Print 2023 May 3.

Oxygen Consumption with High-Flow Nasal Oxygen versus Mechanical Ventilation- An International Multicenter Observational Study in COVID-19 Patients (PROXY-COVID)

Michela Botta  1 , Oriol Caritg  2 , David M P van Meenen  1 , Andrés Pacheco  2 , Anissa M Tsonas  1 , Willemijn E Mooij  1 , Alessia Burgener  1 , Tosca Manrique Hehl  1 , Gentle S Shrestha  3 , Janneke Horn  1   4 , Pieter R Tuinman  5 , Frederique Paulus  1   6 , Oriol Roca  7   8   9 , Marcus J Schultz  1   10   11
Affiliations
Observational Study

Oxygen Consumption with High-Flow Nasal Oxygen versus Mechanical Ventilation- An International Multicenter Observational Study in COVID-19 Patients (PROXY-COVID)

Michela Botta et al. Am J Trop Med Hyg. .

Abstract

The COVID-19 pandemic led to local oxygen shortages worldwide. To gain a better understanding of oxygen consumption with different respiratory supportive therapies, we conducted an international multicenter observational study to determine the precise amount of oxygen consumption with high-flow nasal oxygen (HFNO) and with mechanical ventilation. A retrospective observational study was conducted in three intensive care units (ICUs) in the Netherlands and Spain. Patients were classified as HFNO patients or ventilated patients, according to the mode of oxygen supplementation with which a patient started. The primary endpoint was actual oxygen consumption; secondary endpoints were hourly and total oxygen consumption during the first two full calendar days. Of 275 patients, 147 started with HFNO and 128 with mechanical ventilation. Actual oxygen use was 4.9-fold higher in patients who started with HFNO than in patients who started with ventilation (median 14.2 [8.4-18.4] versus 2.9 [1.8-4.1] L/minute; mean difference = 11.3 [95% CI 11.0-11.6] L/minute; P < 0.01). Hourly and total oxygen consumption were 4.8-fold (P < 0.01) and 4.8-fold (P < 0.01) higher. Actual oxygen consumption, hourly oxygen consumption, and total oxygen consumption are substantially higher in patients that start with HFNO compared with patients that start with mechanical ventilation. This information may help hospitals and ICUs predicting oxygen needs during high-demand periods and could guide decisions regarding the source of distribution of medical oxygen.

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Figures

Figure 1.
Figure 1.
Consolidated Standards of Reporting Trials flow diagram. ECMO = extracorporeal membrane oxygenation; HFNO = high flow nasal oxygen.
Figure 2.
Figure 2.
Mode of oxygen supplementation over time. HFNO = high flow nasal oxygen.
Figure 3.
Figure 3.
Actual oxygen consumption, fraction of inspired oxygen (FiO2) and airflow/minute volume over time. Panels on the left show the primary analysis, panels on the right show the preplanned subgroup analysis. P values refer to the repeated measures analysis of variance. HFNO = high flow nasal oxygen.
Figure 4.
Figure 4.
Cumulative frequency distribution of actual oxygen use, hourly oxygen use, and total oxygen use. P values refer to the Wilcoxon–Mann–Whitney test. HFNO = high flow nasal oxygen.
See this image and copyright information in PMC

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References

    1. Meara JG. et al., 2015. Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development. Lancet 386: 569–624. - PubMed
    1. Duke T, Graham SM, Cherian MN, Ginsburg AS, English M, Howie S, Peel D, Enarson PM, Wilson IH, Were W; Union Oxygen Systems Working Group , 2010. Oxygen is an essential medicine: a call for international action. Int J Tuberc Lung Dis 14: 1362–1368. - PMC - PubMed
    1. Inglis R, Ayebale E, Schultz MJ, 2019. Optimizing respiratory management in resource-limited settings. Curr Opin Crit Care 25: 45–53. - PMC - PubMed
    1. Stein F, Perry M, Banda G, Woolhouse M, Mutapi F, 2020. Oxygen provision to fight COVID-19 in sub-Saharan Africa. BMJ Glob Health 5: e002786. - PMC - PubMed
    1. Shrestha GS, Lamsal R, 2021. Rational use of oxygen in COVID-19 pandemic – are we doing enough? JNMA J Nepal Med Assoc 59: 429–431. - PMC - PubMed

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