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Comparative Study
. 2024 Apr 22;29(1):248.
doi: 10.1186/s40001-024-01826-3.

Comparison between high-flow nasal oxygen (HFNO) alternated with non-invasive ventilation (NIV) and HFNO and NIV alone in patients with COVID-19: a retrospective cohort study

Amanda Pereira da Cruz  1 , Gloria Martins  1   2 , Camila Marinelli Martins  3 , Victoria Marques  1   4 , Samantha Christovam  1   4 , Denise Battaglini  5 , Chiara Robba  5   6 , Paolo Pelosi  5   6 , Patricia Rieken Macedo Rocco  1 , Fernanda Ferreira Cruz  1 , Cynthia Dos Santos Samary  1   4 , Pedro Leme Silva  7
Affiliations
Comparative Study

Comparison between high-flow nasal oxygen (HFNO) alternated with non-invasive ventilation (NIV) and HFNO and NIV alone in patients with COVID-19: a retrospective cohort study

Amanda Pereira da Cruz et al. Eur J Med Res. .

Abstract

Background: Non-invasive respiratory support (conventional oxygen therapy [COT], non-invasive ventilation [NIV], high-flow nasal oxygen [HFNO], and NIV alternated with HFNO [NIV + HFNO] may reduce the need for invasive mechanical ventilation (IMV) in patients with COVID-19. The outcome of patients treated non-invasively depends on clinical severity at admission. We assessed the need for IMV according to NIV, HFNO, and NIV + HFNO in patients with COVID-19 according to disease severity and evaluated in-hospital survival rates and hospital and intensive care unit (ICU) lengths of stay.

Methods: This cohort study was conducted using data collected between March 2020 and July 2021. Patients ≥ 18 years admitted to the ICU with a diagnosis of COVID-19 were included. Patients hospitalized for < 3 days, receiving therapy (COT, NIV, HFNO, or NIV + HFNO) for < 48 h, pregnant, and with no primary outcome data were excluded. The COT group was used as reference for multivariate Cox regression model adjustment.

Results: Of 1371 patients screened, 958 were eligible: 692 (72.2%) on COT, 92 (9.6%) on NIV, 31 (3.2%) on HFNO, and 143 (14.9%) on NIV + HFNO. The results for the patients in each group were as follows: median age (interquartile range): NIV (64 [49-79] years), HFNO (62 [55-70] years), NIV + HFNO (62 [48-72] years) (p = 0.615); heart failure: NIV (54.5%), HFNO (36.3%), NIV + HFNO (9%) (p = 0.003); diabetes mellitus: HFNO (17.6%), NIV + HFNO (44.7%) (p = 0.048). > 50% lung damage on chest computed tomography (CT): NIV (13.3%), HFNO (15%), NIV + HFNO (71.6%) (p = 0.038); SpO2/FiO2: NIV (271 [118-365] mmHg), HFNO (317 [254-420] mmHg), NIV + HFNO (229 [102-317] mmHg) (p = 0.001); rate of IMV: NIV (26.1%, p = 0.002), HFNO (22.6%, p = 0.023), NIV + HFNO (46.8%); survival rate: HFNO (83.9%), NIV + HFNO (63.6%) (p = 0.027); ICU length of stay: NIV (8.5 [5-14] days), NIV + HFNO (15 [10-25] days (p < 0.001); hospital length of stay: NIV (13 [10-21] days), NIV + HFNO (20 [15-30] days) (p < 0.001). After adjusting for comorbidities, chest CT score and SpO2/FiO2, the risk of IMV in patients on NIV + HFNO remained high (hazard ratio, 1.88; 95% confidence interval, 1.17-3.04).

Conclusions: In patients with COVID-19, NIV alternating with HFNO was associated with a higher rate of IMV independent of the presence of comorbidities, chest CT score and SpO2/FiO2. Trial registration ClinicalTrials.gov identifier: NCT05579080.

Keywords: COVID-19; High-flow nasal oxygen; Invasive mechanical ventilation; Non-invasive ventilation; Oxygen therapy.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart of the study. COT conventional oxygen therapy, HFNO high-flow nasal oxygen, NIV non-invasive ventilation. The COT group was used as reference for multivariate Cox regression model adjustment
Fig. 2
Fig. 2
Kaplan–Meier curve of the rate of invasive mechanical ventilation rate according to the groups. NIV non-invasive ventilation, HFNO high-flow nasal oxygen
Fig. 3
Fig. 3
Kaplan–Meier curve of the survival rate according to the groups. NIV non-invasive ventilation, HFNO high-flow nasal oxygen
See this image and copyright information in PMC

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