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Multicenter Study
. 2024 Jul 15;25(1):279.
doi: 10.1186/s12931-024-02873-4.

Effect of noninvasive ventilation on mortality and clinical outcomes among patients with severe hypoxemic COVID-19 pneumonia after high-flow nasal oxygen failure: a multicenter retrospective French cohort with propensity score analysis

Antoine Goury  1 , Zeyneb Houlla  2 , Mathieu Jozwiak  3   4 , Tomas Urbina  5 , Matthieu Turpin  6 , Alexandra Lavalard  7 , Driss Laghlam  8 , Sebastian Voicu  9 , Jeremy Rosman  10 , Claire Coutureau  11   12 , Bruno Mourvillier  2   13
Affiliations
Multicenter Study

Effect of noninvasive ventilation on mortality and clinical outcomes among patients with severe hypoxemic COVID-19 pneumonia after high-flow nasal oxygen failure: a multicenter retrospective French cohort with propensity score analysis

Antoine Goury et al. Respir Res. .

Abstract

Background: We assessed the effect of noninvasive ventilation (NIV) on mortality and length of stay after high flow nasal oxygenation (HFNO) failure among patients with severe hypoxemic COVID-19 pneumonia.

Methods: In this multicenter, retrospective study, we enrolled COVID-19 patients admitted in intensive care unit (ICU) for severe COVID-19 pneumonia with a HFNO failure from December 2020 to January 2022. The primary outcome was to compare the 90-day mortality between patients who required a straight intubation after HFNO failure and patients who received NIV after HFNO failure. Secondary outcomes included ICU and hospital length of stay. A propensity score analysis was performed to control for confounding factors between groups. Exploratory outcomes included a subgroup analysis for 90-day mortality.

Results: We included 461 patients with HFNO failure in the analysis, 233 patients in the straight intubation group and 228 in the NIV group. The 90-day mortality did not significantly differ between groups, 58/228 (25.4%) int the NIV group compared with 59/233 (25.3%) in the straight intubation group, with an adjusted hazard ratio (HR) after propensity score weighting of 0.82 [95%CI, 0.50-1.35] (p = 0.434). ICU length of stay was significantly shorter in the NIV group compared to the straight intubation group, 10.0 days [IQR, 7.0-19.8] versus 18.0 days [IQR,11.0-31.0] with a propensity score weighted HR of 1.77 [95%CI, 1.29-2.43] (p < 0.001). A subgroup analysis showed a significant increase in mortality rate for intubated patients in the NIV group with 56/122 (45.9%), compared to 59/233 (25.3%) for patients in the straight intubation group (p < 0.001).

Conclusions: In severely hypoxemic COVID-19 patients, no significant differences were observed on 90-day mortality between patients receiving straight intubation and those receiving NIV after HFNO failure. NIV strategy was associated with a significant reduction in ICU length of stay, despite an increase in mortality in the subgroup of patients finally intubated.

Keywords: Acute respiratory distress syndrome; Acute respiratory failure; COVID-19; High flow oxygen therapy; Intubation; Mortality; Noninvasive ventilation; Outcomes.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flow chart ICU: intensive care unit, HFNO: high-flow nasal oxygen, NIV: noninvasive ventilation
Fig. 2
Fig. 2
Comparison of Kaplan-Meier survival curves between straight intubation after HFNO failure group and NIV after HFNO failure group. Abbreviations: HFNO: high flow nasal oxygenation. NIV: noninvasive ventilation
See this image and copyright information in PMC

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