TY - JOUR
T1 - High-Flow Nasal Oxygen for Severe Hypoxemia Oxygenation Response and Outcome in Patients with COVID-19
AU - Ranieri, V. Marco
AU - Tonetti, Tommaso
AU - Navalesi, Paolo
AU - Nava, Stefano
AU - Antonelli, Massimo
AU - Pesenti, Antonio
AU - Grasselli, Giacomo
AU - Grieco, Domenico Luca
AU - Menga, Luca Salvatore
AU - Pisani, Lara
AU - Boscolo, Annalisa
AU - Sella, Nicolò
AU - Pasin, Laura
AU - Mega, Chiara
AU - Pizzilli, Giacinto
AU - Dell’Olio, Alessio
AU - Dongilli, Roberto
AU - Rucci, Paola
AU - Slutsky, Arthur S.
N1 - Funding Information:
This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0. For commercial usage and reprints, please contact Diane Gern (dgern@thoracic.org). Supported in part by Progetti di Ricerca di Interesse Nazionale, Ministero dell’Istruzione, dell’Università e della Ricerca (PRIN 2017, project J4BE7A) of the Italian Ministry of University; Ricerca Finalizzata of the Italian Ministry of Health, Ministero della Salute (project PB-0154 PROGETTO COVID-2020-12371675); and the Canadian Institutes of Health Research (grants 137772 and OV3-170344).
Publisher Copyright:
Copyright © 2022 by the American Thoracic Society.
PY - 2022/2/15
Y1 - 2022/2/15
N2 - Rationale: The “Berlin definition” of acute respiratory distress syndrome (ARDS) does not allow inclusion of patients receiving high-flow nasal oxygen (HFNO). However, several articles have proposed that criteria for defining ARDS should be broadened to allow inclusion of patients receiving HFNO. Objectives: To compare the proportion of patients fulfilling ARDS criteria during HFNO and soon after intubation, and 28-day mortality between patients treated exclusively with HFNO and patients transitioned from HFNO to invasive mechanical ventilation (IMV). Methods: From previously published studies, we analyzed patients with coronavirus disease (COVID-19) who had PaO2/FIO2 of <300 while treated with >40 L/min HFNO, or noninvasive ventilation (NIV) with positive end-expiratory pressure of >5 cm H2O (comparator). In patients transitioned from HFNO/NIV to invasive mechanical ventilation (IMV), we compared ARDS severity during HFNO/NIV and soon after IMV. We compared 28-day mortality in patients treated exclusively with HFNO/NIV versus patients transitioned to IMV. Measurements and Main Results: We analyzed 184 and 131 patients receiving HFNO or NIV, respectively. A total of 112 HFNO and 69 NIV patients transitioned to IMV. Of those, 104 (92.9%) patients on HFNO and 66 (95.7%) on NIV continued to have PaO2/FIO2 <300 under IMV. Twenty-eight-day mortality in patients who remained on HFNO was 4.2% (3/72), whereas in patients transitioned from HFNO to IMV, it was 28.6% (32/112) (P, 0.001). Twenty-eight-day mortality in patients who remained on NIV was 1.6% (1/62), whereas in patients who transitioned from NIV to IMV, it was 44.9% (31/69) (P, 0.001). Overall mortality was 19.0% (35/184) and 24.4% (32/131) for HFNO and NIV, respectively (P = 0.2479). Conclusions: Broadening the ARDS definition to include patients on HFNO with PaO2/FIO2 <300 may identify patients at earlier stages of disease but with lower mortality.
AB - Rationale: The “Berlin definition” of acute respiratory distress syndrome (ARDS) does not allow inclusion of patients receiving high-flow nasal oxygen (HFNO). However, several articles have proposed that criteria for defining ARDS should be broadened to allow inclusion of patients receiving HFNO. Objectives: To compare the proportion of patients fulfilling ARDS criteria during HFNO and soon after intubation, and 28-day mortality between patients treated exclusively with HFNO and patients transitioned from HFNO to invasive mechanical ventilation (IMV). Methods: From previously published studies, we analyzed patients with coronavirus disease (COVID-19) who had PaO2/FIO2 of <300 while treated with >40 L/min HFNO, or noninvasive ventilation (NIV) with positive end-expiratory pressure of >5 cm H2O (comparator). In patients transitioned from HFNO/NIV to invasive mechanical ventilation (IMV), we compared ARDS severity during HFNO/NIV and soon after IMV. We compared 28-day mortality in patients treated exclusively with HFNO/NIV versus patients transitioned to IMV. Measurements and Main Results: We analyzed 184 and 131 patients receiving HFNO or NIV, respectively. A total of 112 HFNO and 69 NIV patients transitioned to IMV. Of those, 104 (92.9%) patients on HFNO and 66 (95.7%) on NIV continued to have PaO2/FIO2 <300 under IMV. Twenty-eight-day mortality in patients who remained on HFNO was 4.2% (3/72), whereas in patients transitioned from HFNO to IMV, it was 28.6% (32/112) (P, 0.001). Twenty-eight-day mortality in patients who remained on NIV was 1.6% (1/62), whereas in patients who transitioned from NIV to IMV, it was 44.9% (31/69) (P, 0.001). Overall mortality was 19.0% (35/184) and 24.4% (32/131) for HFNO and NIV, respectively (P = 0.2479). Conclusions: Broadening the ARDS definition to include patients on HFNO with PaO2/FIO2 <300 may identify patients at earlier stages of disease but with lower mortality.
KW - ARDS
KW - COVID-19
KW - HFNO
KW - Mechanical ventilation
KW - Noninvasive ventilation
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U2 - 10.1164/rccm.202109-2163OC
DO - 10.1164/rccm.202109-2163OC
M3 - Article
C2 - 34861135
AN - SCOPUS:85124633254
SN - 1073-449X
VL - 205
SP - 431
EP - 439
JO - American Journal of Respiratory and Critical Care Medicine
JF - American Journal of Respiratory and Critical Care Medicine
IS - 4
ER -