High-flow cannula for frail patients with SARS-CoV-2 infection non-eligible for intensive care unit management

Bouetard, L; Flamand, T; Vignes, Dorothée; Robert, Alain; Sterpu, R.; Lemonnier, L; Mion, Marco; Gerber, V.; Abgrall, Sophie; Martinot, M.

doi:10.1016/j.idnow.2022.11.004

Cited by 1 publication

(1 citation statement)

References 17 publications

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“…For example, in our study, a majority of patients survived and were never intubated, but patients treated initially with NIV spent less total time on noninvasive respiratory support. Although HFNC may be more comfortable than NIV and may not always require ICU-level support, both devices require close monitoring and high oxygen flows (8, 10, 22–24). Therefore, spending less time on noninvasive respiratory support may be a potentially important outcome in patients who survive and are not intubated.…”

Section: Discussionmentioning

confidence: 99%

High-Flow Nasal Cannula Versus Noninvasive Ventilation as Initial Treatment in Acute Hypoxia: A Propensity Score-Matched Study

Munroe,

Prevalska,

Hyer

et al. 2024

Critical Care Explorations

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IMPORTANCE: Patients presenting to the emergency department (ED) with hypoxemia often have mixed or uncertain causes of respiratory failure. The optimal treatment for such patients is unclear. Both high-flow nasal cannula (HFNC) and noninvasive ventilation (NIV) are used. OBJECTIVES: We sought to compare the effectiveness of initial treatment with HFNC versus NIV for acute hypoxemic respiratory failure. DESIGN, SETTING, AND PARTICIPANTS: We conducted a retrospective cohort study of patients with acute hypoxemic respiratory failure treated with HFNC or NIV within 24 hours of arrival to the University of Michigan adult ED from January 2018 to December 2022. We matched patients 1:1 using a propensity score for odds of receiving NIV. MAIN OUTCOMES AND MEASURES: The primary outcome was major adverse pulmonary events (28-d mortality, ventilator-free days, noninvasive respiratory support hours) calculated using a win ratio. RESULTS: A total of 1154 patients were included. Seven hundred twenty-six (62.9%) received HFNC and 428 (37.1%) received NIV. We propensity score matched 668 of 1154 (57.9%) patients. Patients on NIV versus HFNC had lower 28-day mortality (16.5% vs. 23.4%, p = 0.033) and required noninvasive treatment for fewer hours (median 7.5 vs. 13.5, p < 0.001), but had no difference in ventilator-free days (median [interquartile range]: 28 [26, 28] vs. 28 [10.5, 28], p = 0.199). Win ratio for composite major adverse pulmonary events favored NIV (1.38; 95% CI, 1.15–1.65; p < 0.001). CONCLUSIONS AND RELEVANCE: In this observational study of patients with acute hypoxemic respiratory failure, initial treatment with NIV compared with HFNC was associated with lower mortality and fewer composite major pulmonary adverse events calculated using a win ratio. These findings underscore the need for randomized controlled trials to further understand the impact of noninvasive respiratory support strategies.

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Section: Discussionmentioning

confidence: 99%