High-flow nasal oxygen therapy decrease the risk of mortality and the use of invasive mechanical ventilation in patients with severe SARS-CoV-2 pneumonia? A retrospective and comparative study of 265 cases

Abstract

Introduction Corona virus disease (Covid-19) affects the airways and induces pulmonary lesions, patients with this disease require oxygen therapy as the disease progresses. Several oxygenation options have been used, l’HFNO had showed beneficial effects The objective of this study To evaluate the efficacy of high-flow nasal oxygen HFNO versus non-invasive ventilation in COVID-19. Methods This is a retrospective and comparative study conducted over a period of 10 months from March 2020 to December 2020 and involving 600 patients hospitalized in the intensive care unit of the CHU Mohammed VI of Oujda for the management of acute respiratory failure caused by COVID-19. Results Out of 600 patients with acute respiratory failure, 265 patients were included in the analyses. 162 (61.10%) patients were treated with HFNO, the intubation rate was 49.7% (80 patients out of 162) of which 63 died intubated (78.8%). Concerning the 82 non-intubated patients, only 16 died (19.8%). The total number of patients who received NIV was 71 (26.8%), 33 (46.5%) required mechanical ventilation. In-hospital mortality in patients treated with NIV was 100%. The difference in mortality outcome between the two groups was significantly (P < 0.0001) reduced in HFNO. Conclusions Treatment with high-flow oxygen improved survival in patients with acute hypoxemic respiratory failure compared with noninvasive ventilation, although no difference was observed in intubation rate

Comparison between high-flow nasal cannula and noninvasive ventilation in COVID-19 patients: a systematic review and meta-analysis

“…After excluding duplicates and evaluating the full texts of articles, we identified 23 eligible studies 9 , 11 – 32 (3 RCTs, 20 , 24 , 26 8 prospective observational studies, 13 , 16 , 18 , 19 , 22 , 25 , 28 , 30 and 12 retrospective observational studies). 9 , 11 , 12 , 14 , 15 , 17 , 21 , 23 , 27 , 29 , 31 , 32 The process of searching and screening is described in Figure 1 . The main characteristics of the articles included in the meta-analysis are shown in Table 1 .…”

“…Two studies were considered to have an unclear risk of bias. The 20 observational 9 , 11 – 19 , 21 – 23 , 25 , 27 – 32 studies were assessed using the NOS checklist, and the results are shown in the Table 2 . All studies were of medium quality (⩾5 stars) or above, and 10 were considered high quality (⩾8 stars).…”

“…A total of 5354 patients participated in the 23 studies 9 , 11 – 32 of the present meta-analysis, all of whom were adult COVID-19 patients. The patients were admitted to different hospital settings and received noninvasive respiratory support at the time of admission.…”

“…The patients were admitted to different hospital settings and received noninvasive respiratory support at the time of admission. In 4 studies, 11 , 17 , 20 , 25 a helmet was applied, in 11 studies, 9 , 13 – 15 , 18 , 19 , 26 , 28 , 29 , 30 , 32 a face mask was used, 1 study 22 reported applying both a helmet and a face mask, 7 studies 12 , 16 , 21 , 23 , 24 , 27 , 31 did not report whether a helmet or a facemask was used, in 6 studies, 9 , 20 , 22 , 24 , 27 , 29 BiPAP was applied, 7 studies 11 , 17 – 19 , 25 , 26 , 30 featured CPAP, 4 studies 14 – 16 , 23 reported applying both BiPAP and CPAP, and 6 studies 12 , 13 , 21 , 28 , 31 , 32 did not report whether they applied BiPAP or CPAP ( Table 1…”

High-flow nasal oxygen decrease mortality in patients with severe SARS-CoV-2 pneumonia? Issues and controversies

“…We have read with great interest this study [ 1 ] that analyzes the impact obtained with the use of nasal high flow oxygen (HFNO) compared with non-invasive ventilation (NIV) for the treatment of patients with COVID-19 and shows a better survival with the use of HFNO. Although the study has a retrospective design, we consider that there are some points that would be better explained.…”