Non-invasive oxygenation support in acutely hypoxemic COVID-19 patients admitted to the ICU: a multicenter observational retrospective study

Identifier:  imarina:9246565

Handle: https://hdl.handle.net/20.500.11797/imarina9246565

Authors:  Wendel-Garcia, Pedro David; Mas, Arantxa; Gonzalez-Isern, Cristina; Ferrer, Ricard; Manez, Rafael; Masclans, Joan-Ramon; Sandoval, Elena; Vera, Paula; Trenado, Josep; Fernandez, Rafael; Sirvent, Josep-Maria; Martinez, Melcior; Ibarz, Mercedes; Garro, Pau; Lopera, Jose Luis; Bodi, Maria; Yebenes-Reyes, Joan Carles; Triginer, Carles; Vallverdu, Imma; Baro, Anna; Bodi, Fernanda; Saludes, Paula; Valencia, Mauricio; Roche-Campo, Ferran; Huerta, Arturo; Cambra, Francisco Jose; Barbera, Carme; Echevarria, Jorge; Penuelas, Oscar; Mancebo, Jordi

Abstract:
Background: Non-invasive oxygenation strategies have a prominent role in the treatment of acute hypoxemic respiratory failure during the coronavirus disease 2019 (COVID-19). While the efficacy of these therapies has been studied in hospitalized patients with COVID-19, the clinical outcomes associated with oxygen masks, high-flow oxygen therapy by nasal cannula and non-invasive mechanical ventilation in critically ill intensive care unit (ICU) patients remain unclear. Methods: In this retrospective study, we used the best of nine covariate balancing algorithms on all baseline covariates in critically ill COVID-19 patients supported with > 10 L of supplemental oxygen at one of the 26 participating ICUs in Catalonia, Spain, between March 14 and April 15, 2020. Results: Of the 1093 non-invasively oxygenated patients at ICU admission treated with one of the three stand-alone non-invasive oxygenation strategies, 897 (82%) required endotracheal intubation and 310 (28%) died during the ICU stay. High-flow oxygen therapy by nasal cannula (n = 439) and non-invasive mechanical ventilation (n = 101) were associated with a lower rate of endotracheal intubation (70% and 88%, respectively) than oxygen masks (n = 553 and 91% intubated), p < 0.001. Compared to oxygen masks, high-flow oxygen therapy by nasal cannula was associated with lower ICU mortality (hazard ratio 0.75 [95% CI 0.58–0.98), and the hazard ratio for ICU mortality was 1.21 [95% CI 0.80–1.83] for non-invasive mechanical ventilation. Conclusion: In critically ill COVID-19 ICU patients and, in the absence of conclusive data, high-flow oxygen therapy by nasal cannula may be the approach of choice as the primary non-invasive oxygenation support strategy.