Safety and Outcome of High-Flow Nasal Oxygen Therapy Outside ICU Setting in Hypoxemic Patients With COVID-19*

Matthijs L. Janssen; Yasemin Türk; Sara J. Baart; Wessel Hanselaar; Yaar Aga; Mariëlle van der Steen-Dieperink; Folkert J. van der Wal; Vera J. Versluijs; Rogier A.S. Hoek; Henrik Endeman; Dirk P. Boer; Oscar Hoiting; Jürgen Hoelters; Sefanja Achterberg; Susanne Stads; Roxane Heller-Baan; A Dubois; Jan H Elderman; Evert‐Jan Wils

doi:10.1097/ccm.0000000000006068

Key Points

To assess the safety and clinical outcomes of initiating high-flow nasal oxygen (HFNO) therapy on general hospital wards versus intensive care units in hypoxemic COVID-19 patients.
Prospective, observational, pragmatic multicenter study conducted across respiratory wards and ICUs in 10 hospitals in the Netherlands between December 2020 and July 2021 (N = 608; 379 ward starters and 229 ICU starters).
Adult patients treated with HFNO for COVID-19-associated hypoxemia without treatment limitations were compared using propensity score matching (n = 214 matched patients).
In the matched cohort (n = 214), intubation rates were 53% in ward starters compared with 60% in ICU starters (p = 0.41), and 28-day mortality was 8% versus 13% (p = 0.28).
Ward starters achieved significantly more ICU-free days at 28 days than ICU starters (21 vs 17 d, p < 0.001).
Among intubated patients, no deaths occurred prior to intubation, and no significant differences were observed between ward and ICU starters in respiratory rate-oxygenation index (3.20 vs 3.38), PaO2:FiO2 ratio (65 vs 64 mm Hg), 28-day mortality (17% vs 25%), or ventilator-free days (15 vs 13 d; all p > 0.05).

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Implication

Prospective multicenter study demonstrates similar intubation and mortality rates with ward-initiated versus ICU-initiated high-flow nasal oxygen in COVID-19, suggesting safe ICU bed preservation.

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Janssen et al. (2023) studied this question.

synapsesocial.com/papers/6a9768ee57c1a2673676e4ea https://doi.org/10.1097/ccm.0000000000006068

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Safety and Outcome of High-Flow Nasal Oxygen Therapy Outside ICU Setting in Hypoxemic Patients With COVID-19*

Key Points

No abstract yet

Implication

Discussion

Cite This Study

Safety and Outcome of High-Flow Nasal Oxygen Therapy Outside ICU Setting in Hypoxemic Patients With COVID-19*

Key Points

No abstract yet

Implication

Discussion

Cite This Study

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