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Background <p>High-flow nasal oxygen (HFNO) is frequently used to treat patients with acute hypoxemic respiratory failure (AHRF) due to viral pneumonia, including COVID-19. However, its clinical effect compared to conventional oxygen therapy (COT) remains largely unexplored in patients with a do not intubate (DNI) order. We aimed to assess whether HFNO compared to COT is associated with improved clinical outcomes in hospitalized patients with AHRF due to COVID-19 and a DNI order.</p> Methods <p>This analysis included patients with a DNI order and SARS-CoV-2 infection, selected from three observational studies, who were treated with COT only or HFNO. The primary endpoint was in-hospital mortality, the secondary endpoint was hospital length of stay (LOS). The effect of HFNO vs. COT was assessed using multivariable regression, accounting for pre-selected confounders.</p> Results <p>Between March 2020 and September 2021, 116 patients received HFNO and 110 patients received COT. Median age was 78 [72–83], and 78% of the patients had a Clinical Frailty Scale score of 4 to 9. In-hospital mortality was 64% for HFNO and 71% for COT (<i>p</i> = 0.29), with an adjusted odds ratio of 0.72 (95% confidence interval [0.34–1.54], <i>p</i> = 0.40). Hospital LOS was 11 [6–18] days for HFNO, and 7 [4–12] days for COT (<i>p</i> &lt; 0.001), with a remaining difference after adjusting for confounders (<i>p</i> &lt; 0.01).</p> Conclusion <p>The lack of survival benefit and increased hospital LOS should be taken into account when considering HFNO for patients with a DNI order, suffering from AHRF due to viral pneumonia, like COVID-19.</p> <i>Clinical trial registration</i> <p>HFNO-COVID-19 study: DTR, NL9067 (Dutch Trial Registry), registration date: 27-11-2020.</p>

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High-flow nasal oxygen vs. conventional oxygen therapy in patients with COVID-19 related acute hypoxemic respiratory failure and a do not intubate order: a multicentre cohort study

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  • 发表日期：

    2025年4月25日

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  • Daphne J. T. Sjauw,
  • Lisa M. Hessels,
  • Marieke L. Duiverman,
  • Judith Elshof,
  • Matthijs L. Janssen,
  • Yasemin Türk,
  • Leo Heunks,
  • Sara J. Baart,
  • Evert-Jan Wils,
  • Evert-Jan Wils,
  • Yaar Aga,
  • Hendrik Endeman,
  • Wessel Hanselaar,
  • Matthijs L. Janssen,
  • Yasemin Türk,
  • Rogier A. S. Hoek,
  • Roxanne Heller,
  • Dirk P. Boer,
  • Jan H. Elderman,
  • Alain Dubois,
  • Oscar Hoiting,
  • Jürgen Hölters,
  • Marriëlle vd Steen-Dieperink,
  • Leo Heunks,
  • Evert-Jan Wils,
  • Sara J. Baart,
  • Marieke L. Duiverman,
  • Lucas M. Fleuren,
  • Louise C. Urlings-Strop,
  • Joost G. van den Aardweg,
  • Dolf Weller,
  • Carmen A. T. Reep,
  • Daphne J. T. Sjauw

摘要

Background

High-flow nasal oxygen (HFNO) is frequently used to treat patients with acute hypoxemic respiratory failure (AHRF) due to viral pneumonia, including COVID-19. However, its clinical effect compared to conventional oxygen therapy (COT) remains largely unexplored in patients with a do not intubate (DNI) order. We aimed to assess whether HFNO compared to COT is associated with improved clinical outcomes in hospitalized patients with AHRF due to COVID-19 and a DNI order.

Methods

This analysis included patients with a DNI order and SARS-CoV-2 infection, selected from three observational studies, who were treated with COT only or HFNO. The primary endpoint was in-hospital mortality, the secondary endpoint was hospital length of stay (LOS). The effect of HFNO vs. COT was assessed using multivariable regression, accounting for pre-selected confounders.

Results

Between March 2020 and September 2021, 116 patients received HFNO and 110 patients received COT. Median age was 78 [72–83], and 78% of the patients had a Clinical Frailty Scale score of 4 to 9. In-hospital mortality was 64% for HFNO and 71% for COT (p = 0.29), with an adjusted odds ratio of 0.72 (95% confidence interval [0.34–1.54], p = 0.40). Hospital LOS was 11 [6–18] days for HFNO, and 7 [4–12] days for COT (p < 0.001), with a remaining difference after adjusting for confounders (p < 0.01).

Conclusion

The lack of survival benefit and increased hospital LOS should be taken into account when considering HFNO for patients with a DNI order, suffering from AHRF due to viral pneumonia, like COVID-19.

Clinical trial registration

HFNO-COVID-19 study: DTR, NL9067 (Dutch Trial Registry), registration date: 27-11-2020.