High flow nasal cannula oxygen (HFNC) significantly reduced intubation and subsequent invasive mechanical ventilation, but did not affect case fatality in patients with coronavirus disease 2019 (COVID-19) admitted to the intensive care unit (ICU) for acute respiratory failure, according to study results published in the American Journal of Respiratory and Critical Care Medicine.1

Symptomatic management to restore oxygenation of severe acute respiratory failure is key during the COVID-19 pandemic, according to the authors of this retrospective study.1 HFNC has been shown to improve oxygenation, and reduce minute ventilation and the work of breathing in severe de novo acute hypoxemic respiratory failure.2,3 Thus, researchers in Paris, France, tested the hypothesis that HFNC reduces the rates of intubation and mortality in 379 critically ill patients admitted to the ICU for acute respiratory failure between February 21 and April 24, 2020.1

Overall, 146 (39%) patients received HFNC (all within the first 24 hours following ICU admission) and were compared with 233 patients who did not. The percentage of patients requiring invasive mechanical ventilation at day 28 was 56% in the HFNC group vs 75% in those who did not receive HFNC (P <.0001), and mortality at day 28 was 21% vs 30%, respectively.

After adjusting on a propensity score to receive HFNC, 137 patients who received HFNC were matched to 137 patients who did not, and HFNC was associated with a reduced percentage of patients requiring invasive mechanical ventilation at day 28 (55% vs 72%; P<.0001). In addition, day 28 mortality was similar between the 2 groups (21% in the HFNC group vs 22% in the non-HFNC group).


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“This study suggests that HFNC significantly reduces intubation and subsequent invasive mechanical ventilation, but does not affect case fatality,” concluded the study authors.1 They added, “…this study highlights that HFNC was as safe as standard oxygen in a large cohort of COVID-19 patients.”

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

References

1. Demoule A, Baron AV, Darmon M, et al. High flow nasal cannula in critically ill severe COVID-19 patients. Am J Respir Crit Care Med. Published online August 6, 2020. doi:10.1164/rccm.202005-2007LE

2. Mauri T, Turrini C, Eronia N, et al. Physiologic effects of high-flow nasal cannula in acute hypoxemic respiratory failure. Am J Respir Crit Care Med. 2017;195:1207-1215.

3. Mauri T, Alban L, Turrini C, et al. Optimum support by high-flow nasal cannula in acute hypoxemic respiratory failure: effects of increasing flow rates. Intensive Care Med. 2017;43:1453-1463.