Abstract
The effectiveness of noninvasive respiratory support in severe COVID-19 patients is still controversial. We aimed to compare the outcome of patients with COVID-19 pneumonia and hypoxemic respiratory failure treated with high-flow oxygen administered via nasal cannula (HFNC), continuous positive airway pressure (CPAP) or noninvasive ventilation (NIV), initiated outside the intensive care unit (ICU) in 10 university hospitals in Catalonia, Spain. We recruited 367 consecutive patients aged ≥ 18 years who were treated with HFNC (155, 42.2%), CPAP (133, 36.2%) or NIV (79, 21.5%). The main outcome was intubation or death at 28 days after respiratory support initiation. After adjusting for relevant covariates and taking patients treated with HFNC as reference, treatment with NIV showed a higher risk of intubation or death (hazard ratio 2.01; 95% confidence interval 1.32–3.08), while treatment with CPAP did not show differences (0.97; 0.63–1.50). In the context of the pandemic and outside the intensive care unit setting, noninvasive ventilation for the treatment of moderate to severe hypoxemic acute respiratory failure secondary to COVID-19 resulted in higher mortality or intubation rate at 28 days than high-flow oxygen or CPAP. This finding may help physicians to choose the best noninvasive respiratory support treatment in these patients.
Clinicaltrials.gov identifier: NCT04668196.
【초록키워드】 COVID-19, Treatment, pandemic, Respiratory failure, Mortality, intensive care, Pneumonia, Noninvasive ventilation, intubation, nasal, outcome, ICU, Effectiveness, Spain, death, HFNC, moderate, patients, CPAP, Respiratory Support, positive airway pressure, Support, High-flow oxygen, higher risk, 95% confidence interval, hazard ratio, university hospital, help, covariate, intubation rate, physician, hypoxemic, Administered, NIV, recruited, treated, initiated, consecutive patient, noninvasive respiratory, patients treated, patients with COVID-19, severe COVID-19 patient, 【제목키워드】 Mortality, Noninvasive ventilation, CPAP, COVID-19 patient, High-flow oxygen, intubation rate, treated,