Oxygen via high-flow nasal cannula reduces the need for intubation in patients with severe COVID-19

Reference

Ospina-Tascon GA, Calderon-Tapia LE, Garcia AF, et al, for the HiFLo-Covid Investigators. Effect of high-flow oxygen therapy vs. conventional oxygen therapy on invasive mechanical ventilation and clinical recovery in patients with severe COVID-19: A randomized clinical trial. JAMA 2021;326(21):2161-2171.

Synopsis

In patients with severe COVID-19 infection, it is unknown whether oxygen delivered via high-flow nasal cannula (HFNC) is more beneficial than conventional oxygen therapy. For this study from Colombia, the authors randomized patients hospitalized with COVID-19 and acute respiratory failure (PaO2:FiO2 < 200 and signs of respiratory distress) to receive HFNC versus conventional oxygen. In the HFNC group (n = 99), patients received an initial flow of 60 L per minute and FiO2 of 1.0, adjusted to maintain a pulse oxygen saturation of at least 92%. In the conventional group (n = 100), low-flow oxygen was applied to maintain the same oxygenation goal. The 2 groups had similar baseline characteristics: median age was 62 years and 33% were women. Prone therapy was allowed in both groups and the use of steroids, antivirals, antibiotics, and other antimicrobials was left to the clinicians' discretion. Within 28 days of randomization, patients in the HFNC group were less likely to require intubation (34% vs 51%; P = .03) and more likely to experience clinical recovery (78% vs 71%; P = .047). The HFNC group also had a shorter time to clinical recovery (11 vs 14 days). There were no statistically significant differences between groups in length of stay or mortality.