Among patients with severe coronavirus disease 2019 (COVID-19), use of high-flow oxygen through a nasal cannula significantly decreased need for mechanical ventilation support and time to clinical recovery compared with conventional low-flow oxygen therapy, according to a study published in JAMA.
From August 2020 to January 2021, 220 patients with respiratory distress and a ratio of partial pressure of arterial oxygen to fraction of inspired oxygen of less than 200 due to COVID-19 were randomised to receive high-flow oxygen through a nasal cannula (n = 109) or conventional oxygen therapy (n = 111). A total of 199 patients were included in the analysis (median age, 60 years).
High-flow oxygen therapy was continuously delivered for a total of 6 (interquartile range [IQR], 3-9) days in patients randomised to this therapy, and it was successfully weaned to conventional oxygen therapy by 6 (IQR, 4-7) days in 65 (65.7%) of 99 patients.
By day 28 after randomisation, 34 (34.3%) of 99 patients randomised to high-flow oxygen therapy and 51 (51.0%) of 100 randomised to conventional oxygen therapy had been intubated (hazard ratio [HR], 0.62; 95% confidence interval [CI], 0.39-0.96; P = 0.03).
Meanwhile, the median time to recovery within 28 days, as assessed by the 7-category ordinal scale, among patients in the high-flow oxygen therapy group was 11 (IQR, 9-14) days compared to 14 (IQR, 11-19) days in the conventional oxygen therapy group (HR, 1.39; 95% CI, 1.00-1.92; P = 0.047)
Moreover, median ventilator-free days within the first 28 days after randomisation were 28 (IQR, 19-28) days in the high-flow oxygen therapy group compared to 24 (IQR, 14-28) days in the conventional oxygen therapy group (adjusted odds ratio, 2.08; 95% CI 1.18-3.64; P = 0.01).
On the other hand, suspected bacterial pneumonia occurred in 13 patients (13.1%) randomised to high-flow oxygen and in 17 (17.0%) of those randomised to conventional oxygen therapy, while bacteremia was detected in 7 (7.1%) and 11 (11.0%) patients, respectively.
“In this open-label, multicentre randomised clinical trial among patients with acute hypoxemic respiratory failure due to severe COVID-19, the use of high-flow oxygen therapy through a nasal cannula significantly decreased the need for intubation and invasive mechanical ventilation and also led to earlier clinical recovery within 28 days,” wrote Gustavo A Ospina-Tascón, MD, Fundación Valle del Lili, Cali, Colombia, and colleagues.
“Although previous studies have suggested that delay in intubation is related to increased mortality rates in patients with acute hypoxemic respiratory failure, high-flow oxygen therapy seems to be safe, as it is not associated with higher mortality rates or longer recovery times despite nonimmediate intubation in cases that eventually require it,” the authors noted.