key: cord-0061881-53tiidtp
authors: González-Castro, A.; Fajardo Campoverde, A.; Medina, A.; Modesto i Alapont, V.
title: Non-invasive mechanical ventilation and high-flow oxygen therapy in the COVID-19 pandemic: the value of a draw()
date: 2021-04-12
journal: Med Intensiva (Engl Ed)
DOI: 10.1016/j.medine.2021.04.001
sha: 066a84113462c146c61dd828416a7846a90069fa
doc_id: 61881
cord_uid: 53tiidtp

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The second reference is the FLORALI-REVA study 4 . This was a clinical trial involving three cohorts (HFO, NIV and conventional oxygen), and with the proportion of patients requiring intubation as the primary endpoint. A statistical power of 80% in identifying a relevant difference (defined as 20%) in the frequency of intubation was calculated for this purpose.

No statistically significant differences in the primary endpoint were recorded. In the rest of the study, analyses were made of post hoc comparisons between groups of patients, with

Cox regression models to explain the primary endpoint and mortality. Both analyses could be biased: no adjustment for multiple comparisons was made, no model with timedependent variables (HFO and NIV were interchanged) was used, and there may have been over-adjustment. They consequently could only serve to generate hypotheses that would have to be confirmed by future trials.

However, the SEMICyUC document does not cite a clinical trial 5 specifically designed (power 80%) to detect a relevant decrease (now defined as 30%) in the intubation rate. In the mentioned study, NIV versus standard oxygen therapy was seen to significantly reduce the intubation rate in patients with de novo hypoxemic ARF. This experiment has not been replicated, though the preliminary data on the experience with COVID-19 in China appear to J o u r n a l P r e -p r o o f confirm its results. With a beta-binomial model, using an a priori non-informative construct, the probability that the intubation rate is lower with NIV versus HFO was 0.9993 (difference in rates = 0.444; 95%CI = 0.097-0.706) 6 .

The current health emergency situation requires full dedication on the part of intensivists, but also a rational distribution of the available resources. If we seek to avoid intubations, perhaps NIV and HFO should be positioned at the same level as first choice option. The WHO has done so.

The present manuscript has received no financial support of any kind.

The authors declare that they have no conflicts of interest.

Clinical consensus recommendations regarding non-invasive respiratory support in the adult patient with acute respiratory failure secondary to SARS-CoV-2 infection

Clinical management of severe acute respiratory infection when novel coronavirus (2019-nCoV) infection is suspected

Official ERS/ATS clinical practice guidelines: noninvasive ventilation for acute respiratory failure

High-flow oxygen through nasal cannula in acute hypoxemic respiratory failure

Early use of noninvasive positive pressure ventilation for acute lung injury: A multicenter randomized controlled trial

The experience of high-flow nasal cannula in hospitalized patients with 2019 novel coronavirus-infected pneumonia in two hospitals of

Ann Intensive Care