key: cord-0823782-xtfvixvx
authors: Alkouh, Rajae; El Rhalete, Abdelilah; Manal, Merbouh; Ghizlane, El Aidouni; Samia, Berrichi; Salma, Taouihar; Aftiss, Fatima Zahra; Houssam, Bkiyar; Naima, Abda; Brahim, Housni
title: High-flow nasal oxygen therapy decrease the risk of mortality and the use of invasive mechanical ventilation in patients with severe SARS-CoV-2 pneumonia? A retrospective and comparative study of 265 cases
date: 2022-01-04
journal: Ann Med Surg (Lond)
DOI: 10.1016/j.amsu.2021.103230
sha: 0021ebe4404bb7aea40f696a8261b6bd1d4a7f6b
doc_id: 823782
cord_uid: xtfvixvx

INTRODUCTION: Corona virus disease (Covid-19) affects the airways and induces pulmonary lesions, patients with this disease require oxygen therapy as the disease progresses. Several oxygenation options have been used, l’HFNO had showed beneficial effects THE OBJECTIVE OF THIS STUDY: To evaluate the efficacy of high-flow nasal oxygen HFNO versus non-invasive ventilation in COVID-19. METHODS: This is a retrospective and comparative study conducted over a period of 10 months from March 2020 to December 2020 and involving 600 patients hospitalized in the intensive care unit of the CHU Mohammed VI of Oujda for the management of acute respiratory failure caused by COVID-19. RESULTS: Out of 600 patients with acute respiratory failure, 265 patients were included in the analyses. 162 (61.10%) patients were treated with HFNO, the intubation rate was 49.7% (80 patients out of 162) of which 63 died intubated (78.8%). Concerning the 82 non-intubated patients, only 16 died (19.8%). The total number of patients who received NIV was 71 (26.8%), 33 (46.5%) required mechanical ventilation. In-hospital mortality in patients treated with NIV was 100%. The difference in mortality outcome between the two groups was significantly (P < 0.0001) reduced in HFNO. CONCLUSIONS: Treatment with high-flow oxygen improved survival in patients with acute hypoxemic respiratory failure compared with noninvasive ventilation, although no difference was observed in intubation rate

SARS-CoV-2 pneumonia manifests as acute respiratory failure, which most often requires oxygen supplementation. In severely affected patients, the need for oxygen is sometimes so great that it can lead to invasive mechanical ventilation, a procedure that is associated with a high mortality rate. [1] At the beginning of the pandemic, the indications for intubation of patients with COVID-19 were broad. [1] However, as more experience was gained, practitioners began to use high-flow nasal oxygen therapy as an alternative to too early intubation. This method provides humidified and heated oxygen with a FiO2 of up to 100% and a flow rate of up to 80L/min. This would decrease the work of breathing, decrease dead space, improve mucociliary clearance and give a PEEP effect of 2 to 7 mmHg. [2] This technique of high flow nasal oxygen therapy was at the beginning of the pandemic limited to a flow of 30L/min [3] because the learned societies feared a high contamination of the nursing staff through the aerosol droplets. Today, this hypothetical risk is questioned, and this means of oxygen supplementation has become widespread in intensive care units, as it would reduce the rate of mechanical ventilation in patients with hypoxemic respiratory failure. [4] This work is a retrospective observational study that aims to evaluate mortality in patients on high-flow nasal oxygen therapy and the possible risk of resorting to invasive mechanical ventilation in these patients.

This is a monocentric retrospective observational study conducted in the Intensive Care Unit of the Mohammed VI Public University Hospital of Oujda.

It includes all patients (600 patients) hospitalized in intensive care infected with COVID-19 from March 1st, 2020, to December 31st 2021.

These 600 patients were divided into 2 groups: group A which includes the 162 patients who were put on high flow nasal oxygen therapy and group B including the remaining 103 patients who received standard oxygen therapy (SO). Epidemiological, clinical, paraclinical, therapeutic and evolutionary data were collected thanks to an exploitation form including the different variables collected from the patients' medical files. The data were then computerized and analyzed using SPSS software.

Access to patient data was authorized by the Mohammed VI University Hospital, given the retrospective design of this study, the requirement for patient consent was waived. Data anonymity was respected in accordance with national and international guidelines. The aim of our work is to describe the use of high flow oxygen therapy in the initial management of patients admitted to the intensive care unit on admission, to study their mortality and the possible use of invasive mechanical ventilation in these patients.

This case series has been reported in line with the PROCESS Guideline [5] .

Research registry 6573.

Between March 1 and December 31, 600 patients were admitted to the ICU for management of acute respiratory failure due to COVID-19 pneumonia. The degree of parenchymal involvement was in 4 patients (5.8%) 10-25%, in 9 patients (13.0%) 25-50%, in 26 patients (37.7%) 50-75% and in 32 patients (43.5%) it was >75%.

The total number of patients who received NIV was 71 (26.8%), 33 (46.5%) required mechanical ventilation. The evolution of these intubated patients was marked by death in 27 cases (81.8%). 

This retrospective study of 233 cases shows, in a population of severe COVID-19 patients with acute respiratory distress syndrome, that an initial oxygenation strategy including the use of high-flow nasal oxygen therapy is associated with a lower mortality rate In a multicenter, randomized, open-label trial of COVIDS patients hospitalized in an intensive care unit (ICU), the rate of intubation was 38% in the high oxygen flow group (80 or 49.7% in our study), compared with 50% in the non-invasive ventilation group (33 or 46.5% in our study). The use of mechanical ventilation was therefore not significant for our two studies (p=0.18 for this trial, and p=0.08 for our study). [6] In contrast, in a recent large French retrospective observational study, 74% of patients receiving standard oxygen therapy were eventually intubated, compared with 51% in the HFNO group. The use of mechanical ventilation was therefore significant in their study (p=0.007). [7] Concerning mortality, it was not significant in their study (12% in the HFNO group vs 16% in the OS group, p=.017), whereas it was significant in our study 98.6% vs 100% (p<. personnel. This is psychologically very important for everyone involved.

Our study has several limitations. First, the analysis of ventilator-free days must be viewed with caution. Indeed, because of an anomalous distribution, the ventilator-free days were not adjusted for potential confounders. Second, this is not a randomized controlled trial.

And some data were unavailable and missing during chart collection because this study was retrospective. Therefore, it is important to conduct a more complete and thorough investigation in the future in a prospective sense.

In patients with acute respiratory failure caused by COVID19 , high flow oxygen is a simple ventilatory support to use, better tolerated and improves survival rate compared to non-invasive ventilation, although no difference was observed in the intubation rate

This is a retrospective and comparative case series was approved by the ethics committee for biomedical research of Oujda (ECBRO) of the faculty of medicine and pharmacy of Oujda. Data were anonymously registered in our database. Access to data was approved by the head of the department.

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

-Patients with corona virus disease require oxygen therapy as the disease progresses. Several oxygenation options have been used -The objective of this paper is to evaluate the efficacy of high-flow nasal oxygen HFNO versus noninvasive ventilation in COVID-19.

-A significant reduction in mortality was noted in the group of patients treated with high flow oxygen -The difference in intubation outcome between the two groups was not significant J o u r n a l P r e -p r o o f

Clinical Characteristics of Covid-19 in

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

Staff safety during emergency airway management for COVID-19 in Hong Kong Jonathan Chun-Hei Cheung 1, Lap Tin Ho 2

Comparison of high-flow nasal cannula versus oxygen face mask for environmental bacterial contamination in critically ill pneumonia patients: a randomized controlled crossover trial

Neill N for the Process Group The PROCESS 2020 guideline: updating consensus preferred reporting of CasE series in surgery (PROCESS) guidelines

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

High flow nasal oxygen therapy to avoid invasive mechanical ventilation in SARS-CoV-2 pneumonia: a retrospective study. Ann Intensive Care

High-flow nasal oxygen: a safe, efficient treatment for COVID-19 patients not in an ICU

We would like to thank the medical and nursing teams of Mohammed VI University Hospital for their significant involvement in the management of the patients included in our study. Particular thanks to the director of Mohammed VI University Hospital Prof. Abdelkarim Daoudi for his successful management of this outbreak.

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The Guarantor is the one or more people who accept full responsibility for the work and/or the conduct of the study, had access to the data, and controlled the decision to publish Alkouh Rajae Abdelilah El Rhalete