Details

Autor(en) / Beteiligte

• Ospina-Tascón, Gustavo A
• Calderón-Tapia, Luis Eduardo
• García, Alberto F
• Zarama, Virginia
• Gómez-Álvarez, Freddy
• Álvarez-Saa, Tatiana
• Pardo-Otálvaro, Stephania
• Bautista-Rincón, Diego F
• Vargas, Mónica P
• Aldana-Díaz, José L
• Marulanda, Ángela
• Gutiérrez, Alejandro
• Varón, Janer
• Gómez, Mónica
• Ochoa, María E
• Escobar, Elena
• Umaña, Mauricio
• Díez, Julio
• Tobón, Gabriel J
• Albornoz, Ludwig L
• Celemín Flórez, Carlos Augusto
• Ruiz, Guillermo Ortiz
• Cáceres, Eder Leonardo
• Reyes, Luis Felipe
• Damiani, Lucas Petri
• Cavalcanti, Alexandre B

Titel

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

Ist Teil von

• JAMA : the journal of the American Medical Association, 2021-12, Vol.326 (21), p.2161

Ort / Verlag

United States

Erscheinungsjahr

2021

Link zum Volltext

Quelle

MEDLINE

Beschreibungen/Notizen

• The effect of high-flow oxygen therapy vs conventional oxygen therapy has not been established in the setting of severe COVID-19. To determine the effect of high-flow oxygen therapy through a nasal cannula compared with conventional oxygen therapy on need for endotracheal intubation and clinical recovery in severe COVID-19. Randomized, open-label clinical trial conducted in emergency and intensive care units in 3 hospitals in Colombia. A total of 220 adults 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 randomized from August 2020 to January 2021, with last follow-up on February 10, 2021. Patients were randomly assigned to receive high-flow oxygen through a nasal cannula (n = 109) or conventional oxygen therapy (n = 111). The co-primary outcomes were need for intubation and time to clinical recovery until day 28 as assessed by a 7-category ordinal scale (range, 1-7, with higher scores indicating a worse condition). Effects of treatments were calculated with a Cox proportional hazards model adjusted for hypoxemia severity, age, and comorbidities. Among 220 randomized patients, 199 were included in the analysis (median age, 60 years; n = 65 women [32.7%]). Intubation occurred in 34 (34.3%) randomized to high-flow oxygen therapy and in 51 (51.0%) randomized to conventional oxygen therapy (hazard ratio, 0.62; 95% CI, 0.39-0.96; P = .03). The median time to clinical recovery within 28 days was 11 (IQR, 9-14) days in patients randomized to high-flow oxygen therapy vs 14 (IQR, 11-19) days in those randomized to conventional oxygen therapy (hazard ratio, 1.39; 95% CI, 1.00-1.92; P = .047). Suspected bacterial pneumonia occurred in 13 patients (13.1%) randomized to high-flow oxygen and in 17 (17.0%) of those randomized to conventional oxygen therapy, while bacteremia was detected in 7 (7.1%) vs 11 (11.0%), respectively. Among patients with severe 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. ClinicalTrials.gov Identifier: NCT04609462.