9/13/2023 0 Comments Airvo high flow![]() The oxygen flow rate was adjusted to maintain an oxygen saturation level of more than 92%. Standard-oxygen therapy was applied through a non-rebreather face mask at a flow rate of 6 L/min or more. Oxygenation strategyĪll adult patients hospitalized for COVID-19 in participating ICUs required oxygen therapy. We followed the statement guidelines of Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) for observational cohort studies. The study was approved by the Medical Ethics Committee of the Hôpital Avicenne with the reference number: CLEA-2020–146. We did not include patients who were admitted with a decision to withdraw life-sustaining therapy, including do-not-intubate orders, patients who received non-invasive ventilation, and patients who were intubated before ICU admission. Acute respiratory failure was defined as respiratory rate of more than 25 per minute and need for standard oxygen ≥ 3L/min to maintain SpO2 ≥ 92%. All adult patients who were diagnosed with COVID-19 according to WHO interim guidance were screened, and those with a diagnosis of ARF admitted to the ICUs between Ma(i.e., when the first patients were admitted), and May 3, 2020, were included. This was a bicenter retrospective study which took place in two French hospitals located in Paris area: Hôpital Avicenne, Assistance Publique Hopitaux de Paris and Hôpital de Rambouillet. The aim of this study was to compare the need of IMV between two strategies of oxygenation (conventional oxygenation and HFNO) in critically ill COVID 19 patients. Information about clinical outcomes of patients treated by HFNO in ICU for COVID-19 are limited. However, the risk of bio-aerosol dispersion associated with HFNO has since been questioned. This recommendation led intensivists to adopt an early intubation strategy to limit the use of HFNO. ĭue to the hypothetic risk of transmission to healthcare workers at the beginning of the sanitary crisis, expert opinion recommend restricting the use of HFNO and limiting the flow rate to 30 L/min for critically ill patients with COVID-19. A recent retrospective study, which deserves to be confirmed, suggested the same benefit in COVID-19 patients. In a post hoc subgroup analysis of the Florali study, the use of HFNO reduced the need for IMV in most hypoxemic patients. ![]() This non-invasive technic delivers warmed, humidified oxygen with a fraction of inspired oxygen (FiO2) up to 1.0 and a maximum flow rate of 60 L/min. High flow nasal oxygen (HFNO) is increasingly used for adults hospitalized with ARF. The need for IMV is associated with high mortality. In most severe cases, COVID-19 patients are hospitalized in intensive care unit (ICU) and may require invasive mechanical ventilation (IMV). High flow nasal canula oxygen for ARF due to COVID-19 is associated with a lower rate of invasive mechanical ventilation.Īcute respiratory failure (ARF) due to acute hypoxemia is the main manifestation in severe coronavirus disease 2019 (COVID-19). In the HFNO group, predictive factors associated with IMV were SAPS2 score (OR 1.13 p = 0.0002) and ROX index > 4.88 (OR 0.23 p = 0.006). Ventilator-free days at days 28 was higher in HNFO group (21 days vs 10 days, p = 0.005). Length of ICU stay and mortality at day 28 and day 60 did not significantly differ between HFNO and SOT groups after weighted propensity score. After weighted propensity score, HFNO was still associated with a lower rate of IMV (OR 0.31 p = 0.002). ResultsĪmong 138 patients who met the inclusion criteria, 62 (45%) were treated with SOT alone, and 76 (55%) with HFNO. Data from the HFNO group were compared with those from the standard oxygen therapy (SOT) group using weighted propensity score. Secondary outcomes were death at day 28 and day 60, length of ICU stay and ventilator-free days at day 28. The primary outcome was the rate of IMV after ICU admission. We enrolled consecutive patients hospitalized for COVID-19 and acute respiratory failure (ARF) who did not receive IMV at ICU admission. This was a bicenter retrospective study which took place in two intensive care units (ICU) of tertiary hospitals in the Paris region from March 11, to May 3, 2020. The aim of this study was to compare the risk of IMV between two strategies of oxygenation (conventional oxygenation and HFNO) in critically ill COVID 19 patients. The efficacy of high flow nasal canula oxygen therapy (HFNO) to prevent invasive mechanical ventilation (IMV) is not well established in severe coronavirus disease 2019 (COVID-19).
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