PT  - JOURNAL ARTICLE
AU  - Claudia Crimi
AU  - Alberto Noto
AU  - Fabiana Madotto
AU  - Mariachiara Ippolito
AU  - Santi Nolasco
AU  - Raffaele Campisi
AU  - Stefano De Vuono
AU  - Giuseppe Fiorentino
AU  - Ioannis Pantazopoulos
AU  - Athanasios Chalkias
AU  - Alessandro Libra
AU  - Alessio Mattei
AU  - Raffaele Scala
AU  - Enrico M Clini
AU  - Begum Ergan
AU  - Manel Lujan
AU  - Joao Carlos Winck
AU  - Antonino Giarratano
AU  - Annalisa Carlucci
AU  - Cesare Gregoretti
AU  - Paolo Groff
AU  - Andrea Cortegiani
ED  - ,
TI  - High-flow nasal oxygen versus conventional oxygen therapy in patients with COVID-19 pneumonia and mild hypoxaemia: a randomised controlled trial
AID  - 10.1136/thoraxjnl-2022-218806
DP  - 2023 Apr 01
TA  - Thorax
PG  - 354--361
VI  - 78
IP  - 4
4099  - http://thorax.bmj.com/content/78/4/354.short
4100  - http://thorax.bmj.com/content/78/4/354.full
SO  - Thorax2023 Apr 01; 78
AB  - Rationale In patients with COVID-19 pneumonia and mild hypoxaemia, the clinical benefit of high-flow nasal oxygen (HFNO) remains unclear. We aimed to examine whether HFNO compared with conventional oxygen therapy (COT) could prevent escalation of respiratory support in this patient population.Methods In this multicentre, randomised, parallel-group, open-label trial, patients with COVID-19 pneumonia and peripheral oxygen saturation (SpO2) ≤92% who required oxygen therapy were randomised to HFNO or COT. The primary outcome was the rate of escalation of respiratory support (ie, continuous positive airway pressure, non-invasive ventilation or invasive mechanical ventilation) within 28 days. Among secondary outcomes, clinical recovery was defined as the improvement in oxygenation (SpO2 ≥96% with fractional inspired oxygen (FiO2) ≤30% or partial pressure of arterial carbon dioxide/FiO2 ratio >300 mm Hg).Results Among 364 randomised patients, 55 (30.3%) of 181 patients assigned to HFNO and 70 (38.6%) of 181 patients assigned to COT underwent escalation of respiratory support, with no significant difference between groups (absolute risk difference −8.2% (95% CI −18% to +1.4%); RR 0.79 (95% CI 0.59 to 1.05); p=0.09). There was no significant difference in clinical recovery (69.1% vs 60.8%; absolute risk difference 8.2% (95% CI −1.5% to +18.0%), RR 1.14 (95% CI 0.98 to 1.32)), intensive care unit admission (7.7% vs 11.0%, absolute risk difference −3.3% (95% CI −9.3% to +2.6%)), and in hospital length of stay (11 (IQR 8–17) vs 11 (IQR 7–20) days, absolute risk difference −1.0% (95% CI −3.1% to +1.1%)).Conclusions Among patients with COVID-19 pneumonia and mild hypoxaemia, the use of HFNO did not significantly reduce the likelihood of escalation of respiratory support.Trial registration number NCT04655638.Data are available on reasonable request.