RT Journal Article
SR Electronic
T1 High-flow nasal oxygen versus conventional oxygen therapy in patients with COVID-19 pneumonia and mild hypoxaemia: a randomised controlled trial
JF Thorax
JO Thorax
FD BMJ Publishing Group Ltd and British Thoracic Society
SP 354
OP 361
DO 10.1136/thoraxjnl-2022-218806
VO 78
IS 4
A1 Claudia Crimi
A1 Alberto Noto
A1 Fabiana Madotto
A1 Mariachiara Ippolito
A1 Santi Nolasco
A1 Raffaele Campisi
A1 Stefano De Vuono
A1 Giuseppe Fiorentino
A1 Ioannis Pantazopoulos
A1 Athanasios Chalkias
A1 Alessandro Libra
A1 Alessio Mattei
A1 Raffaele Scala
A1 Enrico M Clini
A1 Begum Ergan
A1 Manel Lujan
A1 Joao Carlos Winck
A1 Antonino Giarratano
A1 Annalisa Carlucci
A1 Cesare Gregoretti
A1 Paolo Groff
A1 Andrea Cortegiani
A1 ,
YR 2023
UL http://thorax.bmj.com/content/78/4/354.abstract
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.