NEW YORK (Reuters Health) – Hospitalized patients with severe COVID-19 infection can benefit from high-flow nasal oxygen with less need for intubation and earlier recovery, according to a randomized clinical trial conducted in Colombia.
The effect of high-flow nasal oxygen therapy relative to conventional oxygen therapy has not been firmly established in the setting of severe COVID-19, Dr. Gustavo A. Ospina-Tascon with Fundacion Valle del Lili in Cali and colleagues note in JAMA.
To investigate, they randomly allocated 99 adults with respiratory distress and a ratio of partial pressure of arterial oxygen to fraction of inspired oxygen <200 due to COVID-19 to high-flow nasal oxygen therapy and 100 similar patients to conventional oxygen therapy. The patients had a mean age of 60 years and 65 were women. The trial was not blinded.
The rate of intubation (co-primary endpoint) was statistically significantly lower in the high-flow nasal oxygen group (34.3% vs. 51.0%; hazard ratio, 0.62; 95% CI, 0.39 to 0.96; P=0.03), the researchers report.
In addition, the median time to clinical recovery within 28 days (the other primary endpoint) was also statistically significantly shorter in the high-flow nasal oxygen group (11 days vs. 14 days; HR, 1.39; 95% CI: 1.00 to 1.92; P=0.047).
Suspected bacterial pneumonia occurred in 13 patients (13.1%) in the high-flow oxygen group and in 17 patients (17.0%) in the conventional oxygen therapy; bacteremia was detected in seven (7.1%) and 11 patients (11.0%), respectively.
The investigators note that the study was not powered to show differences in mortality; “nevertheless, the effect of high-flow oxygen therapy on need for intubation and clinical recovery could encourage its use,” they write.
They say their results are in line with studies of high-flow oxygen therapy for acute hypoxemic respiratory failure due to non-COVID etiologies.
The study had no commercial funding. One of the authors received nonfinancial support from Fisher & Paykel (provision of equipment and supplies for another trial assessing high-flow oxygen therapy through a nasal cannula).
SOURCE: https://bit.ly/3Dtwtp2 JAMA, online December 7, 2021.
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