Rationale: The "Berlin definition" of acute respiratory distress syndrome (ARDS) does not allow inclusion of patients receiving high-flow nasal oxygen (HFNO). However, several articles proposed that criteria for defining ARDS should be broadened to allow inclusion of patients receiving HFNO. Objective: To compare the proportion of patients fulfilling ARDS criteria during HFNO and soon after intubation, and 28-day mortality between patients treated exclusively with HFNO and patients transitioned from HFNO to IMV. Methods: From previously published studies we analyzed COVID-19 patients who had PaO2/FiO2 ≤300 while treated with HFNO ≥40 L/min, or NIV with PEEP ≥5 cmH2O (comparator). In patients transitioned from HFNO/NIV to invasive mechanical ventilation (IMV), we compared ARDS severity during HFNO/NIV and soon after IMV. We compared 28-day mortality in patients treated exclusively with HFNO/NIV vs. transitioned to IMV. Measurements and main results: We analyzed 184 and 131 patients receiving HFNO or NIV, respectively. 112 HFNO, and 69 NIV patients transitioned to IMV. 104 (92.9%) HFNO patients and 66 (95.7%) NIV patients continued to have PaO2/FiO2 ≤300 under IMV. 28-day mortality in patients who remained on HFNO was 4.2% (3/72) while in patients transitioned from HFNO to IMV it was 28.6% (32/112) (p<0.001). 28-day mortality in patients who remained on NIV was 1.6% (1/62), while in patients who transitioned from NIV to IMV it was 44.9% (31/69) (p<0.001). Overall mortality was 19.0% (35/184) and 24.4% (32/131) for HFNO and NIV, respectively (p=0.2479). Conclusions: Broadening ARDS definition to include HFNO patients with PaO2/FiO2 ≤300 may identify patients at earlier stages of disease but with lower mortality. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/).
High Flow Nasal Oxygen for Severe Hypoxemia : Oxygenation Response and Outcome in COVID-19 Patients / V.M. Ranieri, T. Tonetti, P. Navalesi, S. Nava, M. Antonelli, A. Pesenti, G. Grasselli, D.L. Grieco, L.S. Menga, L. Pisani, A. Boscolo, N. Sella, L. Pasin, C. Mega, G. Pizzilli, A. Dell'Olio, R. Dongilli, P. Rucci, A.S. Slutsky. - In: AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE. - ISSN 1073-449X. - (2021 Dec 03). [Epub ahead of print] [10.1164/rccm.202109-2163OC]
|Titolo:||High Flow Nasal Oxygen for Severe Hypoxemia : Oxygenation Response and Outcome in COVID-19 Patients|
|Parole Chiave:||ARDS; COVID-19; HFNO; mechanical ventilation; non-invasive ventilation|
|Settore Scientifico Disciplinare:||Settore MED/41 - Anestesiologia|
|Data di pubblicazione:||3-dic-2021|
|Digital Object Identifier (DOI):||http://dx.doi.org/10.1164/rccm.202109-2163OC|
|Appare nelle tipologie:||01 - Articolo su periodico|