High Flow Nasal Oxygen for Severe Hypoxemia: Oxygenation Response and Outcome in COVID-19 Patients

Ranieri, V Marco; Tonetti, Tommaso; Navalesi, Paolo; Nava, Stefano; Antonelli, Massimo; Pesenti, Antonio; Grasselli, Giacomo; Grieco, Domenico Luca; Menga, Luca Salvatore; Pisani, Lara; Boscolo, Annalisa; Sella, Nicolò; Pasin, Laura; Mega, Chiara; Pizzilli, Giacinto; Dell'Olio, Alessio; Dongilli, Roberto; Rucci, Paola; Slutsky, Arthur S

doi:10.1164/rccm.202109-2163OC

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/).

Titolo:	High Flow Nasal Oxygen for Severe Hypoxemia: Oxygenation Response and Outcome in COVID-19 Patients
Autore/i:	Ranieri, V Marco; Tonetti, Tommaso; Navalesi, Paolo; Nava, Stefano; Antonelli, Massimo; Pesenti, Antonio; Grasselli, Giacomo; Grieco, Domenico Luca; Menga, Luca Salvatore; Pisani, Lara; Boscolo, Annalisa; Sella, Nicolò; Pasin, Laura; Mega, Chiara; Pizzilli, Giacinto; Dell'Olio, Alessio; Dongilli, Roberto; Rucci, Paola; Slutsky, Arthur S
Autore/i Unibo:	RANIERI, VITO MARCO TONETTI, TOMMASO Navalesi, Paolo NAVA, STEFANO Antonelli, Massimo Pesenti, Antonio Grasselli, Giacomo Grieco, Domenico Luca Menga, Luca Salvatore PISANI, LARA Boscolo, Annalisa Sella, Nicolò Pasin, Laura MEGA, CHIARA Pizzilli, Giacinto DELL'OLIO, ALESSIO Dongilli, Roberto RUCCI, PAOLA Slutsky, Arthur S mostra contributor esterni nascondi contributor esterni
Anno:	2021
Rivista:	AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE
Digital Object Identifier (DOI):	http://dx.doi.org/10.1164/rccm.202109-2163OC
Abstract:	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/).
Data stato definitivo:	2021-12-10T15:41:45Z
Appare nelle tipologie:	1.01 Articolo in rivista

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