Non-invasive oxygenation support in acutely hypoxemic COVID-19 patients admitted to the ICU: a multicenter observational retrospective study
Pedro David Wendel‐Garcia, Arantxa Mas, Cristina González-Isern, Ricard Ferrer, Rafael Máñez, Joan-Ramon Masclans, Elena Sandoval, Paula Vera, Josep Trenado, Rafael Fernández, Josep-María Sirvent, M. Martínez, Mercedes Ibarz, Pau Garro, J. L. Lopera, María Bodi, J. C. Yébenes-Reyes, C. Triginer, Imma Vallverdú, Anna Moreno Baró, F. Bodí, P. Saludes, Mauricio Valencia, Ferran Roche‐Campo, Arturo Huerta, Francisco José Cambra Lasaosa, Carme Barberà, Jorge Echevarria, Óscar Peñuelas, Jordi Mancebo, for the UCIsCAT study group, Ricard Ferrer, Oriol Roca, Xavier Nuvials, J.C. Ruiz, Elisabeth Papiol, Rafael Máñez, V. D. Gumicio, Elena Sandoval, Guido Muñoz, David Toapanta, Pedro Castro, Julio Osorio, Joan-Ramon Masclans, Rosana Muñoz-Bermúdez, F. Parrilla, Purificación Pérez-Terán, Judith Marín‐Corral, Arantxa Mas, Beatriz Cancio, S. Hernández-Marín, Melinda Rita Koborzan, C. A. Briones, Josep Trenado, Rafael Fernández, J. M. Sirvent, Paulette M. Sebastian, X. Saiz, M. Martínez, Mercedes Ibarz, Pau Garro, Consuelo Pedrós, Ester Vendrell, J. L. Lopera, María Bodi, Alejandro Rodríguez, Antonio Moreno, J. C. Yébenes-Reyes, C. Triginer, I. Vallverdú, A. M. Baró, M. Morales, F. Bodí, P. Saludes, Joaquim Ramon Cervelló, Mauricio Valencia, Ferran Roche‐Campo, Diego Franch-Llasat, Arturo Huerta, P. Santigosa, Francisco José Cambra Lasaosa, Sergio Benito, Carme Barberà, Jorge Echevarria, Jordi Mancebo, Paula Vera, José Alberto Santos, Jaume Baldirà, Antoni Betbesé, M. Izura, Indalecio Morán, J.-C. Suárez, L. Zapata, N. RODRIGUEZ, Marta Torrens, Alejandra Cordón, C. Gomila, Milagros Llanos Flores, A. Segarra, M. Morales
Abstract
BACKGROUND: Non-invasive oxygenation strategies have a prominent role in the treatment of acute hypoxemic respiratory failure during the coronavirus disease 2019 (COVID-19). While the efficacy of these therapies has been studied in hospitalized patients with COVID-19, the clinical outcomes associated with oxygen masks, high-flow oxygen therapy by nasal cannula and non-invasive mechanical ventilation in critically ill intensive care unit (ICU) patients remain unclear. METHODS: In this retrospective study, we used the best of nine covariate balancing algorithms on all baseline covariates in critically ill COVID-19 patients supported with > 10 L of supplemental oxygen at one of the 26 participating ICUs in Catalonia, Spain, between March 14 and April 15, 2020. RESULTS: Of the 1093 non-invasively oxygenated patients at ICU admission treated with one of the three stand-alone non-invasive oxygenation strategies, 897 (82%) required endotracheal intubation and 310 (28%) died during the ICU stay. High-flow oxygen therapy by nasal cannula (n = 439) and non-invasive mechanical ventilation (n = 101) were associated with a lower rate of endotracheal intubation (70% and 88%, respectively) than oxygen masks (n = 553 and 91% intubated), p < 0.001. Compared to oxygen masks, high-flow oxygen therapy by nasal cannula was associated with lower ICU mortality (hazard ratio 0.75 [95% CI 0.58-0.98), and the hazard ratio for ICU mortality was 1.21 [95% CI 0.80-1.83] for non-invasive mechanical ventilation. CONCLUSION: In critically ill COVID-19 ICU patients and, in the absence of conclusive data, high-flow oxygen therapy by nasal cannula may be the approach of choice as the primary non-invasive oxygenation support strategy.