1
|
Ranieri VM, Tonetti T, Navalesi P, Nava S, Antonelli M, Pesenti A, Grasselli G, Grieco DL, Menga LS, Pisani L, Boscolo A, Sella N, Pasin L, Mega C, Pizzilli G, Dell’Olio A, Dongilli R, Rucci P, Slutsky AS. High-Flow Nasal Oxygen for Severe Hypoxemia: Oxygenation Response and Outcome in Patients with COVID-19. Am J Respir Crit Care Med 2022; 205:431-439. [PMID: 34861135 PMCID: PMC8886947 DOI: 10.1164/rccm.202109-2163oc] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 12/03/2021] [Indexed: 11/16/2022] Open
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 have proposed that criteria for defining ARDS should be broadened to allow inclusion of patients receiving HFNO. Objectives: 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 invasive mechanical ventilation (IMV). Methods: From previously published studies, we analyzed patients with coronavirus disease (COVID-19) who had PaO2/FiO2 of ⩽300 while treated with ⩾40 L/min HFNO, or noninvasive ventilation (NIV) with positive end-expiratory pressure of ⩾5 cm H2O (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 versus patients transitioned to IMV. Measurements and Main Results: We analyzed 184 and 131 patients receiving HFNO or NIV, respectively. A total of 112 HFNO and 69 NIV patients transitioned to IMV. Of those, 104 (92.9%) patients on HFNO and 66 (95.7%) on NIV continued to have PaO2/FiO2 ⩽300 under IMV. Twenty-eight-day mortality in patients who remained on HFNO was 4.2% (3/72), whereas in patients transitioned from HFNO to IMV, it was 28.6% (32/112) (P < 0.001). Twenty-eight-day mortality in patients who remained on NIV was 1.6% (1/62), whereas 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 the ARDS definition to include patients on HFNO with PaO2/FiO2 ⩽300 may identify patients at earlier stages of disease but with lower mortality.
Collapse
Affiliation(s)
- V. Marco Ranieri
- Department of Medical and Surgical Sciences
- Anesthesia and Intensive Care Medicine and
| | - Tommaso Tonetti
- Department of Medical and Surgical Sciences
- Anesthesia and Intensive Care Medicine and
| | - Paolo Navalesi
- Department of Medicine, University of Padova
, Padua, Italy
- Institute of Anesthesia and Intensive Care, Padova University Hospital, Padua, Italy
| | - Stefano Nava
- Department of Experimental, Diagnostic and Specialty Medicine
, and
- Pneumology and Respiratory Critical Care, Sant’Orsola Research Hospital IRCCS, Bologna, Italy
| | - Massimo Antonelli
- Department of Anesthesiology and Intensive Care Medicine, Università Cattolica del Sacro Cuore, Rome, Italy
- Anesthesia and Intensive Care, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Antonio Pesenti
- Department of Pathophysiology and Transplantation University of Milan
, Milan, Italy
- Anesthesia and Critical Care, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giacomo Grasselli
- Department of Pathophysiology and Transplantation University of Milan
, Milan, Italy
- Anesthesia and Critical Care, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Domenico Luca Grieco
- Department of Anesthesiology and Intensive Care Medicine, Università Cattolica del Sacro Cuore, Rome, Italy
- Anesthesia and Intensive Care, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Luca Salvatore Menga
- Anesthesia and Intensive Care, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Lara Pisani
- Department of Experimental, Diagnostic and Specialty Medicine
, and
- Pneumology and Respiratory Critical Care, Sant’Orsola Research Hospital IRCCS, Bologna, Italy
| | - Annalisa Boscolo
- Institute of Anesthesia and Intensive Care, Padova University Hospital, Padua, Italy
| | - Nicolò Sella
- Department of Medicine, University of Padova
, Padua, Italy
- Institute of Anesthesia and Intensive Care, Padova University Hospital, Padua, Italy
| | - Laura Pasin
- Institute of Anesthesia and Intensive Care, Padova University Hospital, Padua, Italy
| | - Chiara Mega
- Department of Medical and Surgical Sciences
- Anesthesia and Intensive Care Medicine and
| | | | | | - Roberto Dongilli
- Division of Respiratory Diseases with Intermediate Respiratory Intensive Care Units, Central Hospital of Bolzano, Bolzano, Italy; and
| | - Paola Rucci
- Statistics and Epidemiology, Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum–University of Bologna
, Bologna, Italy
| | - Arthur S. Slutsky
- Keenan Research Centre for Biomedical Science, St. Michael’s Hospital, University of Toronto, Toronto, Canada
| |
Collapse
|