TY - JOUR
T1 - Comparison of Noninvasive Mechanical Ventilation With High-Flow Nasal Cannula, Face-Mask, and Helmet in Hypoxemic Respiratory Failure in Patients With COVID-19
T2 - A Randomized Controlled Trial
AU - Al Hashim, Abdul Hakeem
AU - Al Reesi, Abdullah
AU - Al Lawati, Nabil M
AU - Burad, Jyoti
AU - Al Khabori, Murtadha
AU - Chandwani, Juhi
AU - Al Lawati, Redha
AU - Al Masroori, Yahya
AU - Al Balushi, Abdul Aziz
AU - Al Masroori, Salim
AU - Al Siyabi, Khalsa
AU - Al Lawati, Fatema
AU - Ahmed, Faroug Yousif Nimer
AU - Al Busaidy, Merah
AU - Al Huraizi, Aisha
AU - Al Jufaili, Mahmood
AU - Al Zaabi, Jalila
AU - Varghese, Jerin Treesa
AU - Al Harthi, Ruqaya
AU - Sebastian, Kingsly Prabhakaran
AU - Al Abri, Fahad Hamed
AU - Al Aghbari, Jamal
AU - Al Mubaihsi, Saif
AU - Al Lawati, Adil
AU - Al Busaidi, Mujahid
AU - Foti, Giuseppe
N1 - Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine and Wolters Kluwer Health, Inc.
Publisher Copyright:
© 2023 Lippincott Williams and Wilkins. All rights reserved.
PY - 2023/11/1
Y1 - 2023/11/1
N2 - OBJECTIVES: For COVID-19-related respiratory failure, noninvasive respiratory assistance via a high-flow nasal cannula (HFNC), helmet, and face-mask noninvasive ventilation is used. However, which of these options is most effective is yet to be determined. This study aimed to compare the three techniques of noninvasive respiratory support and to determine the superior technique.DESIGN: A randomized control trial with permuted block randomization of nine cases per block for each parallel, open-labeled arm.SETTING AND PATIENTS: Adult patients with COVID-19 with a Pao2/Fio2 ratio of less than 300, admitted between February 4, 2021, and August 9, 2021, to three tertiary centers in Oman, were studied.INTERVENTIONS: This study included three interventions: HFNC (n = 47), helmet continuous positive airway pressure (CPAP; n = 52), and face-mask CPAP (n = 52).MEASUREMENTS AND MAIN RESULTS: The endotracheal intubation rate and mortality at 28 and 90 days were measured as the primary and secondary outcomes, respectively. Of the 159 randomized patients, 151 were analyzed. The median age was 52 years, and 74% were men. The endotracheal intubation rates were 44%, 45%, and 46% (p = 0.99), and the median intubation times were 7.0, 5.5, and 4.5 days (p = 0.11) in the HFNC, face-mask CPAP, and helmet CPAP, respectively. In comparison to face-mask CPAP, the relative risk of intubation was 0.97 (95% CI, 0.63-1.49) for HFNC and 1.0 (95% CI 0.66-1.51) for helmet CPAP. The mortality rates were 23%, 32%, and 38% at 28 days (p = 0.24) and 43%, 38%, and 40% (p = 0.89) at 90 days for HFNC, face-mask CPAP, and helmet CPAP, respectively. The trial was stopped prematurely because of a decline in cases.CONCLUSIONS: This exploratory trial found no difference in intubation rate and mortality among the three intervention groups for the COVID-19 patients with hypoxemic respiratory failure; however, more evidence is needed to confirm these findings as the trial was aborted prematurely.
AB - OBJECTIVES: For COVID-19-related respiratory failure, noninvasive respiratory assistance via a high-flow nasal cannula (HFNC), helmet, and face-mask noninvasive ventilation is used. However, which of these options is most effective is yet to be determined. This study aimed to compare the three techniques of noninvasive respiratory support and to determine the superior technique.DESIGN: A randomized control trial with permuted block randomization of nine cases per block for each parallel, open-labeled arm.SETTING AND PATIENTS: Adult patients with COVID-19 with a Pao2/Fio2 ratio of less than 300, admitted between February 4, 2021, and August 9, 2021, to three tertiary centers in Oman, were studied.INTERVENTIONS: This study included three interventions: HFNC (n = 47), helmet continuous positive airway pressure (CPAP; n = 52), and face-mask CPAP (n = 52).MEASUREMENTS AND MAIN RESULTS: The endotracheal intubation rate and mortality at 28 and 90 days were measured as the primary and secondary outcomes, respectively. Of the 159 randomized patients, 151 were analyzed. The median age was 52 years, and 74% were men. The endotracheal intubation rates were 44%, 45%, and 46% (p = 0.99), and the median intubation times were 7.0, 5.5, and 4.5 days (p = 0.11) in the HFNC, face-mask CPAP, and helmet CPAP, respectively. In comparison to face-mask CPAP, the relative risk of intubation was 0.97 (95% CI, 0.63-1.49) for HFNC and 1.0 (95% CI 0.66-1.51) for helmet CPAP. The mortality rates were 23%, 32%, and 38% at 28 days (p = 0.24) and 43%, 38%, and 40% (p = 0.89) at 90 days for HFNC, face-mask CPAP, and helmet CPAP, respectively. The trial was stopped prematurely because of a decline in cases.CONCLUSIONS: This exploratory trial found no difference in intubation rate and mortality among the three intervention groups for the COVID-19 patients with hypoxemic respiratory failure; however, more evidence is needed to confirm these findings as the trial was aborted prematurely.
KW - acute respiratory distress syndrome
KW - continuous positive airway pressure
KW - endotracheal intubation
KW - nasal cannula
KW - noninvasive ventilation
KW - COVID-19/complications
KW - Cannula
KW - Humans
KW - Middle Aged
KW - Male
KW - Respiration, Artificial
KW - Respiratory Insufficiency/therapy
KW - Adult
KW - Female
KW - Intubation, Intratracheal
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UR - https://www.mendeley.com/catalogue/97743f34-0528-3c28-9497-6d1675e4c965/
U2 - 10.1097/CCM.0000000000005963
DO - 10.1097/CCM.0000000000005963
M3 - Article
C2 - 37310174
SN - 0090-3493
VL - 51
SP - 1515
EP - 1526
JO - Critical Care Medicine
JF - Critical Care Medicine
IS - 11
ER -