High-flow nasal oxygen versus conventional oxygen therapy in patients with COVID-19 pneumonia and mild hypoxaemia: a randomised controlled trial
High-flow nasal oxygen versus conventional oxygen therapy in patients with COVID-19 pneumonia and mild hypoxaemia: a randomised controlled trial
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DOI：
10.1136/thoraxjnl-2022-218806
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发表时间：
2022-05-17
期刊：
影响因子：
10
通讯作者：
Cortegiani, Andrea
中科院分区：
文献类型：
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作者：
Crimi, Claudia;Noto, Alberto;Cortegiani, Andrea
在患有COVID-19肺炎和轻度低氧血症的患者中，高流量鼻氧（HFNO）的临床益处尚不清楚。我们的目的是检查HFNO与常规氧疗（COT）相比是否可以防止该患者人群呼吸支持的升级。方法在这项多中心、随机、平行组、开放标签试验中，COVID-19肺炎患者外周血氧饱和度（SpO（2））= 96%，吸入氧分数（FiO（2））300 mm Hg。结果在364例随机患者中，HFNO组181例患者中的55例（30.3%）和COT组181例患者中的70例（38.6%）接受了呼吸支持递增，两组之间无显著差异（绝对风险差异-8.2%（95%CI-18%至1.4%）; RR 0.79（95%CI 0.59至1.05）; p=0.09）。临床恢复无显著差异（69.1%对60.8%;绝对风险差8.2%（95% CI -1.5%至18.0%），RR 1.14（95% CI 0.98 - 1.32）），入住重症监护室（7.7% vs 11.0%，绝对风险差异-3.3%（95% CI -9.3%至+2.6%）），以及住院时间（11（IQR 8-17）vs 11（IQR 7-20）天，绝对风险差异-1.0%（95%CI-3.1%至+1.1%））。结论在COVID-19肺炎和轻度低氧血症患者中，HFNO的使用并未显著降低呼吸支持升级的可能性。
Rationale In patients with COVID-19 pneumonia and mild hypoxaemia, the clinical benefit of high-flow nasal oxygen (HFNO) remains unclear. We aimed to examine whether HFNO compared with conventional oxygen therapy (COT) could prevent escalation of respiratory support in this patient population.Methods In this multicentre, randomised, parallel-group, open-label trial, patients with COVID-19 pneumonia and peripheral oxygen saturation (SpO(2)) = 96% with fractional inspired oxygen (FiO(2)) 300 mm Hg).Results Among 364 randomised patients, 55 (30.3%) of 181 patients assigned to HFNO and 70 (38.6%) of 181 patients assigned to COT underwent escalation of respiratory support, with no significant difference between groups (absolute risk difference -8.2% (95% CI -18% to +1.4%); RR 0.79 (95% CI 0.59 to 1.05); p=0.09). There was no significant difference in clinical recovery (69.1% vs 60.8%; absolute risk difference 8.2% (95% CI -1.5% to +18.0%), RR 1.14 (95% CI 0.98 to 1.32)), intensive care unit admission (7.7% vs 11.0%, absolute risk difference -3.3% (95% CI -9.3% to +2.6%)), and in hospital length of stay (11 (IQR 8-17) vs 11 (IQR 7-20) days, absolute risk difference -1.0% (95% CI -3.1% to +1.1%)).Conclusions Among patients with COVID-19 pneumonia and mild hypoxaemia, the use of HFNO did not significantly reduce the likelihood of escalation of respiratory support.