Portal de Periódicos da CAPES

Artigo Acesso aberto Produção Nacional Revisado por pares

BIBTEX RIS

Effect of High-Flow Oxygen Therapy vs Conventional Oxygen Therapy on Invasive Mechanical Ventilation and Clinical Recovery in Patients With Severe COVID-19

2021; American Medical Association; Volume: 326; Issue: 21 Linguagem: Inglês

10.1001/jama.2021.20714

1538-3598

Gustavo A. Ospina‐Tascón, Luis Calderón, Alberto Garcı́a, Virginia Zarama, Freddy Gómez-Álvarez, Tatiana Álvarez-Saa, Stephania Pardo-Otálvaro, Diego F. Bautista-Rincón, Mónica Vargas, José L. Aldana-Díaz, Ángela Marulanda, Alejandro Gutiérrez, Janer Varón, Mónica Liébana Gómez, María Elena Ochoa, E. Cidoncha Escobar, Mauricio Umaña, Julio Diez-Sepúlveda, Gabriel J. Tobón, Ludwig L. Albornóz, Carlos Celemín, Guillermo Ortíz, Eder Cáceres, Luis Felipe Reyes, Lucas Petri Damiani, Alexandre Biasi Cavalcanti, Fernando Rosso, Pablo Andrés Moncada, Sandra Carvajal, Julián Yara, Alejandro Jiménez, Alex Sotomayor, Maria I. Prieto, Daniel Loaiza López, C. Ocaña Medina, Ana María Ángel‐Isaza, Natalia Giraldo, Freddy Watts, Tatiana Morell, Jorge Revelo, David Paz, Wilson Villamil, Nicolás Orozco, Cristhian C. Rojas, Diana Martínez, Á. Sánchez, Liliana Vallecilla, Jenny A. Sandoval, Ana M. Crispín, Katherine Carvajal, L.V. Maldonado Romero, Nicol Guarín,

Intensive Care Unit Cognitive Disorders

Importance The effect of high-flow oxygen therapy vs conventional oxygen therapy has not been established in the setting of severe COVID-19. Objective To determine the effect of high-flow oxygen therapy through a nasal cannula compared with conventional oxygen therapy on need for endotracheal intubation and clinical recovery in severe COVID-19. Design, Setting, and Participants Randomized, open-label clinical trial conducted in emergency and intensive care units in 3 hospitals in Colombia. A total of 220 adults with respiratory distress and a ratio of partial pressure of arterial oxygen to fraction of inspired oxygen of less than 200 due to COVID-19 were randomized from August 2020 to January 2021, with last follow-up on February 10, 2021. Interventions Patients were randomly assigned to receive high-flow oxygen through a nasal cannula (n = 109) or conventional oxygen therapy (n = 111). Main Outcomes and Measures The co–primary outcomes were need for intubation and time to clinical recovery until day 28 as assessed by a 7-category ordinal scale (range, 1-7, with higher scores indicating a worse condition). Effects of treatments were calculated with a Cox proportional hazards model adjusted for hypoxemia severity, age, and comorbidities. Results Among 220 randomized patients, 199 were included in the analysis (median age, 60 years; n = 65 women [32.7%]). Intubation occurred in 34 (34.3%) randomized to high-flow oxygen therapy and in 51 (51.0%) randomized to conventional oxygen therapy (hazard ratio, 0.62; 95% CI, 0.39-0.96; P = .03). The median time to clinical recovery within 28 days was 11 (IQR, 9-14) days in patients randomized to high-flow oxygen therapy vs 14 (IQR, 11-19) days in those randomized to conventional oxygen therapy (hazard ratio, 1.39; 95% CI, 1.00-1.92; P = .047). Suspected bacterial pneumonia occurred in 13 patients (13.1%) randomized to high-flow oxygen and in 17 (17.0%) of those randomized to conventional oxygen therapy, while bacteremia was detected in 7 (7.1%) vs 11 (11.0%), respectively. Conclusions and Relevance Among patients with severe COVID-19, use of high-flow oxygen through a nasal cannula significantly decreased need for mechanical ventilation support and time to clinical recovery compared with conventional low-flow oxygen therapy. Trial Registration ClinicalTrials.gov Identifier:NCT04609462