High-flow oxygen not better than standard O2 in COVID respiratory failureHigh-flow oxygen didn't significantly lower death rates beyond those of standard oxygen therapy in COVID-19 patients with respiratory failure, according to a multicenter randomized clinical trial published yesterday in JAMA.As part of an ongoing trial, researchers enrolled 711 patients who had COVID-19 respiratory failure in 1 of 34 intensive care units (ICUs) in France from January to December 2021, with final follow-up on Mar 5, 2022.Patients were randomly assigned to receive either high-flow oxygen through a nasal cannula (357 patients) or standard oxygen therapy through a non-rebreathing mask (354) for a median of 4 days.
Average patient age was 61 years, and 30% were women.Death rates at 28 days were 10% in the high-flow oxygen group and 11% in standard oxygen recipients, a non-statistically significant difference.
But the intubation rate was significantly lower in high-flow oxygen recipients than in those receiving standard oxygen (45% vs 53%).The most common adverse event was ventilator-associated pneumonia (58% of the high-flow group vs 53% in standard oxygen recipients).The authors said that although high-flow oxygen didn't significantly lower the death rate, the reduced risk of intubation and need for invasive mechanical ventilation may be an important outcome. "It may also help avoid the use of ICU ventilators in resource-constrained settings during a pandemic," they wrote.In a related commentary, Alistair Nichol, PhD, of University College Dublin, and Cecilia O'Kane, PhD, and Daniel McAuley, MD, both of Queen's University Belfast, said that future trials should incorporate different types of COVID-19 patients to determine which subgroups