ORIGINAL ARTICLE   

Minerva Anestesiologica 2022 July-August;88(7-8):580-7

DOI: 10.23736/S0375-9393.22.16094-3

Copyright © 2022 EDIZIONI MINERVA MEDICA

language: English

Endotracheal intubation rate is lower with additional face-mask noninvasive ventilation for critically-ill SARS-CoV-2 patients requiring high-flow nasal oxygen: a retrospective bicentric cohort with propensity score analysis

Tomas URBINA ^{1, 2} ✉, Alexandre ELABBADI ^{2, 3, 4}, Paul GABARRE ^{1, 2, 3}, Naike BIGÉ ^{1, 2}, Matthieu TURPIN ^{2, 3, 4}, Vincent BONNY ^{1, 2}, Cyrielle DESNOS ^{2, 4}, Jean-Luc BAUDEL ^{1, 2}, Jean-Remi LAVILLEGRAND ^{1, 2, 3}, Geoffroy HARIRI ^{1, 2, 3}, Muriel FARTOUKH ^{2, 3, 4}, Bertrand GUIDET ^{1, 2, 3}, Eric MAURY ^{1, 2, 3}, Guillaume DUMAS ^{2, 5}, Guillaume VOIRIOT ^{2, 3, 4}, Hafid AIT-OUFELLA ^{1, 2, 3, 6}

¹ Intensive Care Unit, Saint-Antoine Hospital, Paris, France; ² Assistance Publique-Hôpitaux de Paris, Paris, France; ³ Sorbonne University, Paris, France; ⁴ Intensive Care Unit, Tenon Hospital, Paris, France; ⁵ Intensive Care Unit, Saint-Louis Hospital, Paris, France; ⁶ Inserm U970, Cardiovascular Research Center, University of Paris, Paris, France

BACKGROUND: SARS-CoV-2 pneumonia is responsible for unprecedented numbers of acute respiratory failure requiring invasive mechanical ventilation (IMV). This work aimed to assess whether adding face-mask noninvasive ventilation (NIV) to high-flow nasal oxygen (HFNO) was associated with a reduced need for endotracheal intubation.
METHODS: This retrospective cohort study was conducted from July 2020 to January 2021 in two tertiary care intensive care units (ICUs) in Paris, France. Patients admitted for laboratory confirmed SARS-CoV-2 infection with acute hypoxemic respiratory failure requiring HFNO with or without NIV were included. The primary outcome was the rate of endotracheal intubation. Secondary outcomes included day-28 mortality, day-28 respiratory support and IMV free days, ICU and hospital length-of-stay. Sensitivity analyses with both propensity score matching and overlap weighting were used.
RESULTS: One hundred twenty-eight patients were included, 88 (69%) received HFNO alone and 40 (31%) received additional NIV. Additional NIV was associated with a reduced rate of endotracheal intubation in multivariate analysis (53 [60%] vs. 15 [38%], HR=0.46 [95% CI: 0.23-0.95], P=0.04). Sensitivity analyses by propensity score matching (HR=0.45 [95% CI: 0.24-0.84], P=0.01) and overlap weighting (HR=0.52 [95% CI: 0.28-0.94], P=0.03) were consistent. Day-28 mortality was 25 (28%) in the HFNO group and 8 (20%) in the NIV group (HR=0.75 [95% CI: 0.15-3.82], P=0.72). NIV was associated with higher IMV free days (20 [0-28] vs. 28 [14-28], P=0.015). All sensitivity analyses were consistent regarding secondary outcomes.
CONCLUSIONS: Need for endotracheal intubation was lower in critically-ill SARS-CoV-2 patients receiving face-mask noninvasive mechanical ventilation in addition to high-flow oxygen therapy.

KEY WORDS: Critical care; COVID-19; Oxygen inhalation therapy; Intubation; Noninvasive ventilation; SARS-CoV-2