Effect of High-Flow Nasal Cannula Oxygen vs Standard Oxygen Therapy on Mortality in Patients With Respiratory Failure Due to COVID-19
Authors: Frat Jean-Pierre , Quenot Jean-Pierre , Badie Julio , Coudroy Rémi , Guitton Christophe , Ehrmann Stephan , Gacouin Arnaud , Merdji Hamid , Auchabie Johann , Daubin Cédric , Dureau Anne-Florence , Thibault Laure , Sedillot Nicholas , Rigaud Jean-Philippe , Demoule Alexandre , Fatah Abdelhamid , Terzi Nicolas , Simonin Marine , Danjou William , Carteaux Guillaume , Guesdon Charlotte , Pradel Gaël , Besse Marie-Catherine , Reignier Jean , Beloncle François , La Combe Béatrice , Prat Gwénaël , Nay Mai-Anh , de Keizer Joe , Ragot Stéphanie , Thille Arnaud W. ,   SOHO-COVID Study Group and the REVA Network, RODRIGUEZ Maeva , ARRIVE François , VEINSTEIN Anne , CHATELLIER Delphine , LEPAPE Sylvain , BOISSIER Florence , JACQUIER Marine , LABRUYERE Marie , BERDAGUER Fernando , MALFROY Sylvain , MEZHER Chaouki , CHUDEAU Nicolas , LANDAIS Mickaël , DARREAU Cédric , BODET CONTENTIN Laetitia , JACQUIER Sophie , GAROT Denis , DELAMAIRE Flora , MAAMAR Adel , PAINVIN Benoit , HELMS Julie , DEMISELLE Julien , JAROUSSEAU Fabien , LE MEUR Anthony , JORET Aurélie , Du CHEYRON Damien , OUDEVILLE Pierre , POINTURIER Valentin , ANTOK Emmanuel , MOUREMBLES Gil , SALADIN Cécile , BIGOT Christelle , BUREAU Côme , DELERIS Robin , PHAN Nga , LEDOCHOWSKI Stanislas , GALERNEAU Louis Marie , DARTEVEL Anaïs , BOURDIN Gaël , VIVIER Emmanuel , DHELFT François , MEKONTSO DESSAP Armand , DESTIZONS Audrey , THEILLAUD Marion , BLONZ Gauthier , ASFAR Pierre , CAILLIEZ Pauline , BAILLY Pierre , BRETAGNOL Anne , CONTOU Damien , DELBOVE Agathe , LAUTRETTE Alexandre , NIGEON Olivier , MIRA Jean Paul , SBOUI Ghada , SACCHERI Clément 
Published: September 2022

Importance

The benefit of high-flow nasal cannula oxygen (high-flow oxygen) in terms of intubation and mortality in patients with respiratory failure due to COVID-19 is controversial.

Objective

To determine whether the use of high-flow oxygen, compared with standard oxygen, could reduce the rate of mortality at day 28 in patients with respiratory failure due to COVID-19 admitted in intensive care units (ICUs).

Design, Setting, and Participants

The SOHO-COVID randomized clinical trial was conducted in 34 ICUs in France and included 711 patients with respiratory failure due to COVID-19 and a ratio of partial pressure of arterial oxygen to fraction of inspired oxygen equal to or below 200 mm Hg. It was an ancillary trial of the ongoing original SOHO randomized clinical trial, which was designed to include patients with acute hypoxemic respiratory failure from all causes. Patients were enrolled from January to December 2021; final follow-up occurred on March 5, 2022.

Interventions

Patients were randomly assigned to receive high-flow oxygen (n = 357) or standard oxygen delivered through a nonrebreathing mask initially set at a 10-L/min minimum (n = 354).

Main Outcomes and Measures

The primary outcome was mortality at day 28. There were 13 secondary outcomes, including the proportion of patients requiring intubation, number of ventilator-free days at day 28, mortality at day 90, mortality and length of stay in the ICU, and adverse events.

Results

Among the 782 randomized patients, 711 patients with respiratory failure due to COVID-19 were included in the analysis (mean [SD] age, 61 [12] years; 214 women [30%]). The mortality rate at day 28 was 10% (36/357) with high-flow oxygen and 11% (40/354) with standard oxygen (absolute difference, –1.2% [95% CI, –5.8% to 3.4%]; P = .60). Of 13 prespecified secondary outcomes, 12 showed no significant difference including in length of stay and mortality in the ICU and in mortality up until day 90. The intubation rate was significantly lower with high-flow oxygen than with standard oxygen (45% [160/357] vs 53% [186/354]; absolute difference, –7.7% [95% CI, –14.9% to –0.4%]; P = .04). The number of ventilator-free days at day 28 was not significantly different between groups (median, 28 [IQR, 11-28] vs 23 [IQR, 10-28] days; absolute difference, 0.5 days [95% CI, –7.7 to 9.1]; P = .07). The most common adverse events were ventilator-associated pneumonia, occurring in 58% (93/160) in the high-flow oxygen group and 53% (99/186) in the standard oxygen group.

Conclusions and Relevance

Among patients with respiratory failure due to COVID-19, high-flow nasal cannula oxygen, compared with standard oxygen therapy, did not significantly reduce 28-day mortality.

Trial Registration

ClinicalTrials.gov Identifier: NCT04468126