High-flow nasal oxygen vs. conventional oxygen therapy in patients with COVID-19 related acute hypoxemic respiratory failure and a do not intubate order: a multicentre cohort study
Abstract Background High-flow nasal oxygen (HFNO) is frequently used to treat patients with acute hypoxemic respiratory failure (AHRF) due to viral pneumonia, including COVID-19. However, its clinical effect compared to conventional oxygen therapy (COT) remains largely unexplored in patients with a...
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| Format: | Article |
| Language: | English |
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BMC
2025-04-01
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| Series: | Respiratory Research |
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| Online Access: | https://doi.org/10.1186/s12931-025-03231-8 |
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| author | Daphne J. T. Sjauw Lisa M. Hessels Marieke L. Duiverman Judith Elshof Matthijs L. Janssen Yasemin Türk Leo Heunks Sara J. Baart Evert-Jan Wils Dutch HFNO study group NORMO2 project group |
| author_facet | Daphne J. T. Sjauw Lisa M. Hessels Marieke L. Duiverman Judith Elshof Matthijs L. Janssen Yasemin Türk Leo Heunks Sara J. Baart Evert-Jan Wils Dutch HFNO study group NORMO2 project group |
| author_sort | Daphne J. T. Sjauw |
| collection | DOAJ |
| description | Abstract Background High-flow nasal oxygen (HFNO) is frequently used to treat patients with acute hypoxemic respiratory failure (AHRF) due to viral pneumonia, including COVID-19. However, its clinical effect compared to conventional oxygen therapy (COT) remains largely unexplored in patients with a do not intubate (DNI) order. We aimed to assess whether HFNO compared to COT is associated with improved clinical outcomes in hospitalized patients with AHRF due to COVID-19 and a DNI order. Methods This analysis included patients with a DNI order and SARS-CoV-2 infection, selected from three observational studies, who were treated with COT only or HFNO. The primary endpoint was in-hospital mortality, the secondary endpoint was hospital length of stay (LOS). The effect of HFNO vs. COT was assessed using multivariable regression, accounting for pre-selected confounders. Results Between March 2020 and September 2021, 116 patients received HFNO and 110 patients received COT. Median age was 78 [72–83], and 78% of the patients had a Clinical Frailty Scale score of 4 to 9. In-hospital mortality was 64% for HFNO and 71% for COT (p = 0.29), with an adjusted odds ratio of 0.72 (95% confidence interval [0.34–1.54], p = 0.40). Hospital LOS was 11 [6–18] days for HFNO, and 7 [4–12] days for COT (p < 0.001), with a remaining difference after adjusting for confounders (p < 0.01). Conclusion The lack of survival benefit and increased hospital LOS should be taken into account when considering HFNO for patients with a DNI order, suffering from AHRF due to viral pneumonia, like COVID-19. Clinical trial registration HFNO-COVID-19 study: DTR, NL9067 (Dutch Trial Registry), registration date: 27-11-2020. |
| format | Article |
| id | doaj-art-e7958e505b874146b84ec2bde8cc9d9e |
| institution | DOAJ |
| issn | 1465-993X |
| language | English |
| publishDate | 2025-04-01 |
| publisher | BMC |
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| series | Respiratory Research |
| spelling | doaj-art-e7958e505b874146b84ec2bde8cc9d9e2025-08-20T03:15:12ZengBMCRespiratory Research1465-993X2025-04-0126111010.1186/s12931-025-03231-8High-flow nasal oxygen vs. conventional oxygen therapy in patients with COVID-19 related acute hypoxemic respiratory failure and a do not intubate order: a multicentre cohort studyDaphne J. T. Sjauw0Lisa M. Hessels1Marieke L. Duiverman2Judith Elshof3Matthijs L. Janssen4Yasemin Türk5Leo Heunks6Sara J. Baart7Evert-Jan Wils8Dutch HFNO study groupNORMO2 project groupDepartment of Intensive Care, Franciscus Gasthuis & VlietlandDepartment of Respiratory Medicine, Noordwest ZiekenhuisgroepDepartment of Pulmonary Diseases / Home Mechanical Ventilation, University of Groningen, University Medical Center GroningenDepartment of Pulmonary Diseases / Home Mechanical Ventilation, University of Groningen, University Medical Center GroningenDepartment of Intensive Care, Franciscus Gasthuis & VlietlandDepartment of Respiratory Medicine, Franciscus Gasthuis & VlietlandDepartment of Intensive Care, Radboud University Medical CenterDepartment of Biostatistics, Erasmus Medical CenterDepartment of Intensive Care, Franciscus Gasthuis & VlietlandAbstract Background High-flow nasal oxygen (HFNO) is frequently used to treat patients with acute hypoxemic respiratory failure (AHRF) due to viral pneumonia, including COVID-19. However, its clinical effect compared to conventional oxygen therapy (COT) remains largely unexplored in patients with a do not intubate (DNI) order. We aimed to assess whether HFNO compared to COT is associated with improved clinical outcomes in hospitalized patients with AHRF due to COVID-19 and a DNI order. Methods This analysis included patients with a DNI order and SARS-CoV-2 infection, selected from three observational studies, who were treated with COT only or HFNO. The primary endpoint was in-hospital mortality, the secondary endpoint was hospital length of stay (LOS). The effect of HFNO vs. COT was assessed using multivariable regression, accounting for pre-selected confounders. Results Between March 2020 and September 2021, 116 patients received HFNO and 110 patients received COT. Median age was 78 [72–83], and 78% of the patients had a Clinical Frailty Scale score of 4 to 9. In-hospital mortality was 64% for HFNO and 71% for COT (p = 0.29), with an adjusted odds ratio of 0.72 (95% confidence interval [0.34–1.54], p = 0.40). Hospital LOS was 11 [6–18] days for HFNO, and 7 [4–12] days for COT (p < 0.001), with a remaining difference after adjusting for confounders (p < 0.01). Conclusion The lack of survival benefit and increased hospital LOS should be taken into account when considering HFNO for patients with a DNI order, suffering from AHRF due to viral pneumonia, like COVID-19. Clinical trial registration HFNO-COVID-19 study: DTR, NL9067 (Dutch Trial Registry), registration date: 27-11-2020.https://doi.org/10.1186/s12931-025-03231-8Acute hypoxemic respiratory failureConventional oxygen therapyCOVID-19Do not intubate orderHigh-flow nasal oxygen |
| spellingShingle | Daphne J. T. Sjauw Lisa M. Hessels Marieke L. Duiverman Judith Elshof Matthijs L. Janssen Yasemin Türk Leo Heunks Sara J. Baart Evert-Jan Wils Dutch HFNO study group NORMO2 project group High-flow nasal oxygen vs. conventional oxygen therapy in patients with COVID-19 related acute hypoxemic respiratory failure and a do not intubate order: a multicentre cohort study Respiratory Research Acute hypoxemic respiratory failure Conventional oxygen therapy COVID-19 Do not intubate order High-flow nasal oxygen |
| title | High-flow nasal oxygen vs. conventional oxygen therapy in patients with COVID-19 related acute hypoxemic respiratory failure and a do not intubate order: a multicentre cohort study |
| title_full | High-flow nasal oxygen vs. conventional oxygen therapy in patients with COVID-19 related acute hypoxemic respiratory failure and a do not intubate order: a multicentre cohort study |
| title_fullStr | High-flow nasal oxygen vs. conventional oxygen therapy in patients with COVID-19 related acute hypoxemic respiratory failure and a do not intubate order: a multicentre cohort study |
| title_full_unstemmed | High-flow nasal oxygen vs. conventional oxygen therapy in patients with COVID-19 related acute hypoxemic respiratory failure and a do not intubate order: a multicentre cohort study |
| title_short | High-flow nasal oxygen vs. conventional oxygen therapy in patients with COVID-19 related acute hypoxemic respiratory failure and a do not intubate order: a multicentre cohort study |
| title_sort | high flow nasal oxygen vs conventional oxygen therapy in patients with covid 19 related acute hypoxemic respiratory failure and a do not intubate order a multicentre cohort study |
| topic | Acute hypoxemic respiratory failure Conventional oxygen therapy COVID-19 Do not intubate order High-flow nasal oxygen |
| url | https://doi.org/10.1186/s12931-025-03231-8 |
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