TY - JOUR
T1 - High-flow nasal oxygen vs. conventional oxygen therapy in patients with COVID-19 related acute hypoxemic respiratory failure and a do not intubate order
T2 - a multicentre cohort study
AU - Sjauw, Daphne J.T.
AU - Hessels, Lisa M.
AU - NORMO2 project group
AU - Dutch HFNO study group
AU - Duiverman, Marieke L.
AU - Elshof, Judith
AU - Janssen, Matthijs L.
AU - Türk, Yasemin
AU - Heunks, Leo
AU - Baart, Sara J.
AU - Wils, Evert Jan
AU - vd Steen-Dieperink, Marriëlle
AU - Hölters, Jürgen
AU - Hoiting, Oscar
AU - Dubois, Alain
AU - Endeman, Hendrik
AU - Hoek, Rogier A.S.
AU - Janssen, Matthijs L.
AU - Elderman, Jan
AU - Sjauw, Daphne J.T.
AU - Reep, Carmen A.T.
AU - Weller, Dolf
AU - van den Aardweg, Joost G.
AU - Urlings-Strop, Louise C.
AU - Fleuren, Lucas M.
AU - Duiverman, Marieke L.
N1 - Publisher Copyright:
© The Author(s) 2025.
PY - 2025/12
Y1 - 2025/12
N2 - 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.
AB - 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.
UR - https://www.scopus.com/pages/publications/105003756798
U2 - 10.1186/s12931-025-03231-8
DO - 10.1186/s12931-025-03231-8
M3 - Article
C2 - 40281556
AN - SCOPUS:105003756798
SN - 1465-9921
VL - 26
JO - Respiratory Research
JF - Respiratory Research
IS - 1
M1 - 161
ER -