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Throughout the COVID-19 pandemic, debate has raged about the role of high-flow nasal cannula (HFNC) oxygen in managing hypoxemic respiratory failure. Some studies have shown lower rates of intubation without any effect on mortality (NEJM JW Gen Med Feb 1 2022 and JAMA 2021; 326:2161), whereas others have shown no benefit for HFNC compared with standard oxygen delivery.
During 2021, investigators in France randomized more than 700 patients with COVID-19 and acute hypoxemic respiratory failure to treatment with either HFNC or standard oxygen delivery via non–rebreather masks. Oxygen saturation was titrated to between 92% and 96%, and intubation decisions were protocolized. Almost all patients received glucocorticoids. Patients treated with HFNC were significantly less likely to be intubated (45% vs. 53%) and had improved sense of dyspnea. Overall mortality at 28 days was lower than expected (11%) and did not differ between groups.
Frat J-P et al. Effect of high-flow nasal cannula oxygen vs standard oxygen therapy on mortality in patients with respiratory failure due to COVID-19: The SOHO-COVID randomized clinical trial. JAMA 2022 Sep 27; 328:1212. (https://doi.org/10.1001/jama.2022.15613)
Comment
HFNC remains a reasonable intervention because less dyspnea and avoiding intubation are important patient-centered outcomes. Patient comfort should guide choice of support, including use of noninvasive ventilation, as no intervention is convincingly associated with lower mortality. Perhaps the most encouraging message from this study is that mortality due to COVID-19 has dropped dramatically in the later phase of the pandemic.