To evaluate the respective impact of standard oxygen, high-flow nasal cannula (HFNC) and noninvasive ventilation (NIV) on oxygenation failure rate and mortality in COVID-19 patients admitted to intensive care units (ICUs). Multicenter, prospective cohort study (COVID-ICU) in 137 hospitals in France, Belgium, and Switzerland. Demographic, clinical, respiratory support, oxygenation failure, and survival data were collected. Oxygenation failure was defined as either intubation or death in the ICU without intubation. Variables independently associated with oxygenation failure and Day-90 mortality were assessed using multivariate logistic regression. From February 25 to May 4, 2020, 4754 patients were admitted in ICU. Of these, 1491 patients were not intubated on the day of ICU admission and received standard oxygen therapy (51%), HFNC (38%), or NIV (11%) (P < 0.001). Oxygenation failure occurred in 739 (50%) patients (678 intubation and 61 death). For standard oxygen, HFNC, and NIV, oxygenation failure rate was 49%, 48%, and 60% (P < 0.001). By multivariate analysis, HFNC (odds ratio [OR] 0.60, 95% confidence interval [CI] 0.36–0.99, P = 0.013) but not NIV (OR 1.57, 95% CI 0.78–3.21) was associated with a reduction in oxygenation failure). Overall 90-day mortality was 21%. By multivariable analysis, HFNC was not associated with a change in mortality (OR 0.90, 95% CI 0.61–1.33), while NIV was associated with increased mortality (OR 2.75, 95% CI 1.79–4.21, P < 0.001). In patients with COVID-19, HFNC was associated with a reduction in oxygenation failure without improvement in 90-day mortality, whereas NIV was associated with a higher mortality in these patients. Randomized controlled trials are needed.

中文翻译：

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COVID-19 无创氧合策略的益处和风险：一项在 137 家医院进行的多中心、前瞻性队列研究 (COVID-ICU)

评估标准氧气、高流量鼻插管 (HFNC) 和无创通气 (NIV) 对入住重症监护病房 (ICU) 的 COVID-19 患者氧合失败率和死亡率的各自影响。法国、比利时和瑞士 137 家医院的多中心前瞻性队列研究 (COVID-ICU)。收集了人口统计学、临床、呼吸支持、氧合衰竭和生存数据。氧合失败被定义为在没有插管的情况下在 ICU 中插管或死亡。使用多变量逻辑回归评估与氧合失败和第 90 天死亡率独立相关的变量。2020年2月25日至5月4日，ICU收治患者4754人。其中，1491 名患者在入住 ICU 当天未插管并接受标准氧疗 (51%)、HFNC (38%)、或 NIV (11%) (P < 0.001)。739 名（50%）患者发生氧合失败（678 人插管，61 人死亡）。对于标准氧气、HFNC 和 NIV，氧合失败率分别为 49%、48% 和 60% (P < 0.001)。通过多变量分析，HFNC（比值比 [OR] 0.60，95% 置信区间 [CI] 0.36-0.99，P = 0.013）而不是 NIV（OR 1.57，95% CI 0.78-3.21）与氧合失败的减少相关）。90 天的总死亡率为 21%。通过多变量分析，HFNC 与死亡率的变化无关（OR 0.90，95% CI 0.61-1.33），而 NIV 与死亡率增加相关（OR 2.75，95% CI 1.79-4.21，P < 0.001）。在 COVID-19 患者中，HFNC 与氧合失败减少相关，但 90 天死亡率没有改善，而 NIV 与这些患者的更高死亡率相关。