Non-rebreather mask and low-flow nasal cannula vs high-flow nasal cannula in severe COVID-19 pneumonia in the emergency department

Mohd Kamil, Muhammad Khidir and Yuen Yoong, Khadijah Poh and Azhar, Abdul Muhaimin Noor and Bustam, Aida and Abdullah, Ahmad Hariz and Md Yusuf, Mohd Hafyzuddin and Zambri, Aliyah and Ahmad Zahedi, Ahmad Zulkarnain and Shafie, Hidayah (2023) Non-rebreather mask and low-flow nasal cannula vs high-flow nasal cannula in severe COVID-19 pneumonia in the emergency department. American Journal of Emergency Medicine, 63. pp. 86-93. ISSN 0735-6757, DOI

Full text not available from this repository.


Background: To assess the effectiveness of non-rebreather mask combined with low-flow nasal cannula (NRB + NC) compared to high-flow nasal cannula (HFNC) in improving oxygenation in patients with COVID-19-related hypoxemic respiratory failure (HRF).Methods: This retrospective study was conducted in emergency departments of two tertiary hospitals from June 1 to August 31, 2021. Consecutive patients aged > 18 years admitted for COVID-19-related HRF (World Health Organization criteria: confirmed COVID-19 pneumonia with respiratory rate > 30 breaths/min, severe respiratory distress, or peripheral oxygen saturation < 90% on room air) requiring NRB + NC or HFNC were screened for en-rollment. Primary outcome was improvement of partial pressure arterial oxygen (PaO2) at two hours. Secondary outcomes were intubation rate, ventilator-free days, hospital length of stay, and 28-day mortality. Data were ana-lyzed using linear regression with inverse probability of treatment weighting (IPTW) based on propensity score. Results: Among the 110 patients recruited, 52 (47.3%) were treated with NRB + NC, and 58 (52.7%) with HFNC. There were significant improvements in patients' PaO2, PaO2/FIO2 ratio, and respiratory rate two hours after the initiation of NRB + NC and HFNC. Comparing the two groups, after IPTW adjustment, there were no statistically significant differences in PaO2 improvement (adjusted mean ratio MR] 2.81; 95% CI-5.82 to 11.43; p = .524), in-tubation rate (adjusted OR 1.76; 95% CI 0.44 to 6.92; p = .423), ventilator-free days (adjusted MR 0.00; 95% CI-8.84 to 8.85; p = .999), hospital length of stay (adjusted MR 3.04; 95% CI-2.62 to 8.69; p = .293), and 28-day mortality (adjusted OR 0.68; 95% CI 0.15 to 2.98; p = .608).Conclusion: HFNC may be beneficial in COVID-19 HRF. NRB + NC is a viable alternative, especially in resource -limited settings, given similar improvement in oxygenation at two hours, and no significant differences in long-term outcomes. The effectiveness of NRB + NC needs to be investigated by a powered randomized controlled trial. (c) 2022 Elsevier Inc. All rights reserved.

Item Type: Article
Funders: Ministry of Health
Uncontrolled Keywords: Non-rebreather mask; High-flow nasal cannula; COVID-19; Hypoxemic respiratory failure; Oxygen therapy
Subjects: R Medicine > RC Internal medicine
Divisions: Faculty of Medicine
Depositing User: Ms Zaharah Ramly
Date Deposited: 29 Nov 2023 04:04
Last Modified: 29 Nov 2023 04:04

Actions (login required)

View Item View Item