High-flow nasal oxygen versus conventional oxygen therapy in patients with COVID-19 pneumonia and mild hypoxaemia: a randomised controlled trial.

In patients with COVID-19 pneumonia and mild hypoxaemia, the clinical benefit of high-flow nasal oxygen (HFNO) remains unclear. We aimed to examine whether HFNO compared with conventional oxygen therapy (COT) could prevent escalation of respiratory support in this patient population. In this multicentre, randomised, parallel-group, open-label trial, patients with COVID-19 pneumonia and peripheral oxygen saturation (SpO Among 364 randomised patients, 55 (30.3%) of 181 patients assigned to HFNO and 70 (38.6%) of 181 patients assigned to COT underwent escalation of respiratory support, with no significant difference between groups (absolute risk difference -8.2% (95% CI -18% to +1.4%); RR 0.79 (95% CI 0.59 to 1.05); p=0.09). There was no significant difference in clinical recovery (69.1% vs 60.8%; absolute risk difference 8.2% (95% CI -1.5% to +18.0%), RR 1.14 (95% CI 0.98 to 1.32)), intensive care unit admission (7.7% vs 11.0%, absolute risk difference -3.3% (95% CI -9.3% to +2.6%)), and in hospital length of stay (11 (IQR 8-17) vs 11 (IQR 7-20) days, absolute risk difference -1.0% (95% CI -3.1% to +1.1%)). Among patients with COVID-19 pneumonia and mild hypoxaemia, the use of HFNO did not significantly reduce the likelihood of escalation of respiratory support. NCT04655638.

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Déclaration de conflit d'intérêts

Competing interests: ACh, AG and CG declare a patent, in association with the University of Palermo—Italy (No 102019000020532—Italian Ministry of Economic Development), not discussed in the present study. ACa received honoraria for lectures or consultancies from Breas, Philips (outside the submitted work). CC received honoraria for lectures from Philips, Resmed (outside the submitted work). CG received honoraria for lectures or consultancies from Vivisol, Philips, Mindray, Air Liquide (outside the submitted work). JCW received honoraria for lectures from Vitalaire, Nippon Gases, Philips, Breas and Armstrong Medical (outside the submitted work). The remaining authors declared no competing interests.