• Chao-Jui Li, Yat-Yin Law, Yan-Ren Lin, Chien-Chih Chen, Xin-Hong Lin, and Po-Chun Chuang.
• Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
• Am. J. Med. Sci. 2021 Apr 1; 361 (4): 436-444.

BackgroundLiberal oxygen therapy might increase the mortality rate of patients. Non-rebreathing masks (NRM) are a high-flow, non-invasive oxygen device that can provide oxygen concentration up to 95%. This study aimed to determine the impact of using NRM in patients with respiratory failure.MethodsThis retrospective cohort study was conducted in four medical institutions in Taiwan from January 2010 to December 2016. The association between mortality and NRM use before receiving ventilator support in patients with respiratory failure in the emergency department was analyzed. Patients were divided into the NRM treatment and no NRM treatment groups. A 1:4 propensity score matching was conducted. Regarding the duration of NRM use, treatments were grouped as 0 h, 0-1 h, 1-2 h, and >2 h.ResultsA total of 18,749 patients were included, with 1074 using NRM. After propensity score matching, 1028 patients using NRM (0-1 h: 508, 1-2 h: 193, and >2 h: 327) and 4112 patients not using NRM were analyzed. The 30-day mortality rates were 29.1%, 28.5%, 27.5%, and 35.5% in the 0 h, 0-1 h, 1-2 h, and >2 h treatment groups, respectively. Patients with respiratory failure due to pulmonary disease using NRM over 2 h had a higher mortality rate than patients not using NRM (hazard ratio: 1.3, 95% CI: 1.01-1.66).ConclusionsProlonged use of NRM in patients with respiratory failure due to pulmonary disease possibly increases mortality.Copyright © 2021 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.

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