• Jonathan Chelly, Louis-Marie Coupry, Ly van Phach Vong, Toufik Kamel, Mehdi Marzouk, Nicolas Terzi, Cedric Bruel, Aurélie Autret, Aude Garnero, and Jean-Michel Arnal.
• Intensive Care Unit, Centre Hospitalier Intercommunal Toulon La Seyne sur Mer, Sainte Musse Hospital, Toulon, France - jonathan.chelly@ch-toulon.fr.
• Minerva Anestesiol. 2023 Jan 1; 89 (1-2): 667366-73.

BackgroundThe optimal first-line noninvasive respiratory support (NIRS) to improve outcome in patients affected by COVID-19 pneumonia admitted to ICU is still debated.MethodsWe conducted a retrospective study in seven French ICUs, including all adults admitted between July and December 2020 with documented SARS-CoV-2 acute respiratory failure (PaO2/FiO2<300 mmHg), and treated with either high-flow nasal therapy (HFNT) alone, noninvasive ventilation alone or in combination with HFNT (NIV), or continuous positive airway pressure alone or in combination with HFNT (CPAP). The primary outcome was NIRS failure at day 28, defined as the need for endotracheal intubation (ETI) or death without ETI.ResultsAmong the 355 patients included, 160 (45%) were treated with HFNT alone, 115 (32%) with NIV and 80 (23%) with CPAP. The primary outcome occurred in 65 (41%), 69 (60%), and 25 (31%) patients among those treated with HFNT alone, NIV, and CPAP, respectively (P<0.001). After univariate analysis, patients treated with CPAP had a trend for a lower incidence of the primary outcome, whereas patients treated with NIV had a significant higher incidence of the primary outcome, both compared to those treated with HFNT alone (unadjusted Hazard ratio 0.67; 95% CI [0.42-1.06], and 1.58; 95% CI [1.12-2.22]; P=0.09 and 0.008, respectively).ConclusionsAmong ICU patients admitted for severe COVID-19 pneumonia and managed with NIRS, the outcome seems to differ according to the initial chosen strategy. Prospective randomized controlled studies are warranted to identify the optimal strategy.

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