Author:
Perkins Gavin D,Ji Chen,Connolly Bronwen A,Couper Keith,Lall Ranjit,Baillie J Kenneth,Bradley Judy M,Dark Paul,Dave Chirag,De Soyza Anthony,Dennis Anna V,Devrell Anne,Fairbairn Sara,Ghani Hakim,Gorman Ellen A,Green Christopher A,Hart Nicholas,Hee Siew Wan,Kimbley Zoe,Madathil Shyam,McGowan Nicola,Messer Benjamin,Naisbitt Jay,Norman Chloe,Parekh Dhruv,Parkin Emma M,Patel Jaimin,Regan Scott E,Ross Clare,Rostron Anthony J,Saim Mohammad,Simonds Anita K,Skilton Emma,Stallard Nigel,Steiner Michael,Vancheeswaran Rama,Yeung Joyce,McAuley Daniel F
Abstract
ABSTRACTBackgroundBoth continuous positive airway pressure (CPAP) and high-flow nasal oxygenation (HFNO) have been recommended for acute respiratory failure in COVID-19. However, uncertainty exists regarding effectiveness and safety.MethodsIn the Recovery-Respiratory Support multi-center, three-arm, open-label, adaptive, randomized controlled trial, adult hospitalized patients with acute respiratory failure due to COVID-19, deemed suitable for treatment escalation, were randomly assigned to receive CPAP, HFNO, or conventional oxygen therapy. Comparisons were made between each intervention and conventional oxygen therapy. The primary outcome was a composite of tracheal intubation or mortality within 30-days.ResultsOver 13-months, 1272 participants were randomized and included in the analysis (380 (29.9%) CPAP; 417 (32.8%) HFNO; 475 (37.3%) conventional oxygen therapy). The need for tracheal intubation or mortality within 30-days was lower in the CPAP group (CPAP 137 of 377 participants (36.3%) vs conventional oxygen therapy 158 of 356 participants (44.4%); unadjusted odds ratio 0.72; 95% CI 0.53 to 0.96, P=0.03). There was no difference between HFNO and conventional oxygen therapy (HFNO 184 of 414 participants (44.4%) vs conventional oxygen therapy 166 of 368 participants (45.1%); unadjusted odds ratio 0.97; 95% CI 0.73 to 1.29, P=0.85).ConclusionsCPAP, compared with conventional oxygen therapy, reduced the composite outcome of intubation or death within 30 days of randomisation in hospitalized adults with acute respiratory failure due to COVID-19. There was no effect observed, compared with conventional oxygen therapy, with the use of HFNO.(Funded by the UK National Institute for Health Research; ISRCTN 16912075).
Publisher
Cold Spring Harbor Laboratory