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Critical Care volume 25 , Article number: Cite this article. Metrics details. Demographic, clinical, respiratory support, oxygenation failure, and survival data were collected. Oxygenation failure was defined as either intubation or death in the ICU without intubation. Variables independently associated with oxygenation failure and Day mortality were assessed using multivariate logistic regression.
Randomized controlled trials are needed. Understanding how clinicians can address the demand for emergency mass critical care and fine-tune the standard of care regarding oxygenation management is of the utmost importance. For instance, guidance about how to allocate scarce critical care resources such as ventilators should be made using data showing that safe alternatives to standard oxygen therapy can avoid intubation without lessening survival probabilities.
In patients with de novo acute respiratory failure admitted to the intensive care unit ICU , high-flow nasal cannula oxygen HFNC and noninvasive mechanical ventilation NIV improve oxygenation and reduce inspiratory effort and the work of breathing [ 1 , 2 , 3 ]. High-flow nasal cannula oxygen has shown clinical benefit by reducing the intubation rate [ 4 ], and its use is now recommended in de novo acute respiratory failure [ 5 ].
Noninvasive ventilation decreases the intubation rate [ 6 ], but NIV failure and subsequent intubation is associated with higher mortality compared to first-line intubation [ 7 ], and NIV is not recommended in de novo acute respiratory failure [ 6 ]. The main characteristics of these ICUs have been described elsewhere [ 10 ]. Centers were invited to participate by public announcements and through the REVA network 70 centers were active members of this network. Laboratory confirmation for SARS-Cov-2 was defined as a positive result of real-time reverse transcriptase-polymerase chain reaction RT-PCR assay from either nasal or pharyngeal swabs, or lower respiratory tract aspirate.
For the purposes of the present post hoc analysis, only patients who were not intubated on the day of ICU admission were included. Day 1 was defined as the first day that the patient was in the ICU at 10 am. Each day, the study investigators completed a standardized electronic case report form. Baseline information collected at ICU admission was age, sex, body mass index, active smoking, Simplified Acute Physiology Score II score [ 11 ], Sequential Organ Failure Assessment [ 12 ], comorbidities, immunodeficiency if present , clinical frailty scale [ 13 ], date of the first symptom, date of hospital, and ICU admissions.