ArticleCritical care (London, England)2021
High-flow nasal oxygen in patients with COVID-19-associated acute respiratory failure.
Article in Critical care (London, England), 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 88 papers, 7 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
88 citing papers in PubMed, 7 syntheses or guidelines pooled it, 203 citations in OpenAlex.
- Effect of non-invasive ventilation and high-flow nasal cannula on hospital mortality in COVID-19-induced acute respiratory failure: a meta-analysis.Einstein (Sao Paulo, Brazil) · 2026Pooled it
- Noninvasive oxygenation and ventilation strategies for viral acute respiratory failure: a comprehensive systematic review and meta-analysis.Systematic reviews · 2025Pooled it
- Outcome in early vs late intubation among COVID-19 patients with acute respiratory distress syndrome: an updated systematic review and meta-analysis.Scientific reports · 2022Pooled it
- Early intubation and clinical outcomes in patients with severe COVID-19: a systematic review and meta-analysis.European journal of medical research · 2022Pooled it
- Comparison of clinical characteristics and outcomes of COVID-19 patients undergoing early versus late intubation from initial hospital admission: A systematic review and meta-analysis.Respiratory investigation · 2022Pooled it
- High-Flow Nasal Oxygen for Severe Hypoxemia: Oxygenation Response and Outcome in Patients with COVID-19.American journal of respiratory and critical care medicine · 2022Pooled it
- Effect of timing of intubation on clinical outcomes of critically ill patients with COVID-19: a systematic review and meta-analysis of non-randomized cohort studies.Critical care (London, England) · 2021Pooled it
- Timing of intubation and ICU mortality in COVID-19 patients: a retrospective analysis of 4198 critically ill patients during the first and second waves.BMC anesthesiology · 2023Trial
- High-Dose Dexamethasone and Oxygen Support Strategies in Intensive Care Unit Patients With Severe COVID-19 Acute Hypoxemic Respiratory Failure: The COVIDICUS Randomized Clinical Trial.JAMA internal medicine · 2022Trial
- High- Versus Low-Dose Dexamethasone for the Treatment of COVID-19-Related Acute Respiratory Distress Syndrome: A Multicenter, Randomized Open-Label Clinical Trial.Journal of intensive care medicine · 2022Trial
- Innovation Deimplementation in Emergency Departments During the COVID-19 Pandemic: Qualitative Study of Clinicians' Decision-Making.Interactive journal of medical research · 2026Article
- Cytosolic proliferating cell nuclear antigen (PCNA) orchestrates neutrophil hyperactivation in COVID-19.Proceedings of the National Academy of Sciences of the United States of America · 2025Article
- Effect of early intubation on patient-centered outcomes in urosepsis: a retrospective multicenter cohort study.Journal of intensive care · 2025Article
- Data-driven modelling of IRCU patient flow during the COVID-19 pandemic.Computational and structural biotechnology journal · 2025Article
- Practice of ventilation in critically ill pediatric patients: protocol for an international, long-term, observational study, and results of the pilot feasibility study.Critical care science · 2025Observational
- Ferroptosis and hyperoxic lung injury: insights into pathophysiology and treatment approaches.Frontiers in pharmacology · 2025Review
- Portable UV-C device to treat high flow of infectious aerosols generated during clinical respiratory care.Scientific reports · 2024Article
- Portable UV-C Device to Treat High Flow of Infectious Aerosols Generated during Clinical Respiratory Care.Research square · 2024Article
- Effect of immediate initiation of invasive ventilation on mortality in acute hypoxemic respiratory failure: a target trial emulation.Critical care (London, England) · 2024Article
- Racial Differences in Accuracy of Predictive Models for High-Flow Nasal Cannula Failure in COVID-19.Critical care explorations · 2024Article
28 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
10 authors at 7 institutions in 2 countries.
Funding
Abstract
purposeWhether the use of high-flow nasal oxygen in adult patients with COVID-19 associated acute respiratory failure improves clinically relevant outcomes remains unclear. We thus sought to assess the effect of high-flow nasal oxygen on ventilator-free days, compared to early initiation of invasive mechanical ventilation, on adult patients with COVID-19.
methodsWe conducted a multicentre cohort study using a prospectively collected database of patients with COVID-19 associated acute respiratory failure admitted to 36 Spanish and Andorran intensive care units (ICUs). Main exposure was the use of high-flow nasal oxygen (conservative group), while early invasive mechanical ventilation (within the first day of ICU admission; early intubation group) served as the comparator. The primary outcome was ventilator-free days at 28 days. ICU length of stay and all-cause in-hospital mortality served as secondary outcomes. We used propensity score matching to adjust for measured confounding.
resultsOut of 468 eligible patients, a total of 122 matched patients were included in the present analysis (61 for each group). When compared to early intubation, the use of high-flow nasal oxygen was associated with an increase in ventilator-free days (mean difference: 8.0 days; 95% confidence interval (CI): 4.4 to 11.7 days) and a reduction in ICU length of stay (mean difference: - 8.2 days; 95% CI - 12.7 to - 3.6 days). No difference was observed in all-cause in-hospital mortality between groups (odds ratio: 0.64; 95% CI: 0.25 to 1.64).
conclusionsThe use of high-flow nasal oxygen upon ICU admission in adult patients with COVID-19 related acute hypoxemic respiratory failure may lead to an increase in ventilator-free days and a reduction in ICU length of stay, when compared to early initiation of invasive mechanical ventilation. Future studies should confirm our findings.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.