Trial reportJAMA2021
Effect of High-Flow Oxygen Therapy vs Conventional Oxygen Therapy on Invasive Mechanical Ventilation and Clinical Recovery in Patients With Severe COVID-19: A Randomized Clinical Trial.
Trial report in JAMA, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. It is linked to 4 registered trials, which are not on this map. Cited by 161 papers, 11 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
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.
A Trial of High-Flow Nasal Cannula vs. Conventional Oxygen Therapy in Patients With SARS-CoV-2-Related Acute Respiratory Failure: the HiFlo-COVID Trial.
Evaluation of Gas Composition in the Oropharynx During High-flow Oxygen Therapy Through Nasal Cannula in Healthy Volunteers: a Physiological Study
Gas Composition in the Hypopharynx During High-flow Oxygen Therapy Through Nasal Cannula or Face Mask, or During Standard Oxygen Therapy Through a Non-Rebreather Face Mask in Healthy Volunteers
High-flow Nasal Cannula Oxygen Therapy Versus Conventional Oxygen Therapy in Patients With High-altitude Pulmonary Edema: A Prospective Randomized Controlled Study
Who cites it
161 citing papers in PubMed, 11 syntheses or guidelines pooled it, 294 citations in OpenAlex.
- Respiratory Support in the Emergency Department: An Updated Systematic Review and Meta-Analysis.Worldviews on evidence-based nursing · 2026Pooled it
- 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
- High-flow nasal oxygen in perioperative and critical care: a bibliometric analysis.Frontiers in medicine · 2026Pooled it
- Physiological effects of noninvasive respiratory support strategies in adults with acute hypoxemic respiratory failure: a systematic review and network meta-analysis.Critical care (London, England) · 2025Pooled it
- Eligibility Criteria of Randomized Clinical Trials in Critical Care Medicine.JAMA network open · 2025Pooled it
- High-flow nasal oxygen therapy compared with conventional oxygen therapy in hospitalised patients with respiratory illness: a systematic review and meta-analysis.BMJ open respiratory research · 2024Pooled it
- Lessons Learned from Model-based Economic Evaluations of COVID-19 Drug Treatments Under Pandemic Circumstances: Results from a Systematic Review.PharmacoEconomics · 2024Pooled it
- High-flow nasal oxygen versus conventional oxygen therapy and noninvasive ventilation in COVID-19 respiratory failure: a systematic review and network meta-analysis of randomised controlled trials.British journal of anaesthesia · 2024Pooled it
- High flow nasal oxygen and awake prone positioning - Two allies against COVID-19: A systematic review.Respiratory physiology & neurobiology · 2023Pooled it
- Pooled it
- Comparison between high-flow nasal cannula and conventional oxygen therapy in COVID-19 patients: a systematic review and meta-analysis.Therapeutic advances in respiratory diseasePooled it
- Trial
- Long-term mortality and health-related quality of life with lower versus higher oxygenation targets in intensive care unit patients with COVID-19 and severe hypoxaemia.Intensive care medicine · 2024Trial
- Dyspnea is severe and associated with a higher intubation rate in de novo acute hypoxemic respiratory failure.Critical care (London, England) · 2024Trial
- Prone position versus usual care in hypoxemic COVID-19 patients in medical wards: a randomised controlled trial.Critical care (London, England) · 2023Trial
- Trial
- Trial
- Oxygen physiology and mechanisms of oxygen toxicity: a narrative review.Medical gas research · 2026Review
- Predicting Failure at Initiation of High-Flow Nasal Oxygen in Patients With COVID-19: Literature Review, Development and Internal Validation of a Prediction Model.Respirology (Carlton, Vic.) · 2026Observational
- Efficacy of nasal high-flow therapy versus standard oxygen therapy in hypoxemic respiratory failure: a systematic review and meta-analysis of RCTS.Annals of medicine and surgery (2012) · 2026Article
101 more citing papers are in PubMed but not listed here.
Corrections and comments
- Commented on by
- Commented on by
- Erratum issued
Authors and funding
27 authors at 4 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
importanceThe effect of high-flow oxygen therapy vs conventional oxygen therapy has not been established in the setting of severe COVID-19.
objectiveTo determine the effect of high-flow oxygen therapy through a nasal cannula compared with conventional oxygen therapy on need for endotracheal intubation and clinical recovery in severe COVID-19. DESIGN, SETTING, AND
participantsRandomized, open-label clinical trial conducted in emergency and intensive care units in 3 hospitals in Colombia. A total of 220 adults with respiratory distress and a ratio of partial pressure of arterial oxygen to fraction of inspired oxygen of less than 200 due to COVID-19 were randomized from August 2020 to January 2021, with last follow-up on February 10, 2021.
interventionsPatients were randomly assigned to receive high-flow oxygen through a nasal cannula (n = 109) or conventional oxygen therapy (n = 111). MAIN OUTCOMES AND MEASURES: The co-primary outcomes were need for intubation and time to clinical recovery until day 28 as assessed by a 7-category ordinal scale (range, 1-7, with higher scores indicating a worse condition). Effects of treatments were calculated with a Cox proportional hazards model adjusted for hypoxemia severity, age, and comorbidities.
resultsAmong 220 randomized patients, 199 were included in the analysis (median age, 60 years; n = 65 women [32.7%]). Intubation occurred in 34 (34.3%) randomized to high-flow oxygen therapy and in 51 (51.0%) randomized to conventional oxygen therapy (hazard ratio, 0.62; 95% CI, 0.39-0.96; P = .03). The median time to clinical recovery within 28 days was 11 (IQR, 9-14) days in patients randomized to high-flow oxygen therapy vs 14 (IQR, 11-19) days in those randomized to conventional oxygen therapy (hazard ratio, 1.39; 95% CI, 1.00-1.92; P = .047). Suspected bacterial pneumonia occurred in 13 patients (13.1%) randomized to high-flow oxygen and in 17 (17.0%) of those randomized to conventional oxygen therapy, while bacteremia was detected in 7 (7.1%) vs 11 (11.0%), respectively. CONCLUSIONS AND RELEVANCE: Among patients with severe COVID-19, use of high-flow oxygen through a nasal cannula significantly decreased need for mechanical ventilation support and time to clinical recovery compared with conventional low-flow oxygen therapy.
trial registrationClinicalTrials.gov Identifier: NCT04609462.
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What OpenQuestion holds
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.