Observational studyRespiratory research2025
High-flow nasal oxygen vs. conventional oxygen therapy in patients with COVID-19 related acute hypoxemic respiratory failure and a do not intubate order: a multicentre cohort study.
Observational study in Respiratory research, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
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.
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Who cites it
3 citing papers in PubMed.
- Ward-Based High-Flow Nasal Oxygen Therapy in Acute Respiratory Failure: A Retrospective Analysis of Long-Term Mortality.Respiration; international review of thoracic diseases · 2026Article
- High-Flow Nasal Cannula Outside the ICU: A Systematic Review and Meta-Analysis.Journal of clinical medicine · 2025Review
- Efficacy of high-flow nasal oxygen in preventing hypoxia during Gastrointestinal endoscopy: a retrospective cohort study.BMC anesthesiology · 2025Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
11 authors.
Funding
Abstract
backgroundHigh-flow nasal oxygen (HFNO) is frequently used to treat patients with acute hypoxemic respiratory failure (AHRF) due to viral pneumonia, including COVID-19. However, its clinical effect compared to conventional oxygen therapy (COT) remains largely unexplored in patients with a do not intubate (DNI) order. We aimed to assess whether HFNO compared to COT is associated with improved clinical outcomes in hospitalized patients with AHRF due to COVID-19 and a DNI order.
methodsThis analysis included patients with a DNI order and SARS-CoV-2 infection, selected from three observational studies, who were treated with COT only or HFNO. The primary endpoint was in-hospital mortality, the secondary endpoint was hospital length of stay (LOS). The effect of HFNO vs. COT was assessed using multivariable regression, accounting for pre-selected confounders.
resultsBetween March 2020 and September 2021, 116 patients received HFNO and 110 patients received COT. Median age was 78 [72-83], and 78% of the patients had a Clinical Frailty Scale score of 4 to 9. In-hospital mortality was 64% for HFNO and 71% for COT (p = 0.29), with an adjusted odds ratio of 0.72 (95% confidence interval [0.34-1.54], p = 0.40). Hospital LOS was 11 [6-18] days for HFNO, and 7 [4-12] days for COT (p < 0.001), with a remaining difference after adjusting for confounders (p < 0.01).
conclusionThe lack of survival benefit and increased hospital LOS should be taken into account when considering HFNO for patients with a DNI order, suffering from AHRF due to viral pneumonia, like COVID-19. CLINICAL
trial registrationHFNO-COVID-19 study: DTR, NL9067 (Dutch Trial Registry), registration date: 27-11-2020.
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