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Journals / Hitit Medical Journal / 2026 / Cilt: 8 Sayı: 2

Impact Of Pre-Intubation High-Flow Nasal Oxygen Therapy On Mortality İn Patients With COVID-19 Requiring Invasive Mechanical Ventilation

İnvaziv Mekanik Ventilasyon Gerektiren COVID-19 Hastalarında Entübasyon Öncesi Yüksek Akımlı Nazal Oksijen Tedavisinin Mortalite Üzerine Etkisi

Ali Hakan Emirkadı(SAĞLIK BİLİMLERİ ÜNİVERSİTESİ, İSTANBUL SULTAN ABDÜLHAMİD HAN SAĞLIK UYGULAMA VE ARAŞTIRMA MERKEZİ, CERRAHİ TIP BİLİMLERİ BÖLÜMÜ, ANESTEZİYOLOJİ ANABİLİM DALI)0000-0001-6938-0476
Engin Çetin(Sağlık Bilimleri Üniversitesi, Kocaeli Şehir Hastanesi Anesteziyoloji ve Reanimasyon Kliniği)0000-0002-3011-3968
Pages
283–295
Publication Date
2026-06-29
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AI Summary & Key Takeaways

AI Insight
⚡ TL;DR(Too Long; Didn't Read)

Results: Overall in-hospital mortality was 47.5% (217/457).

📌 3 Key Takeaways

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Objective & Hypothesis:Objective: High-flow nasal cannula (HFNC) is widely used in acute hypoxemic respiratory failure; however, its impact on outcomes in patients with COVID-19 who ultimately require invasive mechanical ventilation (IMV) remains uncertain.
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Key Findings & Data:Methods: This retrospective single-center cohort included 457 adult patients with COVID-19 who underwent IMV between March 2020 and December 2022.
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Conclusion & Impact:Results: Overall in-hospital mortality was 47.5% (217/457).
🔬Design:Modeling & Simulation
📍Scope:2020 Verileri
⚙️Variables:yüksek akışlı nazal kanül · covid-19 · mortalite

Abstract

Objective: High-flow nasal cannula (HFNC) is widely used in acute hypoxemic respiratory failure; however, its impact on outcomes in patients with COVID-19 who ultimately require invasive mechanical ventilation (IMV) remains uncertain. This study evaluated the association between pre-intubation HFNC use and in-hospital mortality, successful extubation, and IMV duration. Methods: This retrospective single-center cohort included 457 adult patients with COVID-19 who underwent IMV between March 2020 and December 2022. Among them, 219 patients (47.9%) received HFNC prior to intubation, while 238 patients (52.1%) were intubated without prior HFNC exposure. Baseline demographic and clinical characteristics were balanced using inverse probability of treatment weighting (IPTW). The primary outcome was time to in-hospital mortality; secondary outcomes were successful extubation and IMV duration. Cox proportional hazards regression was prespecified as the primary analytic method and was complemented by double-robust models, propensity score matching (PSM), trimming scenarios, and E-value analysis. Results: Overall in-hospital mortality was 47.5% (217/457). Although crude mortality was higher in the HFNC group (56.2% vs. 39.5%; p=0.001), IPTW-weighted Cox analysis demonstrated a significant reduction in mortality associated with pre-intubation HFNC use (hazard ratio [HR]=0.65; 95% confidence interval [CI]: 0.49–0.86; p=0.002). Findings were consistent across sensitivity analyses and PSM. Kaplan–Meier curves diverged after approximately 150 hours in favor of HFNC. Male sex independently predicted mortality (HR=1.53; 95% CI: 1.16–2.02). Successful extubation rates were similar between groups, whereas IMV duration was longer in the HFNC group. Conclusion: Pre-intubation HFNC use was independently associated with reduced in-hospital mortality in patients with COVID-19 requiring IMV. Prospective multicenter randomized trials are warranted.

Özet

Amaç: Yüksek akımlı nazal kanül (HFNC), akut hipoksemik solunum yetmezliğinde yaygın olarak kullanılmaktadır; ancak invaziv mekanik ventilasyon (İMV) gerektiren COVID-19 hastalarında klinik sonuçlar üzerindeki etkisi net değildir. Bu çalışmada, entübasyon öncesi HFNC kullanımının hastane içi mortalite, başarılı ekstübasyon ve İMV süresi ile ilişkisini değerlendirmeyi amaçladık. Yöntemler: Bu retrospektif, tek merkezli kohort çalışmasına Mart 2020–Aralık 2022 tarihleri arasında İMV uygulanan 457 erişkin COVID-19 hastası dahil edildi. Hastaların 219’u (%47,9) entübasyon öncesinde HFNC alırken, 238’i (%52,1) doğrudan entübe edildi. Başlangıç demografik ve klinik değişkenler ters olasılık ağırlıklandırması (inverse probability of treatment weighting, IPTW) kullanılarak dengelendi. Birincil sonlanım noktası hastane içi mortaliteye kadar geçen süreydi. İkincil sonlanım noktaları başarılı ekstübasyon ve İMV süresiydi. Cox orantısal risk regresyonu önceden birincil analiz yöntemi olarak belirlendi ve çift-robust modeller, eğilim skoru eşleştirmesi (PSM), kırpma senaryoları ve ölçülmeyen karıştırıcılar için E-değeri analizi ile desteklendi. Bulgular: Genel hastane içi mortalite oranı %47,5 (217/457) idi. Ham analizde HFNC grubunda mortalite daha yüksek görünmesine rağmen (%56,2’ye karşı %39,5; p=0,001), IPTW ile ağırlıklandırılmış Cox analizinde entübasyon öncesi HFNC kullanımı mortalite riskinde anlamlı azalma ile ilişkiliydi (tehlike oranı [HR]=0,65; %95 güven aralığı [GA]: 0,49–0,86; p=0,002). Bu bulgu tüm duyarlılık analizlerinde tutarlıydı. Kaplan–Meier eğrileri yaklaşık 150 saatten sonra HFNC lehine ayrıştı. Erkek cinsiyet mortalitenin bağımsız bir belirleyicisiydi. Başarılı ekstübasyon oranları benzerken, HFNC grubunda İMV süresi daha uzundu. Sonuç: Entübasyon öncesi HFNC kullanımı, COVID-19 nedeniyle İMV gerektiren hastalarda daha uzun İMV süresine rağmen hastane içi mortalitenin azalması ile ilişkiliydi. Bu bulgular HFNC’nin yalnızca entübasyonu geciktirmekten öte fizyolojik stabilizasyon sağlayabileceğini düşündürmektedir. Bulguların doğrulanması için çok merkezli, prospektif randomize çalışmalara ihtiyaç vardır.

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Cite This Article

Emirkadı, A. H., Çetin, E. (2026). Impact Of Pre-Intubation High-Flow Nasal Oxygen Therapy On Mortality İn Patients With COVID-19 Requiring Invasive Mechanical Ventilation. Hitit Medical Journal, Cilt: 8 Sayı: 2, 283–295. https://doi.org/10.52827/hititmedj.1847286

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