At the Presidents' Ground Breaking Research Release session at ESICM LIVES 2022 in Paris, Jean-Pierre Frat (Poitiers, France) presented the findings from the Standard Oxygen Versus High Flow Cannula Oxygen Therapy in Patients With Acute Hypoxemic Respiratory Failure (SOHO-COVID) trial.
COVID-19 has resulted in over six million deaths worldwide due to acute hypoxaemic respiratory failure. Nearly 80% of patients with COVID-19 admitted to the hospital, and 45% to ICUs were treated with standard oxygen as first-line therapy. Other noninvasive oxygenation strategies have also been proposed for COVID-19 patients with respiratory failure to avoid intubation, including high-flow nasal cannula oxygen, noninvasive ventilation with pressure support, and continuous positive airway pressure. Data from observational studies suggest a decreased risk of intubation with high-flow oxygen compared with standard oxygen. However, the benefits of high-flow nasal cannula oxygen for intubation and mortality in COVID-19 patients with respiratory failure remain controversial.
The SOHO-COVID trial aimed to evaluate whether high-flow nasal cannula oxygen reduced mortality risk compared with standard oxygen therapy in patients with respiratory failure due to COVID-19. The trial was conducted in 34 ICUs in France. It included 711 patients with COVID-19 respiratory failure and a ratio of partial pressure of arterial oxygen to fraction of inspired oxygen equal to or below 200 mm Hg.
Three hundred fifty-seven study patients received high-flow oxygen, while 354 patients received standard oxygen delivered through a nonrebreathing mask. The primary outcome of the study was mortality at day 28. Secondary outcomes included the proportion of patients requiring intubation, the number of ventilator-free days at day 28, mortality at day 90, mortality and length of stay in the ICU, and adverse events.