TY - JOUR T1 - Variation in Use of High-Flow Nasal Cannula and Noninvasive Ventilation Among Patients With COVID-19 JF - Respiratory Care SP - 929 LP - 938 DO - 10.4187/respcare.09672 VL - 67 IS - 8 AU - Michael A Garcia AU - Shelsey W Johnson AU - Emily K Sisson AU - Christopher R Sheldrick AU - Vishakha K Kumar AU - Karen Boman AU - Scott Bolesta AU - Vikas Bansal AU - Marija Bogojevic AU - JP Domecq AU - Amos Lal AU - Smith Heavner AU - Sreekanth R Cheruku AU - Donna Lee AU - Harry L Anderson AU - Joshua L Denson AU - Ognjen Gajic AU - Rahul Kashyap AU - Allan J Walkey AU - from the Society of Critical Care Medicine's Discovery Viral Infection and Respiratory Illness Universal Study Investigators Y1 - 2022/08/01 UR - http://rc.rcjournal.com/content/67/8/929.abstract N2 - BACKGROUND: The use of high-flow nasal cannula (HFNC) and noninvasive ventilation (NIV) for hypoxemic respiratory failure secondary to COVID-19 are recommended by critical-care guidelines; however, apprehension about viral particle aerosolization and patient self-inflicted lung injury may have limited use. We aimed to describe hospital variation in the use and clinical outcomes of HFNC and NIV for the management of COVID-19.METHODS: This was a retrospective observational study of adults hospitalized with COVID-19 who received supplemental oxygen between February 15, 2020, and April 12, 2021, across 102 international and United States hospitals by using the COVID-19 Registry. Associations of HFNC and NIV use with clinical outcomes were evaluated by using multivariable adjusted hierarchical random-effects logistic regression models. Hospital variation was characterized by using intraclass correlation and the median odds ratio.RESULTS: Among 13,454 adults with COVID-19 who received supplemental oxygen, 8,143 (60%) received nasal cannula/face mask only, 2,859 (21%) received HFNC, 878 (7%) received NIV, 1,574 (12%) received both HFNC and NIV, with 3,640 subjects (27%) progressing to invasive ventilation. The hospital of admission contributed to 24% of the risk-adjusted variation in HFNC and 30% of the risk-adjusted variation in NIV. The median odds ratio for hospital variation of HFNC was 2.6 (95% CI 1.4–4.9) and of NIV was 3.1 (95% CI 1.2-8.1). Among 5,311 subjects who received HFNC and/or NIV, 2,772 (52%) did not receive invasive ventilation and survived to hospital discharge. Hospital-level use of HFNC or NIV were not associated with the rates of invasive ventilation or mortality.CONCLUSIONS: Hospital variation in the use of HFNC and NIV for acute respiratory failure secondary to COVID-19 was great but was not associated with intubation or mortality. The wide variation and relatively low use of HFNC/NIV observed within our study signaled that implementation of increased HFNC/NIV use in patients with COVID-19 will require changes to current care delivery practices. (ClinicalTrials.gov registration NCT04323787.) ER -