The use of oxygen hoods in patients failing on conventional high-flow oxygen delivery systems, the effects on oxygenation, mechanical ventilation and mortality rates in hypoxic patients with COVID-19. A Prospective Controlled Cohort Study

Abstract

\n Introduction\n Efforts to meet increased oxygen demands in COVID-19 patients are a priority in averting mechanical ventilation (MV), associated with high mortality approaching 76.4 – 97.2%. Novel methods of oxygen delivery could mitigate that risk. Oxygen hoods/helmets may improve: O2-saturation (SaO2), reduce in-hospital mechanical ventilation and mortality rates, and reduce length of hospitalization in hypoxic Covid-19 patients failing on conventional high-flow oxygen delivery systems.\n \n Methods\n .\n \n Design\n Prospective Controlled Cohort Study.\n \n Setting\n Single Center.\n \n Participants\n All patients admitted with a diagnosis of COVID-19 were reviewed and 136/347 patients met inclusion criteria.\n \n Study period\n 3/6/2020 to 5/1/2020.\n 136 participants completed the study with known status for all outcome measures.\n \n Intervention or Exposure\n Oxygen hoods/helmets as compared to conventional high-flow oxygen delivery systems.\n \n Main Outcome(s) and Measure(s)\n 1) Pre and post change in oxygen saturation (SaO2).\n 2) In-hospital Intubation.\n 3) In-hospital Mortality.\n 4) Length of hospitalization.\n \n Results\n 136 patients including 58-intervention and 78-control patients were studied. Age, gender, and other demographics/prognostic indicators were comparable between cohorts.\n Oxygen hoods averted imminent intubation/MV in all 58 COVID-19 patients failing on conventional high-flow oxygen delivery systems with a mean improvement in SaO2 of 8.8%, p < 0.001.\n MV rates were observed to be higher in the control 37/78 (47.4%) as compared to the intervention cohort 23/58 (39.7%), a difference of 7.7%, a 27% risk reduction, not statistically significant, OR 95%CI 0.73 (0.37 to 1.5).\n Mortality rates were observed higher in the control 54/78 (69.2%) as compared to the intervention cohort 36/58 (62.1%), a difference of 7.1%, a 27% risk reduction, not statistically significant OR 95%CI 0.73 (0.36 to 1.5).\n \n Conclusion\n Oxygen hoods demonstrate improvement in SaO2 for patients failing on conventional high-flow oxygen-delivery systems and prevented imminent mechanical ventilation.\n In-hospital mechanical ventilation and mortality rates were reduced with the use of oxygen hoods but not found to be statistically significant.\n The oxygen hood is a safe, effective oxygen-delivery system which may reduce intubation/MV and mortality rates. Their use should be considered in treating hypoxic COVID-19 patients. Further research is warranted.\n \n Trial Registration\n ClinicalTrials.gov Identifier: NCT 04407260.\n