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Other devices, such as a high-flow nasal cannula (HFNC), have been alternatives to IMV in settings with limited resources. This study evaluates whether HFNC exposure time prior to IMV is associated with mortality. This observational, analytical study was conducted on a historical cohort of adults with ARDS due to SARS-CoV-2 who were exposed to HFNC and subsequently underwent IMV. Univariate and multivariate logistic regression was used to analyze the impact of HFNC exposure time on mortality, controlling for multiple potential confounders. Of 325 patients with ARDS, 41 received treatment with HFNC for more than 48\u00a0h before IMV initiation. These patients had a higher mortality rate (43.9% vs. 27.1%,<jats:italic>p<\/jats:italic>: 0.027) than those using HFNC\u2009&lt;\u200948\u00a0h. Univariate analysis evidenced an association between mortality and HFNC\u2009\u2265\u200948\u00a0h (OR 2.16. 95% CI 1.087\u20134.287.<jats:italic>p<\/jats:italic>: 0.028). Such an association persisted in the multivariable analysis (OR 2.21. 95% CI 1.013\u20134.808.<jats:italic>p<\/jats:italic>: 0.046) after controlling for age, sex, comorbidities, basal severity of infection, and complications. This study also identified a significant increase in mortality after 36\u00a0h in HFNC (46.3%,<jats:italic>p<\/jats:italic>: 0.003). In patients with ARDS due to COVID-19, HFNC exposure\u2009\u2265\u200948\u00a0h prior to IMV is a factor associated with mortality after controlling multiple confounders. Physiological mechanisms for such an association are need to be defined.<\/jats:p>","DOI":"10.1007\/s11739-022-03186-4","type":"journal-article","created":{"date-parts":[[2023,2,15]],"date-time":"2023-02-15T19:01:56Z","timestamp":1676487716000},"page":"429-437","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Delayed mechanical ventilation with prolonged high-flow nasal cannula exposure time as a risk factor for mortality in acute respiratory distress syndrome due to SARS-CoV-2"],"prefix":"10.1007","volume":"18","author":[{"given":"Viviana Yiset","family":"L\u00f3pez-Ram\u00edrez","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oscar Orlando","family":"Sanabria-Rodr\u00edguez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Santiago","family":"Bottia-C\u00f3rdoba","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5401-0018","authenticated-orcid":false,"given":"Oscar Mauricio","family":"Mu\u00f1oz-Velandia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2023,2,15]]},"reference":[{"key":"3186_CR1","doi-asserted-by":"crossref","unstructured":"Berlin DA, Gulick RM, Mart\u00ednez FJ. 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