{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T15:43:29Z","timestamp":1793202209899,"version":"4.5.0"},"reference-count":33,"publisher":"Public Library of Science (PLoS)","issue":"2","license":[{"start":{"date-parts":[[2023,2,16]],"date-time":"2023-02-16T00:00:00Z","timestamp":1676505600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background\/Aim<\/jats:title>\n<jats:p>We investigated the association of noninvasive oxygenation support [high flow nasal cannula (HFNC) and BiPAP], timing of invasive mechanical ventilation (IMV), and inpatient mortality among patients hospitalized with COVID-19.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>Retrospective chart review study of patients hospitalized with COVID-19 (ICD-10 code U07.1) and received IMV from March 2020-October 2021. Charlson comorbidity index (CCI) was calculated; Obesity defined as body mass index (BMI) \u2265 30 kg\/m<jats:sup>2<\/jats:sup>; morbid obesity was BMI \u2265 40 kg\/m<jats:sup>2<\/jats:sup>. Clinical parameters\/vital signs recorded at time of admission.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>709 COVID-19 patients underwent IMV, predominantly admitted from March-May 2020 (45%), average age 62\u00b115 years, 67% male, 37% Hispanic, and 9% from group living settings. 44% had obesity, 11% had morbid obesity, 55% had type II diabetes, 75% had hypertension, and average CCI was 3.65 (SD = 3.11). Crude mortality rate was 56%. Close linear association of age with inpatient-mortality risk was found [OR (95% CI) = 1.35 (1.27\u20131.44) per 5 years, p&lt;0.0001)]. Patients who died after IMV received noninvasive oxygenation support significantly longer: 5.3 (8.0) vs. 2.7 (SD 4.6) days; longer use was also independently associated with a higher risk of inpatient-mortality: OR = 3.1 (1.8\u20135.4) for 3\u20137 days, 7.2 (3.8\u201313.7) for \u22658 days (reference: 1\u20132 days) (p&lt;0.0001). The association magnitude varied between age groups: 3\u20137 days duration (ref: 1\u20132 days), OR = 4.8 (1.9\u201312.1) in \u226565 years old vs. 2.1 (1.0\u20134.6) in &lt;65 years old. Higher mortality risk was associated with higher CCI in patients \u226565 (P = 0.0082); among younger patients, obesity (OR = 1.8 (1.0\u20133.2) or morbid obesity (OR = 2.8;1.4\u20135.9) (p&lt;0.05) were associated. No mortality association was found for sex or race.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>Time spent on noninvasive oxygenation support [as defined by high flow nasal cannula (HFNC) and BiPAP] prior to IMV increased mortality risk. Research for the generalizability of our findings to other respiratory failure patient populations is needed.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0281859","type":"journal-article","created":{"date-parts":[[2023,2,16]],"date-time":"2023-02-16T18:33:58Z","timestamp":1676572438000},"page":"e0281859","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":4,"title":["How long is too long: A retrospective study evaluating the impact of the duration of noninvasive oxygenation support strategies (high flow nasal cannula &amp; BiPAP) on mortality in invasive mechanically ventilated patients with COVID-19"],"prefix":"10.1371","volume":"18","author":[{"given":"Aditya","family":"Kasarabada","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kimberly","family":"Barker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Theresa","family":"Ganoe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lindsay","family":"Clevenger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristina","family":"Visco","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica","family":"Gibson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rahim","family":"Karimi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Negar","family":"Naderi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian","family":"Lam","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Stepanova","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7833-6124","authenticated-orcid":true,"given":"Linda","family":"Henry","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3101-319X","authenticated-orcid":true,"given":"Christopher","family":"King","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mehul","family":"Desai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2023,2,16]]},"reference":[{"key":"pone.0281859.ref001","volume-title":"Coronavirus Disease 2019 (COVID-19)\u2013Symptoms","author":"CDC"},{"issue":"7","key":"pone.0281859.ref002","doi-asserted-by":"crossref","first-page":"845","DOI":"10.1055\/s-0040-1715458","article-title":"Hematology Laboratory Abnormalities in Patients with Coronavirus Disease 2019 (COVID-19)","volume":"46","author":"B Christensen","year":"2020","journal-title":"Hemost"},{"issue":"10235","key":"pone.0281859.ref003","doi-asserted-by":"crossref","first-page":"1517","DOI":"10.1016\/S0140-6736(20)30920-X","article-title":"SARS-CoV-2 and viral sepsis: observations and hypotheses","volume":"395","author":"H Li","year":"2020","journal-title":"The Lancet"},{"key":"pone.0281859.ref004","article-title":"Pathogenesis of COVID-19 from a cell biologic perspective","author":"RJ Mason","journal-title":"Eur Respir J"},{"issue":"6","key":"pone.0281859.ref005","doi-asserted-by":"crossref","first-page":"102537","DOI":"10.1016\/j.autrev.2020.102537","article-title":"The Role of Cytokines including Interleukin-6 in COVID-19 induced Pneumonia and Macrophage Activation Syndrome-Like Disease","volume":"19","author":"D McGonagle","year":"2020","journal-title":"Autoimmun Rev"},{"key":"pone.0281859.ref006","doi-asserted-by":"crossref","first-page":"732690","DOI":"10.3389\/fimmu.2021.732690","article-title":"Angiotensin-Converting Enzyme 2 (ACE2) in the Pathogenesis of ARDS in COVID-19","volume":"12","author":"K Kuba","year":"2021","journal-title":"Front Immunol"},{"key":"pone.0281859.ref007","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1111\/j.1749-6632.2010.05826.x","article-title":"Neurokinin-1 receptor: functional significance in the immune system in reference to selected infections and inflammation","volume":"1217","author":"SD Douglas","year":"2011","journal-title":"Ann N Y Acad Sci"},{"issue":"2","key":"pone.0281859.ref008","doi-asserted-by":"crossref","first-page":"227","DOI":"10.4187\/respcare.09056","article-title":"High-Flow Nasal Cannula and COVID-19: A Clinical Review","volume":"67","author":"C Crimi","year":"2022","journal-title":"Respir Care"},{"issue":"11","key":"pone.0281859.ref009","doi-asserted-by":"crossref","first-page":"1190","DOI":"10.23736\/S0375-9393.20.14785-0","article-title":"Noninvasive oxygenation support in acute hypoxemic respiratory failure associated with COVID-19 and other viral infections","volume":"86","author":"C Crimi","year":"2020","journal-title":"Minerva Anestesiol"},{"issue":"17","key":"pone.0281859.ref010","doi-asserted-by":"crossref","first-page":"1731","DOI":"10.1001\/jama.2021.4682","article-title":"COVID-ICU Gemelli Study Group. Effect of Helmet Noninvasive Ventilation vs High-Flow Nasal Oxygen on Days Free of Respiratory Support in Patients With COVID-19 and Moderate to Severe Hypoxemic Respiratory Failure: The HENIVOT Randomized Clinical Trial","volume":"325","author":"DL Grieco","year":"2021","journal-title":"JAMA"},{"issue":"6","key":"pone.0281859.ref011","doi-asserted-by":"crossref","first-page":"546","DOI":"10.1001\/jama.2022.0028","article-title":"RECOVERY-RS Collaborators. Effect of Noninvasive Respiratory Strategies on Intubation or Mortality Among Patients With Acute Hypoxemic Respiratory Failure and COVID-19: The RECOVERY-RS Randomized Clinical Trial","volume":"327","author":"GD Perkins","year":"2022","journal-title":"JAMA"},{"issue":"21","key":"pone.0281859.ref012","doi-asserted-by":"crossref","first-page":"2161","DOI":"10.1001\/jama.2021.20714","article-title":"Effect of High-Flow Oxygen Therapy vs Conventional Oxygen Therapy on Invasive Mechanical Ventilation and Clinical Recovery in Patients With Severe COVID-19: A Randomized Clinical Trial","volume":"326","author":"GA Ospina-Tasc\u00f3n","year":"2021","journal-title":"JAMA"},{"key":"pone.0281859.ref013","article-title":"COVID-HIGH Investigators. High-flow nasal oxygen versus conventional oxygen therapy in patients with COVID-19 pneumonia and mild hypoxaemia: a randomised controlled trial","author":"C Crimi","year":"2022","journal-title":"Thorax"},{"issue":"11","key":"pone.0281859.ref014","doi-asserted-by":"crossref","first-page":"1063","DOI":"10.1001\/jama.2022.15599","article-title":"Saudi Critical Care Trials Group. Effect of Helmet Noninvasive Ventilation vs Usual Respiratory Support on Mortality Among Patients With Acute Hypoxemic Respiratory Failure Due to COVID-19: The HELMET-COVID Randomized Clinical Trial","volume":"328","author":"YM Arabi","year":"2022","journal-title":"JAMA"},{"issue":"12","key":"pone.0281859.ref015","doi-asserted-by":"crossref","first-page":"1212","DOI":"10.1001\/jama.2022.15613","article-title":"SOHO-COVID Study Group and the REVA Network. Effect of High-Flow Nasal Cannula Oxygen vs Standard Oxygen Therapy on Mortality in Patients With Respiratory Failure Due to COVID-19: The SOHO-COVID Randomized Clinical Trial","volume":"328","author":"JP Frat","year":"2022","journal-title":"JAMA"},{"issue":"9","key":"pone.0281859.ref016","doi-asserted-by":"crossref","first-page":"906","DOI":"10.1001\/jamainternmed.2022.2168","article-title":"COVIDICUS Study Group. High-Dose Dexamethasone and Oxygen Support Strategies in Intensive Care Unit Patients With Severe COVID-19 Acute Hypoxemic Respiratory Failure: The COVIDICUS Randomized Clinical Trial","volume":"182","author":"L Bouadma","year":"2022","journal-title":"JAMA Intern Med"},{"issue":"1","key":"pone.0281859.ref017","doi-asserted-by":"crossref","first-page":"e0329","DOI":"10.1097\/CCE.0000000000000329","article-title":"Association Between Early Invasive Mechanical Ventilation and Day-60 Mortality in Acute Hypoxemic Respiratory Failure Related to Coronavirus Disease-2019 Pneumonia","volume":"3","author":"C Dupuis","year":"2021","journal-title":"Crit Care Explor"},{"issue":"9","key":"pone.0281859.ref018","doi-asserted-by":"crossref","first-page":"1014","DOI":"10.23736\/S0375-9393.19.13418-9","article-title":"Patient self-inflicted lung injury: implications for acute hypoxemic respiratory failure and ARDS patients on noninvasive support","volume":"85","author":"DL Grieco","year":"2019","journal-title":"Minerva Anestesiol"},{"key":"pone.0281859.ref019","unstructured":"Clinical care for severe acute respiratory infection: toolkit, update 2022. COVID-19 adaptation. Geneva: World Health Organization; 2022 (WHO\/2019- nCoV\/SARI_toolkit\/2022.1). Licence: CC BY-NC-SA 3.0 IGO."},{"key":"pone.0281859.ref020","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1186\/s13613-021-00904-7","article-title":"High risk of patient self-inflicted lung injury in COVID-19 with frequently encountered spontaneous breathing patterns: a computational modelling study","volume":"11","author":"L. Weaver","year":"2021","journal-title":"Ann. Intensive Care"},{"issue":"11","key":"pone.0281859.ref021","doi-asserted-by":"crossref","first-page":"1914","DOI":"10.1007\/s00134-018-5375-6","article-title":"Mechanical power of ventilation is associated with mortality in critically ill patients: an analysis of patients in two observational cohorts","volume":"44","author":"AS Neto","year":"2018","journal-title":"Intensive Care Med"},{"issue":"2","key":"pone.0281859.ref022","doi-asserted-by":"crossref","first-page":"226","DOI":"10.1016\/j.ajem.2017.07.083","article-title":"The effect of high-flow nasal cannula in reducing the mortality and the rate of endotracheal intubation when used before mechanical ventilation compared with conventional oxygen therapy and noninvasive positive pressure ventilation. A systematic review and meta-analysis","volume":"36","author":"YN Ni","year":"2018","journal-title":"Am J Emerg Med"},{"key":"pone.0281859.ref023","unstructured":"Information on covid-19 treatment, prevention and research [Internet]. National Institutes of Health. U.S. Department of Health and Human Services; [cited 2022Oct3]. Available from: https:\/\/www.covid19treatmentguidelines.nih.gov\/."},{"key":"pone.0281859.ref024","doi-asserted-by":"crossref","first-page":"154262","DOI":"10.1016\/j.metabol.2020.154262","article-title":"Severe obesity, increasing age and male sex are independently associated with worse in-hospital outcomes, and higher in-hospital mortality, in a cohort of patients with COVID-19 in the Bronx, New York","volume":"108","author":"L Palaiodimos","year":"2020","journal-title":"Metabolism"},{"issue":"10","key":"pone.0281859.ref025","doi-asserted-by":"crossref","first-page":"1806","DOI":"10.1002\/oby.22941","article-title":"Obesity is Associated with Increased Risk for Mortality Among Hospitalized Patients with COVID-19","volume":"28","author":"NN Pettit","year":"2020","journal-title":"Obesity (Silver Spring)"},{"issue":"9","key":"pone.0281859.ref026","doi-asserted-by":"crossref","first-page":"1595","DOI":"10.1002\/oby.22913","article-title":"Severe Obesity as an Independent Risk Factor for COVID-19 Mortality in Hospitalized Patients Younger than 50","volume":"28","author":"E Klang","year":"2020","journal-title":"Obesity (Silver Spring)"},{"key":"pone.0281859.ref027","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1079\/PNS2001110","article-title":"Pro-inflammatory cytokines and adipose tissue","volume":"60","author":"SW Coppack","year":"2001","journal-title":"Proceedings of the Nutrition Society"},{"key":"pone.0281859.ref028","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1155\/2006\/834786","article-title":"Altered respiratory physiology in obesity","volume":"13","author":"K Parameswaran","year":"2006","journal-title":"Canadian respiratory journal"},{"key":"pone.0281859.ref029","article-title":"Risk of COVID-19 for patients with obesity","author":"R. Kassir","year":"2020","journal-title":"Obesity Reviews"},{"key":"pone.0281859.ref030","article-title":"Is Adipose Tissue a Reservoir for Viral Spread, Immune Activation and Cytokine Amplification in COVID-19","author":"PM Ryan","year":"2020","journal-title":"Obesity"},{"key":"pone.0281859.ref031","unstructured":"Covid Data Tracker Weekly Review [Internet]. Centers for Disease Control and Prevention. Centers for Disease Control and Prevention; [cited 2022Oct3]. Available from: https:\/\/www.cdc.gov\/coronavirus\/2019-ncov\/covid-data\/covidview\/index.html."},{"issue":"4","key":"pone.0281859.ref032","doi-asserted-by":"crossref","first-page":"623","DOI":"10.1007\/s00134-015-3693-5","article-title":"Failure of high-flow nasal cannula therapy may delay intubation and increase mortality","volume":"41","author":"BJ Kang","year":"2015","journal-title":"Intensive Care Med"},{"issue":"6","key":"pone.0281859.ref033","doi-asserted-by":"crossref","first-page":"e0270138","DOI":"10.1371\/journal.pone.0270138","article-title":"High-flow nasal cannula failure in critically ill cancer patients with acute respiratory failure: Moving from avoiding intubation to avoiding delayed intubation","volume":"17","author":"C Saillard","year":"2022","journal-title":"PLoS One"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0281859","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,2,16]],"date-time":"2023-02-16T18:34:19Z","timestamp":1676572459000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0281859"}},"subtitle":[],"editor":[{"given":"Andrea","family":"Cortegiani","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2023,2,16]]},"references-count":33,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2023,2,16]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0281859","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,2,16]]}}}