{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T01:41:51Z","timestamp":1791250911181,"version":"4.1.0"},"reference-count":45,"publisher":"SAGE Publications","issue":"8","license":[{"start":{"date-parts":[[2022,6,7]],"date-time":"2022-06-07T00:00:00Z","timestamp":1654560000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Respir Care"],"published-print":{"date-parts":[[2022,8]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>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\u20134.9) 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>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.)<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4187\/respcare.09672","type":"journal-article","created":{"date-parts":[[2022,6,7]],"date-time":"2022-06-07T13:26:11Z","timestamp":1654608371000},"page":"929-938","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":11,"title":["Variation in Use of High-Flow Nasal Cannula and Noninvasive Ventilation Among Patients With COVID-19"],"prefix":"10.1177","volume":"67","author":[{"given":"Michael A","family":"Garcia","sequence":"first","affiliation":[{"name":"The Pulmonary Center, Division of Pulmonary, Allergy, Sleep and Critical Care, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shelsey W","family":"Johnson","sequence":"additional","affiliation":[{"name":"The Pulmonary Center, Division of Pulmonary, Allergy, Sleep and 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Minnesota."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amos","family":"Lal","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Smith","family":"Heavner","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Prisma Health, Greenville, South Carolina."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sreekanth R","family":"Cheruku","sequence":"additional","affiliation":[{"name":"Divisions of Cardiothoracic Anesthesiology and Critical Care Medicine, Department of Anesthesia and Pain Management, University of Texas Southwestern Medical Center, Dallas, Texas."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Donna","family":"Lee","sequence":"additional","affiliation":[{"name":"Center for Advanced Analytics, Best Practices, Baptist Health South 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