Impact of Combined Non-Invasive Oxygenation Techniques in the Management of SARS-COV2 Pneumonia, OXY-COV

<bold>Materials and Methods:</bold> we present herein a retrospective monocentric study in the respiratory care unit of CHU of Toulouse from October 2020 to December 2021. We have included 162 patients with a SARS-COV2 pneumonia requiring high-flow nasal (HFN) oxygen therapy. Patients received in addition other non-invasive oxygenation optimization techniques such as CPAP (Continuous Positive Airway Pressure) and/or prone positioning (PP). The primary outcome measure was the mortality and/or endotracheal intubation (ETI) rate at day 28. We also analysed the role of the ROX index in predicting this primary outcome. <bold>Results:</bold> 112 (69%) patients underwent PP (average daily use: 4.31 hours +/-1.82), and 114 (88.8%) received CPAP (average daily use: 4 hours +/-1.81). At day 28, the mortality and/or ETI rate was 21.6% (35 patients), with a mortality rate of 8% (13 patients) and ETI rate of 17.9% (29 patients). The primary outcome in patients receiving a combination of HFN/ CPAP/PP and HFN/CPAP was respectively 19.44% and 30.55%, with a mortality rate of 6.48% and 13.88% and ETI rate of 16.6% and 22.22%. A ROX index equal to or greater than 7.4 at the 24th hour predicted a decrease in mortality and/or ETI at day 28 to 7.76%, a mortality rate of 1.94%, and a ETI rate of 6.79%, with a sensitivity of 77.1% and specificity of 74.8%. <bold>Conclusion:</bold> The combination of non-invasive oxygenation optimization techniques (HFN, CPAP, PP) appears effective in reducing the risk of mortality and the need for ETI. Close monitoring is essential to prevent any delays in the initiation of mechanical ventilation, relying on the kinetics of the ROX index and its value at H24.