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

Dayya, David; O’Neill, Owen J.; Feiertag, Tracy; Tuazon-Boer, Ritzel; Sullivan, John; Perez, Lubiha; Gurash, Sandrah; Eaton, Matthew; Bodley, Taylor; Marker, Joanne; Smykowski, Elizabeth; Hall, T.

INTRODUCTION: 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: O(2)-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. METHODS: . DESIGN: Prospective Controlled Cohort Study. SETTING: Single Center. PARTICIPANTS: All patients admitted with a diagnosis of COVID-19 were reviewed and 136/347 patients met inclusion criteria. STUDY PERIOD: 3/6/2020 to 5/1/2020. 136 participants completed the study with known status for all outcome measures. INTERVENTION OR EXPOSURE: Oxygen hoods/helmets as compared to conventional high-flow oxygen delivery systems. MAIN OUTCOME(S) AND MEASURE(S): 1) Pre and post change in oxygen saturation (SaO(2)). 2) In-hospital Intubation. 3) In-hospital Mortality. 4) Length of hospitalization. RESULTS: 136 patients including 58-intervention and 78-control patients were studied. Age, gender, and other demographics/prognostic indicators were comparable between cohorts. 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 SaO(2) of 8.8%, p < 0.001. 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). 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). CONCLUSION: Oxygen hoods demonstrate improvement in SaO(2) for patients failing on conventional high-flow oxygen-delivery systems and prevented imminent mechanical ventilation. In-hospital mechanical ventilation and mortality rates were reduced with the use of oxygen hoods but not found to be statistically significant. 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. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT 04407260.