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    Low Dose Radiation Therapy for COVID-19 MESHD Pneumonia HP: A Pilot Study

    Authors: Daya Nand Sharma; Randeep Guleria; Naveet Wig; Anant Mohan; Goura Kisor Rath; Vellaiyan Subramani; Sushma Bhatnagar; Supriya Mallick; Aman Sharma; Pritee Patil; Karan Madan; Manish Soneja; Sanjay Thulkar; Angel Rajan Singh; Sheetal Singh; Nan Wu; Hao Chen; Jiangfan Chen; Fan Lu; Jianzhong Su; Jia Qu

    doi:10.1101/2020.11.16.20231514 Date: 2020-11-18 Source: medRxiv

    BackgroundThe World Health Organization (WHO) has declared coronavirus disease 2019 MESHD ( COVID-19 MESHD) as pandemic in March 2020. Currently there is no vaccine or specific effective treatment for COVID-19 MESHD. The major cause of death MESHD in COVID-19 MESHD is severe pneumonia HP pneumonia MESHD leading to respiratory failure HP respiratory failure MESHD. Radiation in low doses (<100 cGy) has been known for its anti-inflammatory effect and therefore, low dose radiation therapy (LDRT) to lungs can potentially mitigate the severity of pneumonia HP pneumonia MESHD and reduce mortality. We conducted a pilot trial to study the feasibility and clinical efficacy of LDRT to lungs in the management of patients with COVID-19 MESHD. MethodsFrom June to Aug 2020, we enrolled 10 patients with COVID-19 MESHD having moderate to severe risk disease [National Early Warning Score (NEWS) of [≥]5]. Patients were treated as per the standard COVID-19 MESHD management guidelines along with LDRT to both lungs with a dose of 70cGy in single fraction. Response assessment was done based on the clinical parameters using the NEWS. ResultsAll patients completed the prescribed treatment. Nine patients had complete clinical recovery mostly within a period ranging from 3-7 days. One patient, who was a known hypertensive, showed clinical deterioration and died 24 days after LDRT. No patients showed the signs of acute radiation toxicity. ConclusionResults of our study (90% response rate) suggest the feasibility and clinical effectiveness of LDRT in COVID-19 MESHD patients having moderate to severe risk disease. This mandates a randomized controlled trial to establish the clinical efficacy of LDRT in COVID-19 MESHD pneumonia HP.

    The occurrence of cardiovascular complications MESHD associated with SARS-CoV-2 infection MESHD: a systematic review

    Authors: Daniele Melo Sardinha; Karla VB Lima; Thalyta MRL Ueno; Yan Correa Rodrigues; Juliana CD Garcez; Anderson LS Santos; Ana LS Ferreira; Ricardo JPS Guimaraes; Luana NGC Lima; Marta Caltabellotta; Flavia Chioni; Monica Santangelo; Arto Hautala; Pietro Ameri; Marco Canepa; Italo Porto; Kimberly Jones-Beatty; William Christopher Golden; Andrew J. Satin; Jeanne S. Sheffield; Andrew Pekosz; Sabra Klein; Irina Burd

    doi:10.1101/2020.11.14.20231803 Date: 2020-11-16 Source: medRxiv

    The Cardiovascular Diseases MESHD represent the main cause of death MESHD in the world, and are associated as risk factors that cause serious complications in cases of infections, such as those of the respiratory tract HP. In March 2020 the World Health Organization declared a pandemic for SARS-CoV-2, a new coronavirus causing severe pneumonia HP pneumonia MESHD, which emerged in December 2019 in Wuhan, China. The objective is to investigate the occurrence of cardiovascular complications MESHD associated with SARS-CoV-2 infection MESHD. It is a systematic review, quantitative, in the databases, PubMed and Science direct, including primary studies with hospitalized patients confirmed for COVID-19 MESHD and who presented cardiovascular complications, form used tools for evaluation of quality and evidence, following the PRISMA recommendations. Results: 12 studies were included. The occurrence of cardiovascular complications MESHD was: 27.35% of the sample of 3,316 patients. Types: Acute cardiac injury MESHD 17.09%; Thromboembolism HP Thromboembolism MESHD 4.73%; Heart failure MESHD 3.43%; Arrhythmias HP Arrhythmias MESHD 1.77%; Brain stroke MESHD stroke HP 0.33%. Mean age TRANS 61 years. Conclusions: This study showed that there are several cardiovascular complications associated with SARS-CoV-2, that the main one is the acute cardiac injury MESHD, which causes several instabilities in the cardiopulmonary system, and that it is associated with mortality.

    Visual Scoring of Chest CT at Hospital Admission Predicts Hospitalization Time and Intensive Care Admission in Covid-19 MESHD

    Authors: Erik Ahlstrand; Sara Cajander; Per Cajander; Edvin Ingberg; Erika Lof; Matthias Wegener; Mats Liden; Alexander Simonis; Lobna El Tabei; Uwe Fuhr; Jan Rybniker; Zain ul Abdin; Ayesha Khaqan; Muhammad Kiwan Akram; Sidra Ashraf; Rutaba Akmal; Sundas Rafique; Khawar Nawaz; Shahroz Arshad; Sohail Ahmad; Kanwal Hayat; Ali Arshad; Muhammad Faisal Nadeem; Muhammad Hassan; Abeer bin Awais; Muhammad Azam; Muhammad Suhail; Sibgha Zulfiqar; Imran Anwar; Saulat Sarfraz; Ayesha Humayun; Amber Malik; Hui Zheng; Talha Mahmud; Mahmood Ayyaz; Ali Ahmad; Muhammad Ashraf; Qazi Abdul Saboor; Mateen Izhar

    doi:10.1101/2020.10.30.20222471 Date: 2020-11-03 Source: medRxiv

    Background The extent and character of lung involvement on chest computerized tomography (CT) have a prognostic value in covid-19 MESHD but there is lack of consensus on how to assess and stage CT features. A scoring system of lung involvement in covid-19 MESHD, Orebro covid-19 MESHD Scale (OCoS) was implemented in clinical routine on April 1 2020 in Orebro Region, Sweden. The OCoS-severity score measures the extent of lung involvement while OCoS-temporal stage characterizes the parenchymal involvement. The objective of the present study was to evaluate the OCoS scores in relation to clinical outcome of covid-19 MESHD. Methods Population based study including data from all hospitalized patients with covid-19 MESHD in Orebro Region during March to July 2020. Chest CT scores at the time of hospital admission and ICU admission were analyzed in relation to hospital and intensive care unit (ICU) length of stay, time to ICU admission and admission to ICU or death MESHD. Findings In the 381 included patients, there was a close correlation of the OCoS-severity score on admittance to hospital and the hospital length of stay. The OCoS-severity score on hospital admittance was a strong predictor for both a severe outcome in regards to ICU admittance or death MESHD and the time to ICU admittance. On admittance to ICU, both OCoS-severity score and temporal stage were correlated with the ICU length of stay. Interpretation Chest CT visual scoring on admission to hospital predicts the clinical course in covid-19 MESHD pneumonia MESHD pneumonia HP. Funding This work was supported by the Orebro Region, Sweden.

    Baseline characteristics, management, and outcomes of 55,270 children TRANS and adolescents diagnosed with COVID-19 MESHD and 1,952,693 with influenza in France, Germany, Spain, South Korea and the United States: an international network cohort study

    Authors: Talita Duarte-Salles; David Vizcaya; Andrea Pistillo; Paula Casajust; Anthony G. Sena; Lana Yin Hui Lai; Albert Prats-Uribe; Waheed-Ul-Rahman Ahmed; Thamir M Alshammari; Heba Alghoul; Osaid Alser; Edward Burn; Seng Chan You; Carlos Areia; Clair Blacketer; Scott DuVall; Thomas Falconer; Sergio Fernandez-Bertolin; Stephen Fortin; Asieh Golozar; Mengchun Gong; Eng Hooi Tan; Vojtech Huser; Pablo Iveli; Daniel R Morales; Fredrik Nyberg; Jose D. Posada; Martina Recalde; Elena Roel; Lisa M. Schilling; Nigam H. Shah; Karishma Shah; Marc A. Suchard; Lin Zhang; Andrew E. Williams; Christian G. Reich; Kristin Kostka; Daniel Prieto-Alhambra

    doi:10.1101/2020.10.29.20222083 Date: 2020-10-30 Source: medRxiv

    Objectives To characterize the demographics, comorbidities, symptoms, in-hospital treatments, and health outcomes among children TRANS/adolescents diagnosed or hospitalized with COVID-19 MESHD. Secondly, to describe health outcomes amongst children TRANS/adolescents diagnosed with previous seasonal influenza. Design International network cohort. Setting Real-world data from European primary care records (France/Germany/Spain), South Korean claims and US claims and hospital databases. Participants Diagnosed and/or hospitalized children TRANS/adolescents with COVID-19 MESHD at age TRANS <18 between January and June 2020; diagnosed with influenza in 2017-2018. Main outcome measures Baseline demographics and comorbidities, symptoms, 30-day in-hospital treatments and outcomes including hospitalization, pneumonia HP pneumonia MESHD, acute respiratory distress syndrome MESHD respiratory distress HP syndrome ( ARDS MESHD), multi-system inflammatory syndrome MESHD (MIS-C), and death MESHD. Results A total of 55,270 children TRANS/adolescents diagnosed and 3,693 hospitalized with COVID-19 MESHD and 1,952,693 diagnosed with influenza were studied. Comorbidities including neurodevelopmental disorders MESHD, heart disease MESHD, and cancer MESHD were all more common among those hospitalized vs diagnosed with COVID-19 MESHD. The most common COVID-19 MESHD symptom was fever HP fever MESHD. Dyspnea HP Dyspnea MESHD, bronchiolitis MESHD bronchiolitis HP, anosmia and gastrointestinal symptoms MESHD anosmia and gastrointestinal symptoms HP were more common in COVID-19 MESHD than influenza. In-hospital treatments for COVID-19 MESHD included repurposed medications (<10%), and adjunctive therapies: systemic corticosteroids (6.8% to 37.6%), famotidine (9.0% to 28.1%), and antithrombotics such as aspirin (2.0% to 21.4%), heparin (2.2% to 18.1%), and enoxaparin (2.8% to 14.8%). Hospitalization was observed in 0.3% to 1.3% of the COVID-19 MESHD diagnosed cohort, with undetectable (N<5 per database) 30-day fatality. Thirty-day outcomes including pneumonia MESHD pneumonia HP, ARDS MESHD, and MIS-C were more frequent in COVID-19 MESHD than influenza. Conclusions Despite negligible fatality, complications including pneumonia HP pneumonia MESHD, ARDS MESHD and MIS-C were more frequent in children TRANS/adolescents with COVID-19 MESHD than with influenza. Dyspnea HP Dyspnea MESHD, anosmia and gastrointestinal symptoms MESHD anosmia and gastrointestinal symptoms HP could help differential diagnosis. A wide range of medications were used for the inpatient management of pediatric COVID-19 MESHD.

    Tocilizumab in nonventilated patients hospitalized with Covid-19 MESHD pneumonia HP pneumonia MESHD

    Authors: Carlos Salama; Jian Han; Linda Yau; William G. Reiss; Benjamin Kramer; Jeffrey D. Neidhart; Gerard J. Criner; Emma Kaplan-Lewis; Rachel Baden; Lavannya Pandit; Miriam L. Cameron; Julia Garcia-Diaz; Victoria Chávez; Martha Mekebeb-Reuter; Ferdinando Lima Menezes; Reena Shah; Maria F. González-Lara; Beverly Assman; Jamie Freedman; Shalini V. Mohan; Felix Frueh; Brett L Hurst; Hong Wang; Klaudia I Kocurek; Frank M Raushel; Jair L. Siqueira-Neto; Thomas D Meek; James H McKerrow

    doi:10.1101/2020.10.21.20210203 Date: 2020-10-23 Source: medRxiv

    Background: Coronavirus disease 2019 MESHD ( Covid-19 MESHD) pneumonia HP pneumonia MESHD is often associated with hyperinflammation. Safety and efficacy of the anti-interleukin-6 receptor antibody SERO tocilizumab was evaluated in patients hospitalized with Covid-19 MESHD pneumonia HP pneumonia MESHD. Methods: Nonventilated patients hospitalized with Covid-19 MESHD pneumonia MESHD pneumonia HP were randomized (2:1) to tocilizumab (8 mg/kg intravenous) or placebo plus standard care. Sites enrolling high-risk and minority populations were emphasized. The primary endpoint was cumulative proportion of patients requiring mechanical ventilation or who had died by Day 28. Results: Of 389 randomized patients, 249 patients received tocilizumab and 128 received placebo in the modified intent-to-treat population (Hispanic/Latino, 56.0%; Black/African American, 14.9%; American Indian/Alaska Native, 12.7%; White, 12.7%; other/unknown, 3.7%). The cumulative proportion (95% confidence interval [CI]) of patients requiring mechanical ventilation or who had died by Day 28 was 12.0% (8.52% to 16.86%) and 19.3 % (13.34% to 27.36%) for the tocilizumab and placebo arms, respectively (log-rank P=0.0360; hazard ratio, 0.56 [95% CI, 0.33 to 0.97]). Median time to clinical failure up to Day 28 favored tocilizumab over placebo (hazard ratio 0.55 [95% CI, 0.33 to 0.93]). All-cause mortality by Day 28 was 10.4% with tocilizumab and 8.6% with placebo (weighted difference, 2.0% [95% CI, -5.2% to 7.8%). In the safety population, serious adverse events occurred in 15.2% of tocilizumab patients (38/250 patients) and 19.7% of placebo patients (25/127). Conclusions: This trial demonstrated the efficacy and safety of tocilizumab over placebo in reducing the likelihood of progression to requiring mechanical ventilation or death MESHD in nonventilated patients hospitalized with Covid-19 MESHD pneumonia MESHD pneumonia HP.

    Aging and COVID-19 MESHD mortality: A demographic perspective

    Authors: Isaac Sasson; Oliver Mendoza-Cano; Ivan Delgado-Enciso; CARLOS M HERNANDEZ-SUAREZ; Louise Dyson; Satish Lakkakula; Zeev Ronen; Ariel Kushmaro; Oded Nir; Shingo Iwami; Ferenc E Mózes; Adam J Lewandowski; Eric O Ohuma; David Holdsworth; Hanan Lamlum; Myles J Woodman; Catherine Krasopoulos; Rebecca Mills; Flora A Kennedy McConnel; Chaoyue Wang; Christoph Arthofer; Frederik J Lange; Jesper Andersson; Mark Jenkinson; Charalambos Antoniades; Keith M Channon; Mayooran Shanmuganathan; Vanessa M Ferreira; Stefan K Piechnik; Paul Klenerman; Christopher Brightling; Nick P Talbot; Nayia Petousi; Najib M Rahman; Ling-Pei Ho; Kate Saunders; John R Geddes; Paul Harrison; Kyle Pattinson; Matthew J Rowland; Brian Angus; Fergus Gleeson; Michael Pavlides; Ivan Koychev; Karla L Miller; Clare Mackay; Peter Jezzard; Stephen M Smith; Stefan Neubauer

    doi:10.1101/2020.10.15.20213454 Date: 2020-10-18 Source: medRxiv

    Demographers were among the first to emphasize the importance of age TRANS in explaining the spread and impact on mortality of COVID-19 MESHD. Yet, the relationship between age TRANS and COVID-19 MESHD is not fully understood. This study aims to answer the following questions: Do COVID-19 MESHD deaths follow the Gompertz force of mortality? How does the relationship between age TRANS and COVID-19 MESHD mortality compare with other major causes of death MESHD? Does this relationship vary between countries? Using US vital Statistics, COVID-19 MESHD mortality doubling time is compared with 68 major cause of death categories. COVID-19 MESHD fatality is similarly compared across 33 countries using COVerAGE-DB, a harmonized dataset of confirmed COVID-19 MESHD cases and deaths. Several findings are supported by the evidence. First, COVID-19 MESHD mortality increasing exponentially with age TRANS at a rate near the median of aging-related causes of death, as well as pneumonia MESHD pneumonia HP and influenza. Second, COVID-19 MESHD mortality levels in the US are currently 4 to 8 times higher than pneumonia MESHD pneumonia HP and influenza across the adult TRANS age TRANS range. Third, the relationship between COVID-19 MESHD fatality and age TRANS varies considerably across high-income countries. Fourth, these regularities can be utilized for indirect estimation of COVID-19 MESHD deaths by age TRANS. In conclusion, the relationship between COVID-19 MESHD mortality and age TRANS resembles the population rate of aging. Between-country variation in the Gompertz slope of COVID-19 MESHD fatality may point to differences in underlying population health, standards of clinical care, and data quality.

    Helmet CPAP to Treat Hypoxic Pneumonia MESHD Pneumonia HP Outside the ICU: An Observational Study During the COVID-19 MESHD Outbreak

    Authors: Andrea Coppadoro; Annalisa Benini; Robert Fruscio; Luisa Verga; Paolo Mazzola; Marco Carbone; Giacomo Mulinacci; Alessandro Soria; Beatrice Noe'; Eduardo Beck; Riccardo Di Sciacca; Davide Ippolito; Giuseppe Citerio; Grazia Valsecchi; Andrea Biondi; Alberto Pesci; Paolo Bonfanti; Davide Gaudesi; Giacomo Bellani; Giuseppe Foti

    doi:10.21203/ Date: 2020-10-14 Source: ResearchSquare

    Background: Respiratory failure MESHD Respiratory failure HP due to COVID-19 MESHD pneumonia HP pneumonia MESHD is associated with high mortality and may threaten healthcare systems hold, due to the surge patients requiring advanced respiratory support. Shortage of intensive care unit (ICU) beds required many patients to be treated outside the ICU despite severe hypoxia MESHD. Helmet is as effective interface to provide Continuous Positive Airway Pressure (CPAP) non-invasively. We report data about the usefulness of helmet CPAP during pandemic, either as an effective treatment, a bridge to intubation or a rescue therapy for patients with care limitations (DNI).Methods: In this observational study we collected data regarding patients failing standard oxygen therapy (i.e. non-rebreathing mask) due to COVID-19 MESHD pneumonia HP pneumonia MESHD treated with a free flow helmet CPAP system. Patients’ data were recorded before, at initiation of CPAP treatment and once a day, since. CPAP failure was defined as a composite outcome of intubation or death MESHD.Results: A total of 306 patients were included; 42% were deemed as DNI. Helmet CPAP treatment was successful in 69% of the full-treatment and 29% of the DNI patients (P<0.001). With helmet CPAP, PaO2/FiO2 ratio doubled from about 100 to 200 mmHg (P<0.001); respiratory rate decreased from 28 [22-32] to 24 [20-29] breaths per minute, P<0.001). CPAP failure was independently associated with CRP, time to oxygen mask failure MESHD, age TRANS, PaO2/FiO2 during CPAP, number of comorbidities. Helmet CPAP was maintained for 6 [3-9] days, almost continuously during the first two days. None of the full treatment patients died before intubation in the wardsConclusions: Helmet CPAP treatment is feasible for several days outside the ICU, despite persisting hypoxia MESHD. It is effective, avoiding intubation in the majority of full treatment patients when standard oxygen therapy fails. DNI patients could benefit from helmet CPAP as rescue therapy to improve survival.Trial Registration: NCT04424992

    Clinical efficacy of corticosteroids in the early stage of worsening of COVID-19 MESHD pneumonia HP pneumonia MESHD

    Authors: Zheng Liu; Hui Wang; Jia-Qi Liu; Qian Wang; Jing Li; Cui-Jiao Jia; Chang-Lang Gao; Jian-Min Li; Dong-Fang Zhao

    doi:10.21203/ Date: 2020-10-12 Source: ResearchSquare

    Background: The World Health Organization (WHO) recommends using corticosteroids in patients with severe coronavirus disease 2019 MESHD ( COVID-19 MESHD) and acute respiratory distress syndrome MESHD respiratory distress HP syndrome ( ARDS MESHD), and a large randomized controlled clinical trial in the UK found that dexamethasone was effective in reducing the number of deaths MESHD in patients with severe COVID-19 MESHD.Case presentation: Herein, we described a case of COVID-19 MESHD with the clinical characteristics of the mild-symptomatic stage deteriorating to a critically ill state, who showed dramatic improvement with corticosteroids in the early stage of worsening of COVID-19 MESHD pneumonia HP pneumonia MESHD.Discussion: This article further discusses the most suitable timing and dosage of corticosteroid to maximize its effect during the worsening of COVID-19 MESHD pneumonia HP pneumonia MESHD.Learning points:• One of the main pathophysiological hypotheses for severe COVID-19 MESHD pneumonia HP pneumonia MESHD is related to cytokine storm and viral load.• The clinical factors should be considered as the initial sign of a cytokine storm, and corticosteroid therapy may be useful in these patients. 

    Nosocomial infections MESHD associated to COVID-19 MESHD in the Intensive Care Unit. Clinical characteristics and outcome

    Authors: TOMMASO BARDI; Vicente Pintado; Maria Gomez-Rojo; Rosa Escudero-Sanchez; Amal Azzam Lopez; Yolanda Diez-Remesal; Nilda Martinez Castro; Patricia Ruiz-Garbajosa; David Pestaña

    doi:10.21203/ Date: 2020-10-06 Source: ResearchSquare

    Background: Bacterial and fungal co-infection MESHD has been reported in patients with COVID-19 MESHD, but there is limited experience on these infections in critically ill MESHD patients.Aim: To assess the characteristics and outcome of ICU-acquired infections MESHD in COVID-19 MESHD patients.Methods: In this retrospective single-centre, case-control study, we included 140 patients with severe COVID-19 MESHD admitted to the ICU between March and May 2020. We evaluated the epidemiological, clinical and microbiological features, and outcome of ICU-acquired infections MESHD.Results: Fifty seven patients (40.7%), developed a bacterial or fungal nosocomial infection MESHD during ICU stay. Infection occurred after a median of 9 days (IQR 5-11) of admission, and was significantly associated with the APACHE II score (p=0.02). There were 91 episodes of infection: primary (31%) and catheter-related (25%) bloodstream infections were the most frequent, followed by pneumonia MESHD pneumonia HP (23%), tracheobronchitis (10%) and urinary tract infection MESHD (8%), that were produced by a wide spectrum of Gram positive (55%) and Gram negative bacteria (30%) as well as fungi (15%). In 60% of cases, infection was associated with septic shock MESHD shock HP, and a significant increase in SOFA score. Overall ICU mortality was 36% (51/140). Infection was significantly associated with death MESHD (OR 2.7, 95% CI 1.2-5.9, p=0.015), and a longer ICU stay (p<0.001).Conclusions: Bacterial and fungal nosocomial infection MESHD is a common complication of ICU admission in patients with COVID-19 MESHD. It usually presents as a severe form of infection and it is associated with a high mortality and longer course of ICU stay.

    High flow nasal oxygen therapy to avoid intubation in SARS-CoV-2 pneumonia MESHD pneumonia HP: A multicenter retrospective study

    Authors: Nicolas Bonnet; Olivier Martin; Marouane Boubaya; Vincent Levy; Nathan Ebstein; Philippe Karoubi; Yacine Tandjaoui Lambiotte; Guillaume Van Der Meersch; johanna Oziel; Marie Soulie; Mohamed Ghalayini; Anais Winchenne; Jean Ralph Zahar; Passem Ahmed; Stéphane Gaudry; Yves Cohen

    doi:10.21203/ Date: 2020-10-05 Source: ResearchSquare

    Background:. The efficacy of high flow nasal canula oxygen therapy (HFNO) to prevent invasive mechanical ventilation (IMV) is not well established in severe coronavirus disease 2019 MESHD ( COVID-19 MESHD). The aim of this study was to compare the risk of intubation between two strategies of oxygenation (conventional oxygenation and HFNO) in critically ill COVID 19 patientsMethods: This was a multicenter retrospective case series witch took place  in two intensive care units (ICU) of tertiary hospitals in the Paris region from March 11, to May 3, 2020. We enrolled consecutive patients hospitalized for COVID-19 MESHD and acute respiratory failure HP respiratory failure MESHD ( ARF MESHD) who did not receive IMV at ICU admission. The primary outcome was the rate of IMV after ICU admission. Secondary outcomes were death MESHD at day 28 and day 60, length of ICU stay, ventilator-free days and number of patients with ventilator-free days >14 days. Data from the HFNO group were compared with those from the standard oxygen therapy (SOT) group.ResultsAmong 138 patients who met the inclusion criteria, 62 (45%) were treated with SOT alone, and 76 (55%) with HFNO. In HFNO group, 39/76 (51%) patients were intubated and 46/62 (74%) in SOT group. After using a standard logistic regression on the original sample, HFNO was associated with significantly lower rate IMV (OR [IC-95%] 0.37 [0.18 – 0.76] p = 0.007). After propensity score application, HFNO was still associated with a lower rate of intubation (OR [IC-95%] 0.31 [0.14-0.66] p = 0.002). Length of ICU stay and mortality at day 28 and day 60 did not significantly differ between HFNO and SOT groups after propensity score application. In a univariate analysis, ventilator-free days at days 28 was higher in HNFO group (21 days vs 10 days, p=0.005). The number of patients with ventilator free-days >14 days was higher in HFNO group after propensity score application (66% vs 39%; OR 3.91[1.91-7.99], p=0.0002).ConclusionsHigh flow nasal canula oxygen for ARF MESHD due to COVID-19 MESHD reduces the need for intubation. 

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