High Flow Nasal Oxygen (HFNO) vs Non-invasive Ventilation (NIV) for Acute Hypoxemic Respiratory Failure (AHRF) in COVID-19

ABSTRACT

Background: COVID-19 patients who develop hypoxemic respiratory failure despite conventional oxygen therapy usually require high flow nasal oxygen (HFNO) or non-invasive ventilation (NIV). Aim: To compare the effect of both in managing COVID- 19 induced respiratory failure and to determine whether HFNO decreases the rate of intubation when compared with NIV. Settings and design: Single centre, retrospective observational study. Materials and methods: Data collected from medical records. As per the inclusion criteria, patients who received either HFNO or NIV as initial therapy for at least 2 calendar days were analysed. Both the therapies were compared in around 200 patients (HFNO = 100, NIV = 100), with the rate of intubation at day 14 as the primary outcome and length of ICU stay, hospital stay, mortality at day 28, no. of ventilatory free days, complications during ICU stay and comfort score as secondary outcomes. Statistical analysis: Data analysis was done using SPSS software. p value < 0.05 was considered statistically significant. Results: The rate of intubation and mortality rates were higher in the NIV group (P = 0.001), whereas there was no difference in length of hospital or ICU stay among the both (P = 0.15, 0.75, respectively). HFNO group patients were more comfortable (P < 0.05). Conclusion: HFNO is effective in the management of COVID- 19 induced acute hypoxemic respiratory failure with a lower rate of intubation, lower mortality rate, and better tolerance compared to NIV though it does not reduce the duration of ICU or hospital stay.