Effect of the Early Combination of Continuous Positive Airway Pressure and High-Flow Nasal Cannula on Mortality and Intubation Rates in Patients With COVID-19 and Acute Respiratory Distress Syndrome. The DUOCOVID Study

Comparison between high-flow nasal oxygen (HFNO) alternated with non-invasive ventilation (NIV) and HFNO and NIV alone in patients with COVID-19: a retrospective cohort study

“…The rate of IMV and mortality observed in NIV + HFNO group herein was similar to a previous study, in Latin America, using combined noninvasive respiratory support therapies within a similar period of time [ 36 ]. The intercalated use of NIV and HFNO was associated with the need for IMV, likely due to the following reasons: (1) the use of NIV alone was also associated with an increased need for IMV in the unadjusted models, suggesting that the hazard condition may be associated with its presence; (2) the periodic application of NIV, which may not have met the patient’s ventilatory support needs; (3) few patients were adapted to HFNO alone, which may have jeopardized the comparisons and may reflect that our population had higher respiratory distress and fatigue on admission; and (4) the decision to implement NIV + HFNO took longer than 24 h in some patients, since delayed application of combined respiratory therapy may be associated with worse outcomes [ 37 ]. When intense respiratory effort was present, the clinical decision favored implementation of NIV.…”