High-Flow Nasal Oxygen and Noninvasive Ventilation for COVID-19

Abstract

High-flow nasal oxygen (HFNO) and non-invasive ventilation (NIV) via face-mask or helmet have been increasingly used in the management of acute hypoxemic respiratory failure (AHRF) due to COVID-19 with the premise of reducing the need for invasive mechanical ventilation and possibly mortality. However, their use carries the risk of delaying intubation and nosocomial infection transmission. To this date, most studies on the effectiveness of these modalities are observational and suggest that HFNO and NIV have a role in the management of AHRF due to COVID-19. A randomized controlled trial among patients with COVID-19 showed that helmet NIV versus HFNO led to a lower intubation rate but no difference in survival or the duration of respiratory support. The RECOVERY respiratory support trial demonstrated that CPAP, but not HFNO reduced a composite outcome of tracheal intubation or mortality within 30-days compared with conventional oxygen therapy. Additional trials are ongoing and are evaluating different aspects of noninvasive respiratory support in patients with AHRF due to COVID-19.

Efficiency of continuous positive airway pressure and high-flow nasal oxygen therapy in critically ill patients with COVID-19

“…23 HFNO and NIV are the main methods used for management of hypoxemic acute respiratory failure, and many clinical studies have shown that they are associated with good results in patients with COVID-19, lowering the need for invasive mechanical ventilation and the mortality rates. [24][25][26] However, a 2022 study showed that NIV was associated with higher mortality and intubation rates compared with HFNO and continuous positive airway pressure (CPAP). 27 A meta-analysis of 58 studies concluded that there is no consensus regarding the use of noninvasive respiratory support and that the information about the indications for initiation or suppression of these therapies is unclear.…”

“… 23 HFNO and NIV are the main methods used for management of hypoxemic acute respiratory failure, and many clinical studies have shown that they are associated with good results in patients with COVID-19, lowering the need for invasive mechanical ventilation and the mortality rates. 24 – 26 However, a 2022 study showed that NIV was associated with higher mortality and intubation rates compared with HFNO and continuous positive airway pressure (CPAP). 27 …”