A Comparative Study between Non-Invasive Continuous Positive Airway Pressure Ventilation and High Flow Nasal Cannula Oxygenation among COVID-19 Patients with Acute Hypoxemic Respiratory Failure

Abstract

Abstract Background Both non-invasive continuous positive airway pressure ventilation (NIV CPAP) and high flow nasal cannula oxygenation (HFNC) are beneficial in patients with acute hypoxemic respiratory failure. COVID-19 is a pandemic infectious disease caused by the coronavirus with a variable clinical picture. This study compares NIV CPAP and HFNC oxygenation in maintaining adequate ventilation, oxygenation and prevention or delaying endotracheal intubation and invasive mechanical ventilation in COVID-19 patients with acute hypoxemic respiratory failure. Objective To study the effect of NIV CPAP versus HFNC oxygenation among COVID-19 patients with acute hypoxemic respiratory failure in maintaining adequate ventilation, oxygenation and prevention or delaying endotracheal intubation when conventional oxygen therapy (COT) fails to maintain adequate oxygenation. Patients and Methods Our study compares the effect of NIV CPAP versus HFNC oxygenation among COVID-19 patients with acute hypoxemic respiratory failure in maintaining adequate ventilation, oxygenation and prevention or delaying endotracheal intubation when conventional oxygen therapy (COT) fails to maintain adequate oxygenation. Results Results showed a significant improvement in most of patients whether using NIV or HFNC and delaying intubation, with superiority of NIV over HFNC specially as regard oxygenation in terms of PaO2/FiO2. As regard invasive ventilation free days NIV-CPAP use yielded a mean invasive ventilation free days of statistically significant longer duration than HFNC group. While comparison between both groups showed that there was no significant difference as regard ICU stay days or mortality rate. Conclusion We concluded that both NI-CPAP and HFNC therapy are effective measures in respiratory support and management of acute hypoxemic respiratory failure caused by COVID-19. This is proved by improvement in oxygenation and ventilation after treatment with both NI-CPAP and HFNC which is evident by increase in both peripheral oxygen saturation (SpaO2) and PaO2/FiO2 ratio with lower both respiratory rates and PaCO2. This makes them as an excellent alternative to prevent or postpone invasive mechanical ventilation as a standalone therapy and as a bridge for respiratory recovery. This is especially important in limited resources in face of worldwide outbreak.