Comparison of high-flow nasal cannula and conventional oxygen therapy in treating COVID-19 patients referred to the emergency department: A randomized, single-blind clinical trial

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Objective: High-flow nasal cannula (HFNC) oxygen therapy has been recently implicated in the treatment of patients with acute respiratory failure (ARF). This study investigated the effect of this treatment on COVID-19 patients. Methods: This was a prospective, randomized, single-blind clinical trial performed between June and November 2021 (Delta variant of the coronavirus) at Al-Zahra Hospital in Iran, on patients with COVID-19 referred to the emergency department (ED). COVID-19 patients who had peripheral oxygen saturation (SpO2)≤90% despite receiving nasal oxygen (up to 6 L/min) were included in the study and randomly assigned to receive either HFNC or conventional oxygen therapy (COT) treatment. The patients were compared regarding vital signs, SpO2, and the need for endotracheal intubation and intensive care unit (ICU) admission. The calculated sample size was 35 patients in each group. The variables were compared using the chi-square, student’s t-test, or Mann-Whitney U tests. The data was analyzed using SPSS version 25. Results: Eighty-seven patients with a mean age of 65.3±14.8 (62.1% male) were included. The two groups were similar in terms of age, sex, time interval from onset to diagnosis, and underlying diseases (hypertension, diabetes, coronary artery disease, etc.) (P<0.05). No statistically significant difference was reported between SpO2 and PaO2/FiO2 vital signs at the beginning of treatment between the two groups. One hour after treatment, respiratory rate, SpO2, and PaO2/ FiO2 were better in the HFNC group compared to the COT group (P<0.05). Also, there was no significant difference between the two groups regarding in-hospital mortality or the need for endotracheal intubation or ICU admission. Conclusion: Early use of HFNC oxygen therapy in patients with COVID-19 can improve SpO2, respiratory rate, and PaO2/FiO2 levels, making it highly valuable from a clinical point of view.