الفهرس 
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Abstract
Conventional oxygen therapy and non-invasive ventilation (NIV) are frontline treatments for hypoxemia before proceeding to invasive mechanical ventilation (IMV). Early after the (COVID-19) outbreak, there was an expert consensus in favor of NIV as the first-line treatment for the associated acute hypoxemic respiratory failure (AHRF).
High flow nasal cannula (HFNC) is a non-invasive, high concentration oxygen delivery interface that circumvents some of the limitations of conventional NIV. Clinically, HFNC effectively reduces dyspnea and improves oxygenation in respiratory failure. Compared to conventional oxygen therapy, HFNC could reduce the rate of endotracheal intubation in patients with AHRF without reducing ICU mortality.
However, previous studies failed to report how the HFNC, or NIV was used. Here, we report the clinical features, settings, and outcomes of HFNC and NIV in COVID-19 patients. We aimed to analyze the settings, clinical data, and outcomes of HFNC and NIV in COVID-19 patients. This prospective observational study was conducted on adult patients admitted to the intensive care unit (ICU).
Summary of our results:
The outcomes of the two intervention methods were comparable in terms of the success rate, without a significant difference (36% with HFNC vs. 24% with NIV; P= 0.19).
The outcome was significantly different between the study groups, as the incidence of intubation was significantly lower in the HFNC group than in the NIV group (28% vs. 52%, P =0.014).
The HFNC group had no nursing care, whereas the NIV group had a median nursing care duration of three days. There were no statistically significant differences between the studied methods regarding the duration of (respiratory support, ICU stay and survival until intubation). The incidence of mortality was not significantly different between the two groups after 7 days, but it was significantly lower in the HFNC group than in the NIV group after 28 days. ARDS according to the P/F ratio after 48 h was significantly different, being less severe in the HFNC group than in the NIV group.
The incidence of mortality on day 28 was significantly higher in patients who transitioned to NIV than in those treated exclusively with HFNC. On the other hand, there was no statistically significant difference between patients treated exclusively with NIV and those transitioned to HFNC regarding 28- day mortality.
Based on the results of the overall survival analysis, the HR of intubation in the HFNC group was significantly lower with a longer survival time than that in the NIV group.
Regarding respiratory rate, the HFNC group had significantly lower respiratory rates at admission and after 2 and 6 h of intervention than the NIV group, while both groups were comparable after 12, 24, and 48 h. The heart rate was significantly lower in the HFNC group than in the NIV group at all time points over 48 h of intervention.
SPO2 was significantly higher in the HFNC group than in the NIV group on admission, whereas after 2 h, it significantly decreased in the HFNC group, and both groups were comparable after 6, 12, 24, and 48 h. The P/F ratio was significantly higher in the HFNC group than in the NIV group at admission and after 2, 6, and 48 h.
Intubated patients had significantly higher RR and HR than the non-intubated patients at all time points. Systolic BP, GCS were insignificantly different between both groups at all times.
Intubated patients had significantly higher APACHE II and SOFA scores than non-intubated patients. However, there were no statistically significant differences between the groups in terms of the baseline characteristics.
There was a statistically significant relationship between ROX score and success of HFNC as ROX score was significantly lower in patients who experienced HFNC failure than in those who experienced successful HFNC over 48 h of intervention (P<0.001).
The HACOR score was significantly higher in patients who experienced NIV failure than in those who experienced successful NIV over 48 h of intervention (P<0.001).