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Research ArticleOriginal Research

Comparison of High-Flow Nasal Cannula and Noninvasive Ventilation in Acute Hypoxemic Respiratory Failure Due to Severe COVID-19 Pneumonia

Parvathy Ramachandran Nair, Damarla Haritha, Srikant Behera, Choro Athiphro Kayina, Souvik Maitra, Rahul Kumar Anand, Bikash Ranjan Ray, Manish Soneja, Rajeshwari Subramaniam and Dalim Kumar Baidya
Respiratory Care December 2021, 66 (12) 1824-1830; DOI: https://doi.org/10.4187/respcare.09130
Parvathy Ramachandran Nair
Department of Anesthesiology, Pain Medicine and Critical Care All India Institute of Medical Sciences, New Delhi, India.
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Damarla Haritha
Department of Anesthesiology, Pain Medicine and Critical Care All India Institute of Medical Sciences, New Delhi, India.
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Srikant Behera
Department of Anesthesiology, Pain Medicine and Critical Care All India Institute of Medical Sciences, New Delhi, India.
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Choro Athiphro Kayina
Department of Anesthesiology, Pain Medicine and Critical Care All India Institute of Medical Sciences, New Delhi, India.
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Souvik Maitra
Department of Anesthesiology, Pain Medicine and Critical Care All India Institute of Medical Sciences, New Delhi, India.
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Rahul Kumar Anand
Department of Anesthesiology, Pain Medicine and Critical Care All India Institute of Medical Sciences, New Delhi, India.
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Bikash Ranjan Ray
Department of Anesthesiology, Pain Medicine and Critical Care All India Institute of Medical Sciences, New Delhi, India.
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Manish Soneja
Department of Anesthesiology, Pain Medicine and Critical Care All India Institute of Medical Sciences, New Delhi, India.
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Rajeshwari Subramaniam
Department of Anesthesiology, Pain Medicine and Critical Care All India Institute of Medical Sciences, New Delhi, India.
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Dalim Kumar Baidya
Department of Anesthesiology, Pain Medicine and Critical Care All India Institute of Medical Sciences, New Delhi, India.
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Abstract

BACKGROUND: Efficacy of high-flow nasal cannula (HFNC) over noninvasive ventilation (NIV) in severe coronavirus disease 2019 (COVID-19) pneumonia is not known. We aimed to assess the incidence of invasive mechanical ventilation in patients with acute hypoxemic respiratory failure due to COVID-19 treated with either HFNC or NIV.

METHODS: This was a single-center randomized controlled trial performed in the COVID-19 ICU of a tertiary care teaching hospital in New Delhi, India. One hundred and nine subjects with severe COVID-19 pneumonia presenting with acute hypoxemic respiratory failure were recruited and allocated to either HFNC (n = 55) or NIV (n = 54) arm. Primary outcome was intubation by 48 h. Secondary outcomes were improvement in oxygenation by 48 h, intubation rate at day 7, and in-hospital mortality.

RESULTS: Baseline characteristics and Embedded Image/Embedded Image ratio were similar in both the groups. Intubation rate at 48 h was similar between the groups (33% NIV vs 20% HFNC, relative risk 0.6, 95% CI 0.31–1.15, P = .12). Intubation rate at day 7 was lower in the HFNC (27.27%) compared to the NIV group (46.29%) (relative risk 0.59, 95% CI 0.35–0.99, P = .045), and this difference remained significant after adjustment for the incidence of chronic kidney disease and the arterial pH (adjusted OR 0.40, 95% CI 0.17–0.93, P = .03). Hospital mortality was similar between HFNC (29.1%) and NIV (46.2%) group (relative risk 0.6, 95% CI 0.38–1.04, P = .06).

CONCLUSIONS: We were not able to demonstrate a statistically significant improvement of oxygenation parameters nor of the intubation rate at 48 h between NIV and HFNC. These findings should be further tested in a larger randomized controlled trial. The study was registered at the Clinical Trials Registry of India (www.ctri.nic.in; reference number: CTRI/2020/07/026835) on July 27, 2020.

  • high-flow nasal cannula
  • noninvasive ventilation
  • coronavirus disease 2019
  • acute respiratory failure
  • HFNC
  • NIV

Footnotes

  • Correspondence: Dalim Kumar Baidya MD EDIC, 5th Floor, Teaching Block, All India Institute of Medical Sciences, New Delhi-110029, India. E-mail: dalimkumar.ab8{at}gmail.com
  • The authors declare no conflicts of interest.

  • Copyright © 2021 by Daedalus Enterprises
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Respiratory Care: 66 (12)
Respiratory Care
Vol. 66, Issue 12
1 Dec 2021
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Comparison of High-Flow Nasal Cannula and Noninvasive Ventilation in Acute Hypoxemic Respiratory Failure Due to Severe COVID-19 Pneumonia
Parvathy Ramachandran Nair, Damarla Haritha, Srikant Behera, Choro Athiphro Kayina, Souvik Maitra, Rahul Kumar Anand, Bikash Ranjan Ray, Manish Soneja, Rajeshwari Subramaniam, Dalim Kumar Baidya
Respiratory Care Dec 2021, 66 (12) 1824-1830; DOI: 10.4187/respcare.09130

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Comparison of High-Flow Nasal Cannula and Noninvasive Ventilation in Acute Hypoxemic Respiratory Failure Due to Severe COVID-19 Pneumonia
Parvathy Ramachandran Nair, Damarla Haritha, Srikant Behera, Choro Athiphro Kayina, Souvik Maitra, Rahul Kumar Anand, Bikash Ranjan Ray, Manish Soneja, Rajeshwari Subramaniam, Dalim Kumar Baidya
Respiratory Care Dec 2021, 66 (12) 1824-1830; DOI: 10.4187/respcare.09130
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Keywords

  • High-flow nasal cannula
  • noninvasive ventilation
  • coronavirus disease 2019
  • acute respiratory failure
  • HFNC
  • NIV

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