Table 1.
Studies that reported the use of high-flow nasal oxygen and/or noninvasive positive pressure ventilation for patients with COVID-19
| Study | Study Type | Patients/Setting/Country | Respiratory Support | Outcomes |
|---|---|---|---|---|
| Chen et al,61 2020 | Retrospective observational (single-center) | 145 patients with COVID-19 (43 severely ill) (China) |
HFNO: 6 patients IMV: 1 patient |
Not reported |
| Lagi et al,62 2020 | Retrospective observational (single-center) | 84 patients with COVID-19 admitted to the Infectious and Tropical Disease Unit in February–March 2020; nurse and physician coverage intensified with time (Italy) | HFNO: 9 patients IMV: 1 patient |
1/9 (11.1%) patients treated with HFNO required ICU admission and intubationa |
| Calligaro et al,63 2020 | Prospective observational (multicenter) | 293 consecutive patients with COVID-19 and AHRF in April–June 2020 (South Africa) | HFNO: 293 patients | HFNO success: 134/293 (47%) HFNO failure: 156/293 (53%) with 111 received IMV and 45 died without intubation 84/111 (75,7%) who received IMV dieda |
| Zhou et al,64 2020 | Retrospective observational (multicenter) | 191 patients with COVID-19 admitted to 2 hospitals in December 2019–January 2020; 50 were admitted to ICU (Wuhan, China) | HFNO: 41 patients NIV: 26 patients IMV: 32 patients |
33/41 (80.5%) patients treated with HFNO died 24/26 (92.3%) patients treated with NIV died 31/32 (96.9%) patients treated with IMV died |
| Yang et al,65 2020 | Retrospective observational (single-center) | 52 critically ill patients with COVID-19 December 2019–January 2020 (Wuhan, China) | HFNO: 33 patients NIV: 29 patients IMV: 22 patients |
16/33 (48.5%) patients treated with HFNO died 23/29 (79.3%) patients treated with NIV died 19/22 (86.4%) patients treated with IMV died |
| Grasselli et al,2 2020 | Retrospective observational (multicenter) | 1591 patients admitted to the ICU in February–March 2020 (Italy) | NIV: 137 (11%) patients IMV: 1150 (88%) patients |
No outcome reported for patients who were treated with NIV or IMVa |
| Avdeev et al,66 2021 | Retrospective observational (multicenter) | 61 patients receiving NIV for AHRF in wards in April–June 2020 (Russia) | NIV: 61 patients | 44/61 (72.1%) patients had NIV success 17/61 (27.9%) patients treated with NIV required intubation Mortality was 24.6% |
| Forrest et al,45 2021 | Retrospective observational (multicenter) | 688 adult patients with confirmed COVID-19 and hypoxia in March–April 2020 (New York City, USA) | NIV: 534 patients IMV: 154 patients |
171/534 (32.0%) patients treated with NIV died 128/154 (83.1%) patients treated with IMV died Across all subgroups and propensity-matched analysis, IMV was associated with a greater risk of death than NIV |
| Bellani et al,67 2021 | Prospective, single-day observational study (multicenter) | 8753 patients with COVID-19 present in the participating hospitals on the study day in March 2020 (Italy) | 909 (10%) patients received NIV outside the ICU (85%) with CPAP; delivered by helmet in 617 (68%) patients | 300/909 (37.6%) patients had NIV failure 498/909 (62.4%) patients were discharged alive without intubation C-reactive protein, PF ratio, and platelet counts were independently associated with increased risk of NIV failure |
| Franco et al,36 2020 | Retrospective observational (multicenter) | 670 consecutive patients with confirmed COVID-19 in pulmonology units in 9 hospitals in March–May 2020 (Italy) | HFNO: 163 patients CPAP/NIV: 507 patients |
Intubation: 47 (28.8%) patients on HFNO, 82 (24.8%) patients on CPAP, and 49 (27.7%) patients on NIV Mortality: 16%, 30%, and 30% for HFNO, CPAP and NIV, respectively |
| Karagiannidis et al,11 2021 | Retrospective observational (multicenter) | Nationwide cohort of 7490 patients with COVID-19 hospitalized in 2 periods (February–May and October–November 2020) with hospital setting not specified (Germany) |
NIV only: 1614 (21.5%) patients NIV followed by intubation: 1247 (16.6%) patients IMV: 3851 (51.4%) patients |
1247/2861 (43.6%) patients had NIV failure 624/1614 (38.7%) patients treated with NIV only died 818/1247 (65.6%) patients with NIV failure died 2003/3851 (52.0%) patients treated with IMV died |
| Faraone et al,37 2021 | Retrospective observational (single-center) | 50 consecutive patients with COVID-19 admitted to the general wards in March–May 2020 (Italy) | NIV: 50 patients | 25 (50%) patients had do-not-intubate order 22 patients were weaned from NIV and did not require intubation (6/25 patients with treatment limitation and16/25 without treatment limitation) 9 (36%) patients had NIV failure and needed IMV |
| Menga et al,68 2021 | Prospective observational (single-center) | 85 consecutive patients with COVID-19 admitted to the ICU in March–April 20 (Italy) | Helmet NIV: 42 patients Face-mask NIV: 19 patients HFNO: 24 patients |
Helmet NIV failure: 27/42 (64.3%) Face-mask NIV failure: 10/19 (52.6%) HFNO failure: 15/24 (62.5%) 21/52 (40.4%) of patient with NIV/HFNO failure died Higher illness severity predicted NIV/HFNO failure |
| Burns et al,69 2020 | Retrospective observational (single-center) | 28 patients with COVID-19 admitted to the ward in March–April 2020 (United Kingdom) | NIV: 28 patients | 14/28 (50%) patients treated with NIV died |
| Xie et al,70 2020 | Retrospective observational (multicenter) | 733 patients with COVID-19 admitted to the ICU in January-February 2020 (China) | HFNO: 320 patients NIV: 164 patients IMV: 100 |
144/320 (%) patients treated with HFNO died 107/164 (%) patients treated with NIV died 75/100 (75%) patients treated with IMV died |
| Garcia et al,71 2020 | Prospective observational (multicenter) | 639 patients with COVID-19 admitted to the ICU after April 2020 (Europe) | HFNO: 25 patients NIV: 27 patients IMV: 317 patients |
4/25 (16.0%) patients treated with HFNO died in the ICUa 9/27 (33.3%) patients treated with NIV died in the ICUa 58/317 (18.3%) patients treated with IMV died in the ICUa |
| Elhadi et al,72 2021 | Prospective observational (multicenter) | 465 consecutive COVID-19 critically ill patients May-December 2020 (Libya) | HFNO:20 patients NIV/CPAP: 20 patients |
15/20 (75%) patients treated with HFNO died 18/20 (90%) patients treated with NIV died |
| Rahim et al,73 2020 | Cross-sectional (single) | 204 patients admitted to the ICU April–August 2020 (Pakistan) | NIV: 126 patients IMV: 78 patients |
84/126 (66.7%) patients treated with NIV died 73/78 (93.6%) patients treated with IMV died |
| Carpagnano et al,74 2021 | Retrospective (single-center) | 78 consecutive patients with COVID-19 and moderate to severe ARDS hospitalized in an intermediate respiratory ICU, in March–April 2020 (Italy) | HFNO: 7 patients NIV: 61 patients |
2/7 (28.6%) patients treated with HFNO died 25/61 (41.0%) patients treated with NIV died |
| Rodríguez et al,75 2021 | Prospective observational (multicenter) | 1362 critically ill patients with confirmed COVID-19 disease and acute respiratory failure in February–May 2020 (Spain) | HFNO: 375 patients NIV: 140 patients IMV: 1172 patients |
80/375 (21.3%) patients treated with HFNO died in ICU 42/140 (30.0%) patients treated with NIV died in ICU 458/1172 (39.1%) patients treated with IMV died in ICU |
| Roomi et al,76 2021 | Retrospective observational (multicenter) | 1204 patients with COVID-19 admitted to the ICU in March–August 2020 (Philadelphia area, USA) | HFNO: 573 patients NIV: 399 patients IMV: 713 patients |
203/573 (35.4%) patients treated with HFNO died 187/399 (46.9%) patients treated with NIV died 373/713 (52.3%) patients treated with IMV died |
| Grosgurin et al.77 2021 | Retrospective observational (single-center) | 157 patients with COVID-19 admitted to the intermediate care unit in March–April 2020 (Switzerland) | HFNO alternating with NIV was provided to 85 patients with worsening respiratory failure | 33/85 (39%) required ICU admission and IMV 52 (61%) were discharged to the ward without ICU admission |
| Grieco et al,47 2021 | Randomized controlled trial (multicenter) | 109 patients with COVID-19 and moderate-severe AHRF (PF ratio < 200) admitted to 4 ICUs (Italy) |
Helmet-NIV group: helmet applied continuously for the first 48 h (PEEP: 10–12 cmh2o; pressure support: 10–12 cmh2o) followed by HFNO: 54 HFNO group at 60 L/min: 55 |
No difference in the duration of respiratory support at 28 d (primary outcome): mean difference 2 d, 95% CI, −2 to 6, P = .26) Intubation rate: 16/54 (30%) vs 28/55 (51%); P = .03 in favor of the Helmet NIV group Ventilator-free days within 28 d (median of 28 vs 25 d; mean difference; P = .04) 13/54 (24%) patients in the helmet-NIV group and 14/55 (25%) patients in HFNO group died in the hospital (P = 1.0) |
| Perkins et al,48 2021 | Randomized controlled trial (multicenter) | 1272 hospitalized patients with acute respiratory failure due to COVID-19 (United Kingdom) | CPAP: 380 patients HFNO: 417 patients Conventional oxygen therapy: 475 patients |
The primary outcome (composite of tracheal intubation or mortality within 30 d) was lower in the CPAP group (36.3%) compared with conventional oxygen therapy (44.4%; P = .03), but similar in the HFNO and conventional oxygen therapy groups (P = .85). The difference in between CPAP and HFNO was due to tracheal intubation Safety events were most common in the CPAP group (CPAP 34.2%; HFNO 20.6%; conventional oxygen therapy 13.9%, P<.001) |
Abbreviation: IMV, invasive mechanical ventilation.
a
Outcome data incomplete at the time of publication.