Table 2.

Considerations in non-invasive oxygenation and ventilation for the known or suspected COVID-19 patient with acute hypoxic respiratory failure – the pros and cons of high-flow nasal cannula and non-invasive positive-pressure ventilation

High-flow Nasal Cannula (HFNC)	Non-invasive Positive-pressure Ventilation (NIPPV)
Pros	Pros
•Ability to deliver FiO2 approaching 1.0 •Modest increase in PEEP with limited adjustment ability •Tolerated in patients with borderline hemodynamic status • Patient comfort / tolerance · lack of facemask · warmed and humidified gas delivery · ability to speak and take PO •Reduced need for endotracheal intubation-more “ventilator-free” days •Decreased rate of re-intubation •Uncommon infectious complications •Mortality reduction •Less aerosol generation (clinician contagion)	•Beneficial for patients with co-existing obstructive pulmonary disease and congestive heart failure (CHF) (cardiogenic pulmonary edema) exacerbations •Increased ability to provide PEEP with adjustment •Reduced need for endotracheal intubation-more “ventilator-free” days •Decreased rate of re-intubation •Mortality reduction
Cons	Cons
•Minimal positive pressure delivery-limited impact on work of breathing reduction • Not appropriate for patients with · diminished respiratory drive · abnormal mental status •May result in aerosol generation (potential risk for clinician contagion)	•Occurrence of pressure-related lung injury •Patient discomfort / intolerance due to facemask and positive pressure • Not appropriate for patients with · diminished respiratory drive · abnormal mental status · hemodynamic instability · excessive respiratory secretions and emesis •May result in aerosol generation (potential risk for clinician contagion)