2020-06-26T07:52:40
Hypoxemia is common in hospitalized patients with COVID-19. The criteria for hospital admission, intensive care unit (ICU) admission, and mechanical ventilation differ between countries. In some hospitals in the United States, >25% of hospitalized patients require ICU care, mostly due to acute respiratory failure.1-5
In adults with COVID-19 and acute hypoxemic respiratory failure, conventional oxygen therapy may be insufficient to meet the oxygen needs of the patient. Options include HFNC, NIPPV, or intubation and invasive mechanical ventilation.
HFNC and NIPPV are preferable to conventional oxygen therapy based on data from non-COVID-19 clinical trials and meta-analyses that showed reductions in the need for therapeutic escalation and the need for intubation in patients who received HFNC or NIPPV.6, 7
HFNC is preferred over NIPPV in patients with acute hypoxemic respiratory failure based on data from an unblinded clinical trial that was performed prior to the COVID-19 pandemic. This trial found more ventilator-free days with HFNC than with conventional oxygen therapy or NIPPV (24 days vs. 22 days vs. 19 days, respectively; P = 0.02) and lower 90-day mortality with HFNC than with both conventional oxygen therapy (hazard ratio [HR] 2.01; 95% confidence interval [CI], 1.01–3.99) and NIPPV (HR 2.50; 95% CI, 1.31–4.78)
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