Continuous positive airway pressure (CPAP) and high-flow nasal oxygen (HFNO) are the treatments of choice for acute hypoxemic respiratory failure in patients with COVID-19; however, there remains uncertainty regarding the effectiveness and safety of these noninvasive respiratory strategies.

A recent study determined if either CPAP or HFNO, compared with conventional oxygen therapy, can improve clinical outcomes in hospitalized patients with COVID-19–related acute hypoxemic respiratory failure.

1273 hospitalized adults with COVID-19–related acute hypoxemic respiratory failure were included in the study and followed up. They were randomized to receive CPAP, HFNO, or conventional oxygen therapy; and were assessed for a composite of tracheal intubation or mortality within 30 days.

The observations were as follows-

• The trial observed premature termination due to declining COVID-19 case numbers in the UK and the end of the funded recruitment period.
• Among 1273 randomized patients (mean age, 57.4 years; 66% male; 65% White race), primary outcome data were available for 1260.
• Crossover between interventions was observed in 17.1% of participants (15.3%, 11.5% and 23.6% in the CPAP group, HFNO group, and conventional oxygen therapy group, respectively).
• The requirement for tracheal intubation or mortality within 30 days was observed to be much lower with CPAP (36.3%) vs conventional oxygen therapy (44.4%) but not between HFNO (44.3%) vs conventional oxygen therapy (45.1%).
• Adverse events were documented in 34.2%, 20.6% and 13.9% of participants in the CPAP group, HFNO group, and conventional oxygen therapy group, respectively.

Thus, among patients with acute hypoxemic respiratory failure due to COVID-19, an initial strategy of CPAP, but not HFNO, can significantly reduce the risk of tracheal intubation or mortality compared with conventional oxygen therapy. These results must be confirmed in further studies.

JAMA. 2022;327(6):546–558. doi:10.1001/jama.2022.0028