Effectiveness of High-Flow Nasal Cannula Oxygen Therapy vs. Non-Invasive Ventilation in Moderate COVID-19 ARDS: RCT Results
Abstract
Background
The optimal non-invasive respiratory support strategy for moderate COVID-19-associated ARDS remains debated. High-flow nasal cannula (HFNC) and non-invasive ventilation (NIV) each offer distinct physiological advantages. This RCT compares both strategies in a resource-limited ICU setting.
Methods
Multicentre open-label RCT across 5 tertiary ICUs in Maharashtra (November 2021–March 2022). Adults with moderate COVID-19 ARDS (PaO2/FiO2 100–200 mmHg) were randomised 1:1 to HFNC (n=98) or NIV via helmet interface (n=97). Primary endpoint: intubation rate within 28 days. Secondary: ICU mortality, ICU-free days, patient comfort score.
Results
Intubation rate was significantly lower in the HFNC group (31.6% vs. 47.4%; RR 0.67; 95% CI 0.47–0.95; p=0.02). 28-day ICU mortality was 22.4% (HFNC) vs. 29.9% (NIV) (p=0.22). ICU-free days were higher in HFNC (14.2 ± 6.8 vs. 11.8 ± 7.1; p=0.03). Patient comfort scores favoured HFNC significantly (p<0.001).
Conclusion
HFNC significantly reduces intubation rates compared to NIV in moderate COVID-19 ARDS and offers superior patient comfort. These findings support preferential use of HFNC as first-line non-invasive respiratory support in this population.
Conflict of Interest
Fisher & Paykel Healthcare provided HFNC equipment for the study. No cash compensation received. Remaining authors declare no conflicts.