The effectiveness of high-flow nasal cannula and standard non-rebreathing mask for oxygen therapy in moderate category COVID-19 pneumonia: Randomised controlled trial

Abstract

Background. COVID-19 caused by the highly infectious severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection is a matter of concern and has led to severe health problems all over the world. Oxygen therapy is the mainstay for the management of patients suffering from various stages of the disease.

Objectives. To compare the effectiveness of high-flow nasal cannula (HFNC) and standard non-rebreathing mask (NRBM) as oxygen delivery devices in moderate cases of COVID-19 pneumonia.

Methods. A single-centre, open-label, randomised controlled trial was conducted between February 2021 and April 2021. All the enrolled patients (N=120) were randomly allocated into two groups according to the oxygen delivery device used. Group 1 (n=60) received HFNC and group 2 (n=60) received NRBM as the initial oxygen delivery device, to maintain a target saturation ≥96% in both groups.
The progression-free survival without escalation of respiratory support, partial pressure of arterial oxygen (PaO2), a ratio of partial pressure of arterial oxygen to fractional inspiratory oxygen concentration (PaO2/FiO2), respiratory rate, heart rate, blood pressure, number of patients requiring non-invasive ventilation or endotracheal intubation, time for de-escalation of oxygen therapy to lower FiO2device, time to
progression to severe disease, survival at day 28, and patient satisfaction level were compared between the two groups.

Results. Demographic, clinical variables and treatment received were comparable in the two groups. In the HFNC group, 90% of patients had successful outcomes with the initial oxygen therapy device used as compared with 56.6% in the NRBM group (p<0.001; odds ratio (OR) 0.145; 95% confidence interval (CI) 0.054 - 0.389). Using HFNC also resulted in improved oxygenation (PaO2/FiO2) (p<0.001), better
patient satisfaction (p<0.001), and a shorter time for de-escalation of oxygen therapy to a lower FiO2device (p<0.001). The 28-day survival was higher in the HFNC group, but the difference was statistically insignificant (p=0.468).

Conclusion. HFNC is a reliable oxygen therapy modality for moderate category COVID-19 pneumonia and results in a higher success rate of oxygen therapy, better oxygenation, and a greater patient satisfaction level as compared with a NRBM.
Keywords. COVID-19; hypoxaemia; ICU; on-invasive ventilation; oxygen therapy; pneumonia; respiratory failure.