Abstract
In this pandemic, the high-flow nasal cannula (HFNC) gained popularity for managing hypoxemia. However, failure of HFNC is thought to delay the intubation. We report a 53-year-old male with COVID-19 pneumonia with hypoxemic respiratory failure. HFNC was given, but the respiration-oxygenation (ROX) index was below the target. The patient was declared as having failed HFNC and was intubated after 12 hours. After intubation, the clinical condition was improved. The patient survived and was discharged from the hospital two weeks later with a negative swab result. This case highlights that HFNC failure does not affect the intubation outcome in severe COVID-19 pneumonia.