High velocity nasal insufflation versus continuous positive airway pressure in COVID-19 pneumonia patients with acute type 1 respiratory failure

Background Noninvasive respiratory support plays a central role in the management of acute hypoxemic respiratory failure in patients with COVID-19 pneumonia, yet the optimal modality remains debated. This study aimed to compare the efficacy of High-Velocity Nasal Insufflation (HVNI) versus Continuous Positive Airway Pressure (CPAP) in managing patients with COVID-19 pneumonia with acute type 1 respiratory failure, focusing on the ne requirement for invasive mechanical ventilation (IMV) and 28-day mortality. Methods A prospective randomized controlled trial (RCT) was conducted on 108 patients with COVID-19 pneumonia with acute hypoxemic respiratory failure (AHRF) at Mansoura University Hospitals. Patients were randomized into two equal groups: HVNI group and CPAP group. Results Baseline characteristics were comparable between groups with the exception of a higher prevalence of diabetes mellitus in the CPAP group (40.74% vs. 18.52%, P = 0.011). The requirement for IMV (51.85% vs. 55.56%, P = 0.700) and 28-day mortality (51.85% vs. 55.56%, P = 0.700) did not differ significantly between groups. The ROX index at 12 h (cut-off ≤ 4.2, AUC = 0.934, sensitivity 92.86%, specificity 84.62%) and HACOR score at 1 h (cut-off > 6, AUC = 0.975, sensitivity 80%, specificity 100%) were strong predictors of treatment failure. Conclusions HVNI demonstrated comparable effectiveness to CPAP in managing patients with COVID-19 pneumonia with acute type 1 respiratory failure. The ROX index and HACOR score provided strong predictive value for treatment failure, enabling early intervention to prevent IMV.