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This study aims to compare the effectiveness of HVNI and CPAP in patients with COVID-19 pneumonia experiencing acute type 1 respiratory failure.

June 11, 2026Egyptian Journal of Bronchology0 citationsOpen Access

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

MEMohamed M. El-GamalMansoura University KEKhalid Mohamed El-SherbinyMansoura University AHAsem HewidyMansoura University

Key Points

This study aims to compare the effectiveness of HVNI and CPAP in patients with COVID-19 pneumonia experiencing acute type 1 respiratory failure.
Prospective randomized controlled trial conducted with 108 patients at Mansoura University Hospitals.
Patients were randomly assigned to the HVNI group or CPAP group.
Primary outcomes included need for invasive mechanical ventilation and 28-day mortality.
Requirement for IMV was 51.85% in HVNI and 55.56% in CPAP, P=0.700, indicating no significant difference.
28-day mortality was also comparable, with both groups at 51.85% for HVNI and 55.56% for CPAP, P=0.700.
The ROX index and HACOR score were effective predictors of treatment failure with high sensitivity and specificity.

Abstract

Abstract 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.

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