For acute hypoxemic respiratory failure in patients with COVID-19, recommendations of continuous positive airway pressure (CPAP) and high-flow nasal oxygen (HFNO) have been made. Researchers herein investigated how these noninvasive respiratory strategies in the initial phase affect the risk of tracheal intubation or mortality among hospitalized adults with acute hypoxemic respiratory failure due to COVID-19, compared with an initial strategy of conventional oxygen therapy.

• A randomized clinical trial of 1,273 patients conducted across 48 acute care hospitals in the UK and Jersey.

• In the CPAP vs conventional oxygen therapy group, the composite primary outcome of tracheal intubation or mortality within 30 days occurred in 36% vs 44% of the patients, respectively; in the HFNO vs the conventional oxygen therapy group, the composite primary outcome occurred in 44% vs 45% of the patients, respectively; the difference was statistically significant in the former but not latter comparison.

• Per findings, an initial strategy of CPAP correlate with a significant reduction in the risk of tracheal intubation or mortality among patients with acute hypoxemic respiratory failure and COVID-19 when compared with conventional oxygen therapy, but an initial strategy of HFNO did not differ significantly from conventional oxygen therapy.