High Velocity Nasal Insufflation versus Continuous Positive Airway Pressure in COVID 19 Pneumonic Patients with Acute Type 1 Respiratory Failure

Background To compare the efficacy of High-Velocity Nasal Insufflation (HVNI) versus Continuous Positive Airway Pressure (CPAP) in managing COVID 19 pneumonic cases with acute type 1 respiratory failure, focusing on the need for invasive mechanical ventilation (IMV) and 28-day mortality. Methods A prospective randomised controlled trial (RCT) was conducted on 108 cases with COVID 19 pneumonia with acute hypoxemic respiratory failure (AHRF) at Mansoura University Hospitals. Cases were randomised into two equal groups: HVNI group and CPAP group. Baseline characteristics, respiratory parameters, and clinical outcomes were documented. Results Basal 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 need for IMV (51.85% vs. 55.56%, P = 0.700) and 28-day mortality (51.85% vs. 55.56%, P = 0.700) didn't significantly vary between groups. The ROX index at 12 hours (cut-off ≤ 4.2, AUC = 0.934, sensitivity 92.86%, specificity 84.62%) and HACOR score at 1 hour (cut-off > 6, AUC = 0.975, sensitivity 80%, specificity 100%) were strong predictors of treatment failure. Conclusions HVNI was as effective as CPAP in managing pneumonic cases 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.