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. 2024 Oct 31:60:164-172.
doi: 10.29390/001c.125145. eCollection 2024.

CPAP vs HFNC in treatment of patients with COVID-19 ARDS: A retrospective propensity-matched study

Ivan Šitum  1 , Lovro Hrvoić  2 , Ante Erceg  1 , Anja Mandarić  1 , Dora Karmelić  1 , Gloria Mamić  1 , Nikolina Džaja  1 , Anđela Babić  1 , Slobodan Mihaljević  1 , Mirabel Mažar  1 , Daniel Lovrić  3
Affiliations

CPAP vs HFNC in treatment of patients with COVID-19 ARDS: A retrospective propensity-matched study

Ivan Šitum et al. Can J Respir Ther. .

Abstract

Background: Previous studies exploring the application of noninvasive ventilation or high-flow nasal cannula in patients with COVID-19-related acute respiratory distress syndrome (ARDS) have yielded conflicting results on whether any method of respiratory support is superior. Our aim is to compare the efficacy and safety of respiratory therapy with high-flow nasal cannula and noninvasive ventilation with continuous positive airway pressure in treatment of COVID-19-related ARDS.

Methods: This is a retrospective cohort study based on data from patients who received respiratory support as part of their treatment in the COVID intensive care unit at the University Hospital Centre Zagreb between February 2021 and February 2023. Using propensity score analysis, 42 patients treated with high-flow nasal cannula (HFNC group) were compared to 42 patients treated with noninvasive ventilation with continuous positive airway pressure (CPAP group). Primary outcome was intubation rate.

Results: Intubation rate was 71.4% (30/42) in the HFNC group and 40.5% (17/42) in the CPAP group (p = 0.004). Hazard ratio for intubation was 3.676 (95% confidence interval [CI] 1.480 to 9.232) with the HFNC versus CPAP group. Marginally significant difference in survival between the two groups was observed at 30 days (p = 0.050) but was statistically significant at 60 days (p = 0.043).

Conclusions: Respiratory support with high-flow nasal cannula and noninvasive ventilation with continuous positive airway pressure yielded significantly different intubation rates in favour of continuous positive airway pressure. The same patients also had better 30-day and 60-day survival post-admission.

Keywords: acute respiratory distress syndrome; covid-19; endotracheal intubation; mechanical ventilation; pneumonia.

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Conflict of interest statement

The authors have no relevant financial or non-financial interests to disclose. The authors declare no conflict of interest.

Figures

Figure 1.
Figure 1.. Propensity score-matching analysis of study participants: out of a total of 152 patients, 42 patients in HFNC group and 42 in CPAP group were matched.
(a) Propensity scores of CPAP and HFNC group respectively prior to and after matching. (b) Standardized mean differences of included covariates prior to and after matching; improvement towards no difference (0.0) is visible after the match. ARDS – acute respiratory distress syndrome; BMI – body mass index; CPAP – continuous positive airway pressure; HFNC – high-flow nasal cannula; SOFA – Sequential Organ Failure Assessment
Figure 2.
Figure 2.. Enrolment and inclusion of potential study participants.
CPAP – continuous positive airway pressure; HFNC – high-flow nasal cannula
Figure 3.
Figure 3.. (a) Kaplan-Meier plot of the cumulative need for intubation from admission to the ICU to day 14. (b) Kaplan-Meier plot of cumulative survival rate from admission to the ICU to day 60.
CPAP – continuous positive airway pressure; HFNC – high-flow nasal cannula
See this image and copyright information in PMC

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