Is high-flow nasal cannula oxygenation more effective than noninvasive ventilation or conventional oxygen therapy in treating acute hypoxemic respiratory failure in COVID-19 patients?

  • Cary Amiel G. Villanueva
  • Marie Gene D. Cruz
  • Lia M. Palileo-Villanueva
Keywords: high-flow nasal cannula, noninvasive ventilation, respiratory insufficiency, COVID-19, coronavirus


Very low-quality evidence suggests lower mortality (based on five observational studies) but higher failure
rate of respiratory support (based on two observational studies) in COVID-19 patients given high-flow nasal
cannula (HFNC) oxygen compared with noninvasive ventilation (NIV) and conventional oxygenation therapy.
Randomized controlled trials (RCT) are urgently needed in this area.
• Respiratory failure accounts for about half of deaths in patients with COVID-19.
• High-flow nasal cannula (HFNC) oxygen therapy reduces the need for escalating respiratory support and improves
patient comfort compared with conventional oxygen therapy among those with acute respiratory failure.
• Mortality was consistently lower in COVID-19 patients who received HFNC rather than NIV or conventional
oxygen therapy (COT) across 5 very low-quality retrospective observational studies from China.
• Several international guidelines recommend the use of HFNC oxygen therapy in COVID-19 patients who
develop acute hypoxemic respiratory failure. However, local guidelines from the Philippine Society for
Microbiology and Infectious Diseases (PSMID) and the Philippine College of Chest Physicians (PCCP) recommend
against HFNC due to risks of transmission and paucity of direct evidence for efficacy.
• Additional infection control precautions, i.e. wearing a surgical mask over the cannula, and locating in a negative
pressure room, are recommended whenever using HFNC or NIV.
• There are at least two ongoing trials due to be completed by the second quarter of 2021 comparing
HFNC oxygenation with NIV or COT in COVID-19 patients.


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