• Abdul Hakeem Al Hashim, Abdullah Al Reesi, Nabil M Al Lawati, Jyoti Burad, Murtadha Al Khabori, Juhi Chandwani, Redha Al Lawati, Yahya Al Masroori, Abdul Aziz Al Balushi, Al MasrooriSalimSDepartment of Medicine, Field Hospital, Ministry of Health, Muscat, Oman., Khalsa Al Siyabi, Fatema Al Lawati, Faroug Yousif Nimer Ahmed, Merah Al Busaidy, Aisha Al Huraizi, Mahmood Al Jufaili, Jalila Al Zaabi, Jerin Treesa Varghese, Ruqaya Al Harthi, Kingsly Prabhakaran Sebastian, Fahad Hamed Al Abri, Jamal Al Aghbari, Saif Al Mubaihsi, Adil Al Lawati, Mujahid Al Busaidi, and Giuseppe Foti.
• Department of Medicine, Sultan Qaboos University Hospital, Sultan Qaboos University, Muscat, Oman.
• Crit. Care Med. 2023 Nov 1; 51 (11): 151515261515-1526.

ObjectivesFor COVID-19-related respiratory failure, noninvasive respiratory assistance via a high-flow nasal cannula (HFNC), helmet, and face-mask noninvasive ventilation is used. However, which of these options is most effective is yet to be determined. This study aimed to compare the three techniques of noninvasive respiratory support and to determine the superior technique.DesignA randomized control trial with permuted block randomization of nine cases per block for each parallel, open-labeled arm.Setting And PatientsAdult patients with COVID-19 with a Pa o2 /F io2 ratio of less than 300, admitted between February 4, 2021, and August 9, 2021, to three tertiary centers in Oman, were studied.InterventionsThis study included three interventions: HFNC ( n = 47), helmet continuous positive airway pressure (CPAP; n = 52), and face-mask CPAP ( n = 52).Measurements And Main ResultsThe endotracheal intubation rate and mortality at 28 and 90 days were measured as the primary and secondary outcomes, respectively. Of the 159 randomized patients, 151 were analyzed. The median age was 52 years, and 74% were men. The endotracheal intubation rates were 44%, 45%, and 46% ( p = 0.99), and the median intubation times were 7.0, 5.5, and 4.5 days ( p = 0.11) in the HFNC, face-mask CPAP, and helmet CPAP, respectively. In comparison to face-mask CPAP, the relative risk of intubation was 0.97 (95% CI, 0.63-1.49) for HFNC and 1.0 (95% CI 0.66-1.51) for helmet CPAP. The mortality rates were 23%, 32%, and 38% at 28 days ( p = 0.24) and 43%, 38%, and 40% ( p = 0.89) at 90 days for HFNC, face-mask CPAP, and helmet CPAP, respectively. The trial was stopped prematurely because of a decline in cases.ConclusionsThis exploratory trial found no difference in intubation rate and mortality among the three intervention groups for the COVID-19 patients with hypoxemic respiratory failure; however, more evidence is needed to confirm these findings as the trial was aborted prematurely.Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine and Wolters Kluwer Health, Inc.

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