In people having acute hypoxemic respiratory failure and coronavirus disease, an initial approach of continuous positive airway pressure considerably decreased the risk of death or tracheal intubation in comparison with conventional oxygen therapy.

This adaptive, parallel-group, randomized clinical trial was carried out to explore if either continuous positive airway pressure (CPAP) or high-flow nasal oxygen (HFNO), compared with conventional oxygen therapy leads to improvement in clinical outcomes in hospitalized adults suffering from coronavirus disease.

In Randomized Evaluation of COVID-19 Therapy–Respiratory Support (RECOVERY-RS), a total of 1273 people infected with coronavirus disease were recruited. Participants were randomly allocated to get HFNO (n = 418), CPAP (n = 380), or conventional oxygen therapy (n = 475). The composite of tracheal intubation or death within thirty days was the major endpoint ascertained.

Out of 1273 randomized people (mean age, 57.4 years; 66% men), the major endpoint data were available for 1260. The crossover between interventions took place in 17.1% of people (23.6% in the conventional oxygen therapy group, 11.5% in the HFNO group, 15.3% in the CPAP group). The requirement for tracheal intubation or death within thirty days was considerably reduced with CPAP (36.3%; 137/377 people) when compared to the conventional oxygen therapy (44.4%; 158/356 people) (absolute difference, -8%).

However, no profound difference was noted between an initial strategy of HFNO (44.3%; 184/415 people) vs. conventional oxygen therapy (45.1%; 166/368 people) (absolute difference, -1%). Side effects were reported to occur in 13.9% (66/475) in the conventional oxygen therapy arm, 34.2% (130/380) of people in the CPAP arm, and 20.6% (86/418) in the HFNO arm.

Compared with conventional oxygen therapy, HFNO appears to be beneficial to decrease the composite outcome of tracheal intubation or mortality within 30 days. in people suffering from SARS-CoV-2 infection.