Among the many innovative research projects of the 10th National Research Award organised by the Ministry of Higher Education, Research and Innovation, ‘Comparison of Noninvasive Mechanical Ventilation With High-Flow Nasal Cannula, Face-Mask, and Helmet in Hypoxemic Respiratory Failure in Patients With Covid-19: A Randomised Controlled Trial’ has been awarded in the Health and Social Services field in the PhD category.
This research is carried out by the principal investigator Dr Abdulhakeem bin Yaqoob al Hashim, Senior Consultant in Internal Medicine and Critical Care at Sultan Qaboos University Hospital, Sultan Qaboos University.
Dr Al Hashim explained that for the Covid-19-related respiratory failure, noninvasive respiratory assistance via a high-flow nasal cannula (HFNC), helmet, and face-mask noninvasive ventilation can be used. This study compared these three techniques of noninvasive respiratory support for Covid patients and to determine the superior technique.
Dr Al Hashim mentioned that research project used a randomised control clinical trial, with three open-labelled arms. Adult patients with Covid-19 with a Pao2/Fio2 ratio of less than 300, admitted between February 4, 2021, and August 9, 2021, to three tertiary centres in Oman, were included. They were then randomised into the three interventions: HFNC (n = 47), helmet continuous positive airway pressure (CPAP; n = 52), and face-mask CPAP (n = 52). The endotracheal intubation rate and mortality at 28- and 90- days were measured as the primary and secondary outcomes, respectively.
According to him, the results showed that out of the 159 randomised patients, 151 were analysed. The median age was 52 years, and 74 per cent were men. The endotracheal intubation rates were 44 per cent, 45 per cent, and 46 per cent (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 per cent CI, 0.63–1.49) for HFNC and 1.0 (95 per cent CI 0.66–1.51) for helmet CPAP. The mortality rates were 23 per cent, 32 per cent, and 38 per cent at 28 days (p = 0.24) and 43 per cent, 38 per cent, and 40 per cent (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.
Dr Abdulhakeem stated that the 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. All three modalities of noninvasive ventilator interfaces are equally effective and safe. This is important because two of these modalities do not require a ventilator and can be provided outside the intensive care unit settings.
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