High-flow nasal cannulae (HFNC), non-invasive mechanical ventilation (NIV), and invasive mechanical ventilation (IMV) are all forms of advanced respiratory assistance that might be necessary for up to 30% of COVID-19 patients who were hospitalized. During the 1st 2 years of the pandemic, researchers sought to characterize the clinical features, outcomes, and risk factors for failure of non-invasive respiratory support in patients treated with severe COVID-19 in high-income countries (HICs) and low-middle-income countries (LMICs). Prospectively, investigators enrolled patients with proven SARS-CoV-2 infections who needed hospitalization. Included in this analysis were hospitalized patients who received HFNC, NIV, or IMV within the first 24 hours of their stay. Patients treated with various forms of advanced respiratory assistance had their clinical characteristics described and their clinical outcomes compared using descriptive statistics, random forest, and logistic regression analysis. There were 66,565 patients in total in this research. In the initial wave of the pandemic, 40.6% of patients were admitted to the hospital, and 82.6% were treated in HIC. Patients in HICs were more likely to get HFNC (48.0%), followed by NIV (38.6%), and then IMV (13.4%) within the first 24 hours of hospitalization. The majority of patients hospitalized in LMICs were given IMV (59%), whereas just 16.1% were given HFNC. Non-invasive respiratory assistance (i.e., HFNC or NIV) had a 15.5% failure rate, with 71.2% coming from HIC and 28.8% from LMIC. High leukocyte counts at hospital admission (OR [95%CI]; 5.86 [4.83-7.10]), treatment in an LMIC (OR [95% CI]; 2.04 [1.97-2.11]), and tachypnoea at hospital admission (OR [95% CI]; 1.16 [1.14-1.18]) were the most strongly associated variables with non-invasive ventilation failure, defined as progression to IMV. Higher odds of death after 28 days were seen in patients who had HFNC/NIV fail (OR [95%CI]; 1.27 [1.25-1.30]). The present cohort found that the HFNC was the most often used form of advanced respiratory support. In contrast, IMV was more common in LMIC. Inadequate HFNC/NIV function was associated with a higher leucocyte count, tachypnoea, and receiving care in a low- and middle-income country. Clinical outcomes, including 28-day mortality, were poorer in patients with HFNC/NIV failure. The Signup Process for Trials All participants received routine health care as part of this prospective observational study. Therefore, trial registration is not required.

Source: ccforum.biomedcentral.com/articles/10.1186/s13054-022-04155-1