We confirm that use of early continuous positive airway pressure (CPAP) with high-flow output combined with an “ad hoc” algorithm to inform the decision to intubate is a valid and safe strategy for respiratory support in patients with AHRF due to COVID-19 pneumonia.

The rate of CPAP success varies depending on patient-related risk factors.

CPAP was associated with a small risk of barotrauma and had no apparent detrimental effect in those patients who eventually progressed to IMV.

The overall recovery rate from respiratory failure was 50% in the DNI and 89% in the full-code group.

Among the latter, 71% recovered with CPAP-only, 3% died under CPAP and 26% were intubated after a median CPAP time of 7 days (IQR: 5–12 days).

Of the patients who were intubated, 68% recovered and were discharged from the hospital within 28 days.

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