Acute hypoxic respiratory failure in coronavirus disease 2019 (COVID-19) pneumonia has been treated with oxygen delivered by oxygen masks and non-invasive ventilation (NIV) with continuous positive airway pressure (CPAP), and more recently with high-flow nasal cannula (HFNC) devices.

There is a paucity of randomized controlled trials to compare the efficacy of CPAP with HFNC in COVID-19 pneumonia.

We conceptualized a randomized control study to compare the efficacy of HFNC and CPAP in reducing the need for invasive mechanical ventilation, estimation of mechanical ventilation-free days, and risk of intubation in COVID-19 patients with hypoxic respiratory failure.

The administration of CPAP significantly reduced the intubation rate and prolonged invasive mechanical ventilation-free period in COVID-19 patients with hypoxic respiratory failure.

We also inferred a two-fold increase in the risk of intubation in patients receiving HFNC compared to CPAP.