The use of high-flow nasal oxygen upon ICU admission in adult patients with COVID-19 related acute hypoxemic respiratory failure may lead to an increase in ventilator-free days and a reduction in ICU length of stay, when compared to early initiation of invasive mechanical ventilation. Future studies should confirm our findings.

This was a multicentre cohort study using a prospectively collected database of patients with COVID-19 associated acute respiratory failure admitted to 36 Spanish and Andorran intensive care units (ICUs).

Out of 468 eligible patients, a total of 122 matched patients were included in the present analysis (61 for each group).

When compared to early intubation, the use of high-flow nasal oxygen was associated with an increase in ventilator-free days and a reduction in ICU length of stay.

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