Safety Assessment of a Noninvasive Respiratory Protocol for Adults With COVID-19

J Hosp Med. 2020 Dec;15(12):734-738. doi: 10.12788/jhm.3548.


As evidence emerged supporting noninvasive strategies for coronavirus disease 2019 (COVID-19)-related respiratory distress, we implemented a noninvasive COVID-19 respiratory protocol (NCRP) that encouraged high-flow nasal cannula (HFNC) and self-proning across our healthcare system. To assess safety, we conducted a retrospective chart review evaluating mortality and other patient safety outcomes after implementation of the NCRP protocol (April 3, 2020, to April 15, 2020) for adult patients hospitalized with COVID-19, compared with preimplementation outcomes (March 15, 2020, to April 2, 2020). During the study, there were 469 COVID-19 admissions. Fewer patients underwent intubation after implementation (10.7% [23 of 215]), compared with before implementation (25.2% [64 of 254]) (P < .01). Overall, 26.2% of patients died (24% before implementation vs 28.8% after implementation; P = .14). In patients without a do not resuscitate/do not intubate order prior to admission, mortality was 21.8% before implementation vs 21.9% after implementation. Overall, we found no significant increase in mortality following implementation of a noninvasive respiratory protocol that decreased intubations in patients with COVID-19.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Aged
  • COVID-19 / mortality
  • COVID-19 / therapy*
  • Cannula*
  • Female
  • Humans
  • Intubation, Intratracheal / statistics & numerical data
  • Male
  • Noninvasive Ventilation / statistics & numerical data*
  • Patient Safety*
  • Retrospective Studies