High Velocity Nasal Insufflation versus Continuous Positive Airway Pressure in COVID 19 Pneumonic Patients with Acute Type 1 Respiratory Failure

High Velocity Nasal Insufflation versus Continuous Positive Airway Pressure in COVID 19 Pneumonic Patients with Acute Type 1 Respiratory Failure | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article High Velocity Nasal Insufflation versus Continuous Positive Airway Pressure in COVID 19 Pneumonic Patients with Acute Type 1 Respiratory Failure Mohamed M Elgamal, Khalid M El-Sherbiny, Asem Hewidy, Magda A Ahmed, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8041794/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 11 You are reading this latest preprint version Abstract Background To compare the efficacy of High-Velocity Nasal Insufflation (HVNI) versus Continuous Positive Airway Pressure (CPAP) in managing COVID 19 pneumonic cases with acute type 1 respiratory failure, focusing on the need for invasive mechanical ventilation (IMV) and 28-day mortality. Methods A prospective randomised controlled trial (RCT) was conducted on 108 cases with COVID 19 pneumonia with acute hypoxemic respiratory failure (AHRF) at Mansoura University Hospitals. Cases were randomised into two equal groups: HVNI group and CPAP group. Baseline characteristics, respiratory parameters, and clinical outcomes were documented. Results Basal characteristics were comparable between groups with the exception of a higher prevalence of diabetes mellitus in the CPAP group (40.74% vs. 18.52%, P = 0.011). The need for IMV (51.85% vs. 55.56%, P = 0.700) and 28-day mortality (51.85% vs. 55.56%, P = 0.700) didn't significantly vary between groups. The ROX index at 12 hours (cut-off ≤ 4.2, AUC = 0.934, sensitivity 92.86%, specificity 84.62%) and HACOR score at 1 hour (cut-off > 6, AUC = 0.975, sensitivity 80%, specificity 100%) were strong predictors of treatment failure. Conclusions HVNI was as effective as CPAP in managing pneumonic cases with acute type 1 respiratory failure. The ROX index and HACOR score provided strong predictive value for treatment failure, enabling early intervention to prevent IMV. High-Velocity Nasal Insufflation CPAP Acute Respiratory Failure ROX Index HACOR Score Figures Figure 1 Introduction Acute respiratory failure (ARF) is a frequent cause of emergency department visits, necessitating various respiratory support plans, comprising oxygen therapy, non-invasive positive-pressure ventilation (NIV), and mechanical ventilation. (1). COVID 19 Pneumonia can cause acute respiratory failure and need non-invasive respiratory support with positive end-expiratory pressure (PEEP)(2). Continuous positive airway pressure (CPAP) is a non-invasive modality which should be the first choice in managing respiratory failure due to COVID 19 pneumonia by improving oxygenation and reducing the work of breathing(2&3). By delivering a continuous positive pressure, CPAP helps maintain airway patency, reducing the risk of intubation and ICU admission (3). However, CPAP adherence can be limited by discomfort due to high pressure, claustrophobia, poor mask fit, nasal irritation, and mucosal injury (4) HVNI, a specialized form of HFNC, initially used in neonatal care, has gained increasing attention in adults as a high-flow oxygen therapy delivering humidified and warmed oxygen at high velocities. It offers several physiological advantages over conventional oxygen therapy, including enhanced positive airway pressure, reduced anatomic dead space, washing out CO₂ between breaths and improved work of breathing (5&6). Additionally, HVNI provides a mild to moderate PEEP effect, which is flow-dependent and contributes to improved oxygenation and secretion clearance (7). Given the increasing usage of non-invasive respiratory support care, HVNI has been recommended as a possible substitute to CPAP for managing ARF. This study aimed to compare the efficiency of HVNI and CPAP in COVID-19 pneumonic cases with acute type 1 respiratory failure. Patients and methods Settings and Duration : This randomised controlled trial (RCT) was conducted at at the Chest Medicine Department (Isolation Building), Mansoura University Hospitals between February 2021 and February 2022. Inclusion criteria: Cases aged above 18 years with COVID 19 pneumonia with type 1 ARF were included. Exclusion criteria : Cases with hypercapnic respiratory failure, cases with a disturbed conscious level and/or a high risk of aspiration, individuals with hypotension, and cases needing IMV. Patient selection A total of 188 patients were assessed for eligibility, of whom 70 didn’t match the inclusion criteria and 10 declined participations. The remaining 108 cases were haphazardly assigned into two equal groups (54 patients each) using computer-generated numbers, with allocation codes concealed in sealed, opaque envelopes. Group 1 received HVNI, while Group 2 received CPAP Fig. 1 All patients were subjected to the followings: All patients underwent a comprehensive clinical evaluation, laboratory workup, radiological investigation and two clinical assessment tools (ROX Index and HACOR Score). The clinical evaluation included presenting symptoms, demographic data, comorbidities and complete physical examination. Laboratory investigations included a complete blood count, C-Reactive Protein (CRP),liver function tests, kidney function tests, serial arterial blood gas analysis (ABG). Additionally, all patients underwent RT-PCR testing for COVID-19 via a nasopharyngeal swab. Radiological investigations included a chest X-ray upon admission and daily thereafter, as well as high-resolution computed tomography (HRCT) of the chest upon admission and after one week, if available. The two clinical assessment indices were used to predict treatment success or failure were ROX Index and HACOR Score. ROX Index: described as the ratio of pulse oximetry (SpO2)/fraction of inspired oxygen (FiO2) to respiratory rate (RR) (8). It was calculated with the next formula: ROX index = (SpO2/FiO2) /RR. This index was assessed at initiation, 12 hours, and 24 hours after device application to assess response to therapy and potential need for mechanical ventilation (9). ROX index is a simple, non-invasive bedside modality that helps expect the success of HFNC in cases with AHRF (8). Higher values are indicative of better lung function and gas exchange, signifying a more favorable prognosis while on HFNC therapy. A ROX index ≥ 4.88 following twelve hours of HFNC initiation has been accompanied by a minimal risk of intubation. In contrast, a ROX index below this level suggests a higher likelihood that the patient will not respond adequately to HFNC and may thus require endotracheal intubation (9).ROX index also, had an excellent predicting power of CPAP failure after 24h with cut-off point <6.64 in patients with COVID-19 and AHRF. So, ROX index can help making decision of endotracheal intubation without delay (10). HACOR Score: This score consisted of: heart rate (HR), acidosis (pH), consciousness (Glasgow Coma Scale (GCS)), oxygenation (PaO₂/FiO₂), and RR (11). The HACOR score was recorded at one hour, 12 hours, and 24 hours following the application of CPAP or HVNI. An elevated HACOR score, measured one hour after the NIV initiation, is accompanied by increased probability of intubation and mortality and may be an indicator of switching to IMV after non-invasive mechanical ventilation (NIV) failure(12). Outcome Measures Primary outcome: Requirement for to invasive mechanical ventilation (IMV) within 28 days of initiating CPAP or HVNI, secondary outcome: Mortality within 28 days of initiating CPAP or HVNI. Statistical methods Statistical analysis was conducted using SPSS v26 (IBM Inc., Chicago, IL, USA). Quantitative variables were expressed as mean±SD and compared using the unpaired t-test, while qualitative variables were analyzed using the Chi-square or Fisher’s exact test. Multivariate regression was used to assess relationships between variables. Diagnostic performance was assessed through sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Sensitivity identified patients requiring to IMV and/or mortality within 28 days, while specificity determined those who did not. Receiver Operating Characteristic (ROC) curve was utilized to evaluate diagnostic accuracy, with area under the curve (AUC) values >0.5 indicating acceptable performance, >0.7 good, >0.8 strong, and 1.0 representing perfect prediction. AUC values below 0.5 indicated poor model performance, and p ≤ 0.05 was considered statistically significant. Results In this study, 188 cases were evaluated for eligibility, of whom 70 didn’t meet the inclusion criteria and 10 declined participations. The remaining 108 cases were haphazardly assigned into two equal groups (54 patients each). Group 1 received HVNI, while Group 2 received CPAP (Fig 1). The basal characteristics of the studied groups showed non-significant differences in age (P = 0.783), sex distribution (P = 0.111) and smoking status (P = 0.909). Both groups were comparable to each other as regards hypertension, renal diseases, hepatic diseases ,cardiac diseases ,respiratory diseases, oncological diseases, and thyroid diseases frequencies. However, diabetes mellitus was significantly less frequent in the HVNI group (18.52%) compared to the CPAP group (40.74%) (P = 0.011). Regarding symptoms on presentation, dry cough was significantly more common in the HVNI group (48.15%) than in the CPAP group (22.22%) (P = 0.005), whereas expectoration was significantly decreased in the HVNI group (48.15%) than in the CPAP group (74.07%) (P = 0.006). Other symptoms, including shortness of breath , sore throat , smell and taste affection , fever, fatigue , bone ache and diarrhea were not significantly different between both groups ( Table 1). Table 1: Baseline characteristics of the studied subjects Characteristic HVNI Group (n=54) CPAP Group (n=54) P-value Age (years) Mean±SD 57.63 ± 15.87 58.41 ± 13.32 0.783 Range 21 – 82 24 – 87 Sex Male 24 (44.44%) 16 (29.63%) Female 30 (55.56%) 38 (70.37%) 0.111 Smoking Status Smoker 16 (29.63%) 14 (25.93%) Ex-smoker 4 (7.41%) 4 (7.41%) 0.909 Non-smoker 34 (62.96%) 36 (66.67%) Comorbidities Diabetes 10 (18.52%) 22 (40.74%) 0.011* HTN 22 (40.74%) 26 (48.15%) 0.439 Renal Comorbidity 2 (3.7%) 0 (0%) 0.153 Hepatic Comorbidity 4 (7.41%) 2 (3.7%) 0.401 Cardiac Comorbidity 4 (7.41%) 16 (29.63%) 0.133 Respiratory Comorbidity 4 (7.41%) 4 (7.41%) 1.00 Oncological Comorbidity 2 (3.7%) 2 (3.7%) 1.00 Thyroid Comorbidity 4 (7.41%) 6 (11.11%) 0.507 Symptoms on Presentation Dry Cough 26 (48.15%) 12 (22.22%) 0.005* Expectoration 26 (48.15%) 40 (74.07%) 0.006* Shortness of Breath 54 (100%) 54 (100%) 1.00 Sore Throat 18 (33.33%) 24 (44.44%) 0.236 Smell and Taste Affection 14 (25.93%) 18 (33.33%) 0.296 Fever 54 (100%) 54 (100%) 1.00 Fatigue 44 (81.48%) 44 (81.48%) 0.808 Bone Ache 38 (70.37%) 42 (77.78%) 0.515 Diarrhea 14 (25.93%) 14 (25.93%) 0.824 HVNI: High-Velocity Nasal Insufflation, CPAP: Continuous Positive Airway Pressure, SD: Standard Deviation, HTN: Hypertension, BA: Bronchial Asthma, n: Number, *: Statically significant as P ≤ 0.05. Systolic blood pressure (SBP) was significantly diminished in the HVNI group compared with the CPAP group (P = 0.049). Additionally, platelet count (P = 0.014) was significantly decreased in the HVNI group compared to the CPAP group. Other parameters, including pulse rate, diastolic blood pressure, Glasgow Coma Scale (GCS), SpO₂/FiO₂ ratio, and respiratory rate (RR ), showed no significant differences between both groups. Similarly, hemoglobin , white blood cell count , lymphocyte count , C-Reactive Protein (CRP), pH , PaCO₂ , and bicarbonate, did not differ significantly between the HVNI and CPAP groups. Table 2 Table 2: Clinical and laboratory parameters at baseline Parameter HVNI Group (n=54) CPAP Group (n=54) P-value Pulse Rate (beats/min) 101.33 ± 16.15 106.93 ± 18.66 0.099 Range 60 – 128 75 – 170 SBP (mmHg) 120 ± 14.79 125.93 ± 16.08 0.049* Range 100 – 160 100 – 160 DBP (mmHg) 75.56 ± 10.4 77.78 ± 10.76 0.278 Range 60 – 90 60 – 100 GCS Fully Conscious Fully Conscious 1.00 SpO2/FiO2 Ratio 125.67 ± 27.49 124.61 ± 24.21 0.831 Range 91 – 194 93.68 – 165 Respiratory Rate (RR) (breaths/min) 34.11 ± 4.65 33.33 ± 4.34 0.371 Range 28 – 46 26 – 40 Hemoglobin (g/dL) 12.15 ± 2.12 12.53 ± 1.61 0.299 Range 8.1 – 17 8.8 - 15.1 WBCs (k/uL) 11.05 ± 8.87 10.97 ± 5.61 0.953 Range 1.25 – 50 4.4 – 27 Lymphocytes (k/uL) 1.42 ± 1.35 1.24 ± 0.94 0.417 Range 0.09 - 6.3 0.09 - 3.8 Platelets (k/uL) 183.56 ± 84.68 233.27 ± 117.31 0.014* Range 35 – 372 48 – 523 CRP (mg/L) 98.44 ± 82.6 119.35 ± 88.89 0.212 Range 6 – 322 3 – 383 PH 7.45 ± 0.05 7.44 ± 0.04 0.302 Range 7.35 - 7.56 7.35 - 7.57 PaCO2 (mmHg) 34.01 ± 5.17 34.69 ± 4.65 0.480 Range 22.5 – 44 25 - 43.5 HCO3 (mmol/L) 23.87 ± 3.17 23.72 ± 3.02 0.795 Range 18 – 31 17.3 – 30 HVNI: High-Velocity Nasal Insufflation, CPAP: Continuous Positive Airway Pressure, SBP: Systolic Blood Pressure, DBP: Diastolic Blood Pressure, GCS: Glasgow Coma Scale, SpO₂/FiO₂ Ratio: Ratio of Peripheral Oxygen Saturation to Fraction of Inspired Oxygen, RR: Respiratory Rate, ROX Index: Respiratory Rate-Oxygenation Index, WBCs: White Blood Cells (k/uL), CRP: C-Reactive Protein (mg/L), PaCO₂: Partial Pressure of Carbon Dioxide (mmHg), HCO₃: Bicarbonate (mmol/L). All assessed respiratory parameters, including SpO₂/FiO₂ ratio, respiratory rate, ROX index, and HACOR score at baseline, 12 hours, and 24 hours, showed no significant differences between the HVNI and CPAP groups. Specifically, SpO₂/FiO₂ ratio (P = 0.831 at baseline, P = 0.783 at 12 hours, P = 0.642 at 24 hours), respiratory rate (P = 0.371 at baseline, P = 0.370 at 12 hours, P = 0.583 at 24 hours), ROX index (P = 0.724 at baseline, P = 0.561 at 12 hours, P = 0.670 at 24 hours), and HACOR score (P = 0.324 at 1 hour, P = 0.957 at 12 hours, P = 0.245 at 24 hours) did not differ significantly between both groups. Table 3 Table 3: Respiratory parameters and HACOR score over time Parameter HVNI Group (n=54) CPAP Group (n=54) P-value SpO2/FiO2 Ratio Baseline 125.67 ± 27.49 124.61 ± 24.21 0.831 12 h 131.97 ± 44.97 129.9 ± 30.55 0.783 24 h 131.18 ± 46.98 135.03 ± 36.65 0.642 Respiratory Rate (breaths/min) Baseline 34.11 ± 4.65 33.33 ± 4.34 0.371 12 h 28.26 ± 4.75 29.08 ± 4.6 0.370 24 h 27.92 ± 4.64 28.46 ± 5.3 0.583 ROX Index Baseline 3.77 ± 1.02 3.84 ± 1.05 0.724 12 h 4.9 ± 2.15 4.68 ± 1.67 0.561 24 h 4.89 ± 2.09 5.07 ± 2.18 0.670 HACOR Score 1 h 6.22 ± 1.72 5.85 ± 2.14 0.324 12 h 5.37 ± 2.17 5.35 ± 2.49 0.957 24 h 5.58 ± 1.94 5.08 ± 2.39 0.245 HVNI: High-Velocity Nasal Insufflation, CPAP: Continuous Positive Airway Pressure, SpO₂/FiO₂ Ratio: Ratio of Peripheral Oxygen Saturation to Fraction of Inspired Oxygen, ROX Index: Respiratory Rate-Oxygenation Index, HACOR Score: Heart Rate, Acidosis (pH), Consciousness (GCS), Oxygenation (PaO₂/FiO₂), and Respiratory Rate Score, n: Number. The need for IMV and mortality rates weren’t significantly different between the HVNI and CPAP groups (P = 0.700 for both). On the other hand, within subgroup analysis, all cases in the HVNI failure subgroup required IMV and experienced mortality, whereas none of the HVNI success subgroup required IMV or died (P = 0.001 for both). Similarly, all patients in the CPAP failure subgroup required IMV and experienced mortality, while none of the CPAP success subgroup required IMV or died (P = 0.001 for both). Table 4 Table 4: Study outcomes and comparison between groups and subgroups Outcome HVNI Group (n=54) CPAP Group (n=54) P-value Need for IMV 28 (51.85%) 30 (55.56%) 0.700 No IMV 26 (48.15%) 24 (44.44%) Mortality 28 (51.85%) 30 (55.56%) 0.700 Outcome HVNI Success (n=26) HVNI Failure (n=28) P-value Need for IMV 0 28 (100%) 0.001* Mortality 0 28 (100%) 0.001* Outcome CPAP Success (n=24) CPAP Failure (n=30) P-value Need for IMV 0 30 (100%) 0.001* Mortality 0 30 (100%) 0.001* HVNI: High-Velocity Nasal Insufflation, CPAP: Continuous Positive Airway Pressure, IMV: Invasive Mechanical Ventilation, n: Number, *: Statically significant as P ≤ 0.05. The predictive power of the ROX index and HACOR score was assessed for both HVNI and CPAP failure. In the HVNI group, the ROX index at baseline (≤3.84) demonstrated a sensitivity of 71.43% and specificity of 69.23% (AUC = 0.714), while at 12 hours (≤4.2), the sensitivity increased to 92.86% with a specificity of 84.62% (AUC = 0.934). At 24 hours, the ROX index (≤4.2) retained high specificity (83.33%) and sensitivity (78.57%) (AUC = 0.875). The HACOR score in the HVNI group at 1 hour (>6) showed moderate sensitivity (57.14%) and high specificity (84.62%) (AUC = 0.706). At 12 hours (>5), it had 100% sensitivity and 69.23% specificity (AUC = 0.923), while at 24 hours (>5), it retained 100% sensitivity with 66.67% specificity (AUC = 0.905). Table 5 In the CPAP group, the ROX index at baseline (≤3.53) had a sensitivity of 73.33% and specificity of 83.33% (AUC = 0.833), while at 12 hours (≤4.11), the sensitivity was 85.71% and specificity was 91.67% (AUC = 0.952). At 24 hours (≤3.68), the ROX index showed 71.43% sensitivity and 100% specificity (AUC = 0.940). The HACOR score at 1 hour (>6) demonstrated 80% sensitivity and 100% specificity (AUC = 0.975). At 12 hours (>4), it reached 100% sensitivity and 66% specificity (AUC = 0.940), while at 24 hours (>5), it had a sensitivity of 92.86% and specificity of 75.0% (AUC = 0.926). Table 5 Table 5: Predictive power of ROX Index and HACOR score for failure Time Cut-off Sensitivity Specificity PPV NPV AUC ROX Index (HVNI) Baseline ≤3.84 71.43% 69.23% 71.4% 69.2% 0.714 12 h ≤4.2 92.86% 84.62% 86.7% 91.7% 0.934 24 h ≤4.2 78.57% 83.33% 84.6% 76.9% 0.875 HACOR Score (HVNI) 1 h >6 57.14% 84.62% 80% 64.7% 0.706 12 h >5 100% 69.23% 77.8% 100% 0.923 24 h >5 100% 66.67% 77.8% 100% 0.905 ROX Index (CPAP) Baseline ≤3.53 73.33% 83.33% 84.6% 71.4% 0.833 12 h ≤4.11 85.71% 91.67% 92.3% 84.6% 0.952 24 h ≤3.68 71.43% 100% 100% 75.0% 0.940 HACOR Score (CPAP) 1 h >6 80.0% 100% 100% 80.0% 0.975 12 h >4 100% 66% 77.8% 100% 0.940 24 h >5 92.86% 75.0% 81.2% 90.0% 0.926 HVNI: High-Velocity Nasal Insufflation, CPAP: Continuous Positive Airway Pressure, ROX Index: Respiratory Rate-Oxygenation Index, HACOR Score: Heart Rate, Acidosis (pH), Consciousness (Glasgow Coma Scale), Oxygenation (PaO₂/FiO₂), and Respiratory Rate Score, PPV: Positive Predictive Value, NPV: Negative Predictive Value, AUC: Area Under the Curve. Discussion This study included 108 patients with COVID 19 pneumonia with AHRF. The participants were divided into two equal groups: the HVNI group and the CPAP group. Each group was further stratified into success and failure subgroups: HVNI success (n=26), HVNI failure (n=28), CPAP success (n=24), and CPAP failure (n=30). In our study, age and sex distribution weren’t significantly different between the HVNI and CPAP groups. Our findings align with Mirunalini et al. (13), who conducted a RCT on 100 cases with COVID-19 pneumonia and acute respiratory distress syndrome (ARDS), randomly allocating them to HFNC or CPAP groups. They found no significant differences in age and sex between the two groups. Similarly, Nair et al. (14) conducted a randomised, controlled prospective trial comprising 109 cases with severe COVID-19 pneumonia, with 55 participants in the HFNC group and 54 in the NIV group. They also reported non-significant differences in age and sex distribution between both groups. Conversely, Duan et al. (15) found that age was significantly lower in the NIV group compared to the HFNC group, and the percentage of male patients was significantly diminished in the HFNC group compared to the NIV group. In our study, comorbidities, including HTN, renal, hepatic, cardiac, respiratory, oncological, and thyroid diseases, as well as presenting symptoms which include shortness of breath, sore throat, anosmia, fever, fatigue, bone pain, and diarrhea, weren’t significantly different between the HVNI and CPAP groups. However, DM and expectoration were significantly decreased in the HVNI group, while dry cough was significantly increased in the HVNI group compared to the CPAP group. Abd El Aziz et al. (16) recorded similar findings in a prospective RCT on 60 ARF cases receiving either NIV or HVNI. They found no significant differences in comorbidities which include HTN, cardiac diseases, chronic kidney failure, and chronic hepatic failure between the two groups. In our study, SBP was significantly decreased in the HVNI group compared with the CPAP group at baseline. However, baseline SpO₂/FiO₂ ratio, RR, pulse rate, DBP, and GCS revealed non-significant differences between both groups. Similarly, RR and SpO₂/FiO₂ ratio at 12 and 24 hours weren’t significantly different between the groups. Similarly, Nair et al. (14) recorded no significant differences in SBP, RR, and HR at baseline between the HFNC and NIV groups. Regarding laboratory parameters, hemoglobin (HGB), WBC count, lymphocytes, CRP, pH, PaCO₂, and HCO₃ weren’t significantly different between both groups. However, platelet count level were significantly lower in the HVNI group than in the CPAP group. These findings align with those of Abd El Aziz et al. (16), who also reported non-significant differences in pH, PaCO₂, and HCO₃ between the HVNI and NIV groups. The ROX index at baseline, 12 hours, and 24 hours and the HACOR score at one hour, 12 hours, and 24 hours weren’t significantly different between both groups. Furthermore, the need for IMV and 28-day mortality rates was comparable between the HVNI and CPAP groups. Another study conducted by Buendía et al. (17) assessed the efficacy and safety of CPAP versus HFNC in acute bronchiolitis and displayed non-significant differences in the risk of IMV or mortality between the two interventions. Similarly, da Silva Costa et al. (18) reported that IMV and mortality rates weren’t significantly different between NIV and HFNC groups. The ROX index demonstrated strong predictive value for HVNI failure, with an AUC of 0.714 at baseline (cut-off ≤3.84), 0.934 at 12 hours (cut-off ≤4.2), and 0.875 at 24 hours (cut-off ≤4.2). The HACOR score at 1 hour (cut-off >6, AUC = 0.706), 12 hours (cut-off >5, AUC = 0.923), and 24 hours (cut-off >5, AUC = 0.905) also significantly predicted HVNI failure. Likewise, Ferrer et al. (19) demonstrated that the ROX index at 12 and 24 hours could reliably predict HFNC failure. Similarly, the ROX index and HACOR score significantly predicted CPAP failure, with an AUC of 0.833 at baseline (cut-off ≤3.53), 0.952 at 12 hours (cut-off ≤4.11), and 0.940 at 24 hours (cut-off ≤3.68). The HACOR score at 1 hour (cut-off >6, AUC = 0.975), 12 hours (cut-off >4, AUC = 0.940), and 24 hours (cut-off >5, AUC = 0.926) also showed strong predictive performance. Our study's limitations comprise a small sample size and being conducted in a single center, which limits the generalizability of our findings. Additionally, the majority of patients were COVID-19 positive due to the study’s location in an Isolation ICU, despite our aim to include all pneumonic cases and AHRF. Firm infection control measures and the utilization of personal protective equipment posed operational challenges. The high admission rate in the ER and ICU, along with patient agitation or weak peripheral pulses, sometimes made ABG sampling difficult. Consequently, venous blood gas samples were utilized, preventing reliance on the PaO2/FiO2 (P/F) ratio at presentation. However, we mitigated this by using the SpO2/FiO2 (S/F) ratio as an alternative for oxygenation assessment. Conclusions HVNI was as effective as CPAP in managing COVID 19 pneumonic cases with acute type 1 respiratory failure. The ROX index and HACOR score provided strong predictive value for treatment failure, enabling early intervention to prevent IMV Declarations Ethical Approval Written informed consents were obtained from all subjects. Data confidentialities were warranted. The study was approved by Institutional Research Board (IRB) at faculty of medicine Mansoura University, code number: MS.21.08.1614 Conflict of interest: None. Author Contribution Mohamed M El gamel , Asem Hewidy , Magda A Ahmed and Eman AA Ali wrote the main manuscript. Khalid M ELsherbiny collecting Data,data analysis. All authors reviewed the manuscript. References Doshi P, Whittle JS, Bublewicz M, Kearney J, Ashe T, Graham R, et al. High-Velocity Nasal Insufflation in the Treatment of Respiratory Failure: A Randomized Clinical Trial. Ann Emerg Med. 2018;72(1):73-83.e5. Aliberti S, Radovanovic D, Billi F, et al. Helmet CPAP treatment in patients with COVID-19 pneumonia: a multicentre cohort study. Eur Respir J 2020;56:2001935. Colaianni-Alfonso N, Montiel GC, Castro-Sayat M, Roca O, Grieco DL. ROX index to predict CPAP outcome in hypoxemic respiratory failure due to COVID-19. Intensive Care Med. 2022;48(12):1818-9. Esmond G, Mikelsons C. 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Comparison of High Flow Nasal Cannula and Continuous Positive Airway Pressure in COVID-19 Patients With Acute Respiratory Distress Syndrome in Critical Care Unit: A Randomized Control Study. Cureus. 2023;15(9):e45798. Nair PR, Haritha D, Behera S, Kayina CA, Maitra S, Anand RK, et al. Comparison of High-Flow Nasal Cannula and Noninvasive Ventilation in Acute Hypoxemic Respiratory Failure Due to Severe COVID-19 Pneumonia. Respir Care. 2021;66(12):1824-30. Duan J, Chen B, Liu X, Shu W, Zhao W, Li J, et al. Use of high-flow nasal cannula and noninvasive ventilation in patients with COVID-19: A multicenter observational study. Am J Emerg Med. 2021;46:276-81. Abd El Aziz AA, Abdelaal GA, Gasad HR, Tawadros BB. High velocity nasal insufflation versus non-invasive ventilation in acute respiratory failure: a comparative study. The Egyptian Journal of Chest Diseases and Tuberculosis. 2024;73(2):161-8. Buendía JA, Feliciano-Alfonso JE, Laverde MF. Systematic review and meta-analysis of efficacy and safety of continuous positive airways pressure versus high flow oxygen cannula in acute bronchiolitis. BMC Pediatr. 2022;22(1):696. da Silva Costa WN, Miguel JP, dos Santos Prado F, de Mello Lula LHS, Amarante GAJ, Righetti RF, et al. Noninvasive ventilation and high-flow nasal cannula in patients with acute hypoxemic respiratory failure by covid-19: A retrospective study of the feasibility, safety and outcomes. Respiratory Physiology & Neurobiology. 2022;298:103842. Ferrer S, Sancho J, Bocigas I, Bures E, Mora H, Monclou E, et al. ROX index as predictor of high flow nasal cannula therapy success in acute respiratory failure due to SARS-CoV-2. Respir Med. 2021;189:106638. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 28 Jan, 2026 Reviews received at journal 11 Jan, 2026 Reviews received at journal 04 Jan, 2026 Reviewers agreed at journal 02 Jan, 2026 Reviewers agreed at journal 02 Jan, 2026 Reviews received at journal 17 Dec, 2025 Reviewers agreed at journal 08 Dec, 2025 Reviewers invited by journal 06 Dec, 2025 Editor assigned by journal 09 Nov, 2025 Submission checks completed at journal 09 Nov, 2025 First submitted to journal 05 Nov, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8041794","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":556851475,"identity":"9b035a19-af79-42cb-b231-6c8462ca3992","order_by":0,"name":"Mohamed M Elgamal","email":"","orcid":"","institution":"Mansoura University","correspondingAuthor":false,"prefix":"","firstName":"Mohamed","middleName":"M","lastName":"Elgamal","suffix":""},{"id":556851476,"identity":"e0cb8d74-eab3-4e99-b6d6-0a649803174e","order_by":1,"name":"Khalid M El-Sherbiny","email":"","orcid":"","institution":"Mansoura 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1","display":"","copyAsset":false,"role":"figure","size":345094,"visible":true,"origin":"","legend":"\u003cp\u003eFlowchart of the studied cases.\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8041794/v1/d500c95cc872f1d8988fb27b.jpeg"},{"id":98444752,"identity":"60900fd6-6370-49f0-98ec-a8cd703a2b81","added_by":"auto","created_at":"2025-12-17 17:17:17","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1387052,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8041794/v1/bae8f02e-078e-4531-977a-fbefb42944e2.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"High Velocity Nasal Insufflation versus Continuous Positive Airway Pressure in COVID 19 Pneumonic Patients with Acute Type 1 Respiratory Failure","fulltext":[{"header":"Introduction","content":"\u003cp\u003eAcute respiratory failure (ARF) is a frequent cause of emergency department visits, necessitating various respiratory support plans, comprising oxygen therapy, non-invasive positive-pressure ventilation (NIV), and mechanical ventilation. (1). COVID 19 Pneumonia can cause acute respiratory failure and need non-invasive respiratory support with positive end-expiratory pressure (PEEP)(2).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eContinuous positive airway pressure (CPAP) is a non-invasive modality which should be the first choice in managing respiratory failure due to COVID 19 pneumonia by improving oxygenation and reducing the work of breathing(2\u0026amp;3). By delivering a continuous positive pressure, CPAP helps maintain airway patency, reducing the risk of intubation and ICU admission (3). However, CPAP adherence can be limited by discomfort due to high pressure, claustrophobia, poor mask fit, nasal irritation, and mucosal injury (4)\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eHVNI, a specialized form of HFNC, initially used in neonatal care, has gained increasing attention in adults as a high-flow oxygen therapy delivering humidified and warmed oxygen at high velocities. It offers several physiological advantages over conventional oxygen therapy, including enhanced positive airway pressure, reduced anatomic dead space, washing out CO₂ between breaths and improved work \u0026nbsp;of breathing (5\u0026amp;6). Additionally, HVNI provides a mild to moderate PEEP effect, which is flow-dependent and contributes to improved oxygenation and secretion clearance (7).\u003c/p\u003e\n\u003cp\u003eGiven the increasing usage of non-invasive respiratory support care, HVNI has been recommended as a possible substitute to CPAP for managing ARF. This study aimed to compare the efficiency of HVNI and CPAP in COVID-19 pneumonic cases with acute type 1 respiratory failure.\u0026nbsp;\u003c/p\u003e"},{"header":"Patients and methods","content":"\u003cp\u003e\u003cstrong\u003eSettings and Duration\u003c/strong\u003e: This randomised controlled trial (RCT) was conducted at at the Chest Medicine Department (Isolation Building), Mansoura University Hospitals between February 2021 and February 2022.\u003c/p\u003e\n\u003cp\u003eInclusion criteria:\u0026nbsp;Cases aged above 18 years with COVID 19 pneumonia with type 1 ARF were included.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eExclusion criteria\u003c/strong\u003e\u003cstrong\u003e:\u003c/strong\u003e Cases with hypercapnic respiratory failure, cases with a disturbed conscious level and/or a high risk of aspiration, individuals with hypotension, and cases needing IMV.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePatient selection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 188 patients were assessed for eligibility, of whom 70 didn\u0026rsquo;t match the inclusion criteria and 10 declined participations. The remaining 108 cases were haphazardly assigned into two equal groups (54 patients each) using computer-generated numbers, with allocation codes concealed in sealed, opaque envelopes. \u003cstrong\u003eGroup 1\u003c/strong\u003e received HVNI, while \u003cstrong\u003eGroup 2\u003c/strong\u003e received CPAP Fig. 1\u003c/p\u003e\n\u003cp\u003eAll patients were subjected to the followings:\u003c/p\u003e\n\u003cp\u003eAll patients underwent a comprehensive clinical evaluation, laboratory workup, radiological investigation and two clinical assessment tools (ROX Index and HACOR Score). The clinical evaluation included presenting symptoms, demographic data, comorbidities and complete physical examination. Laboratory investigations included a complete blood count, C-Reactive Protein (CRP),liver function tests, kidney function tests, serial arterial blood gas analysis (ABG). Additionally, all patients underwent RT-PCR testing for COVID-19 via a nasopharyngeal swab. Radiological investigations included a chest X-ray upon admission and daily thereafter, as well as high-resolution computed tomography (HRCT) of the chest upon admission and after one week, if available. The two clinical assessment indices were used to predict treatment success or failure were ROX Index and HACOR Score.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eROX Index:\u003c/strong\u003e described as the ratio of pulse oximetry (SpO2)/fraction of inspired oxygen (FiO2) to respiratory rate (RR) (8). It was calculated with the next formula: ROX index = (SpO2/FiO2) /RR. This index was assessed at initiation, 12 hours, and 24 hours after device application to assess response to therapy and potential need for mechanical ventilation (9). ROX index is a simple, non-invasive bedside modality that helps expect the success of HFNC in cases with AHRF (8).\u003c/p\u003e\n\u003cp\u003eHigher values are indicative of better lung function and gas exchange, signifying a more favorable prognosis while on HFNC therapy. A ROX index \u0026ge; 4.88 following twelve hours of HFNC initiation has been accompanied by a minimal risk of intubation. In contrast, a ROX index below this level suggests a higher likelihood that the patient will not\u003cu\u003e\u0026nbsp;\u003c/u\u003erespond adequately to HFNC and may thus require endotracheal intubation (9).ROX index also, had an excellent predicting power of CPAP failure after 24h with cut-off point \u0026lt;6.64 in patients with COVID-19 and AHRF. So, ROX index can help making decision of endotracheal intubation without delay (10).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHACOR Score:\u003c/strong\u003e This score consisted of: heart rate (HR), acidosis (pH), consciousness (Glasgow Coma Scale (GCS)), oxygenation (PaO₂/FiO₂), and RR (11). The HACOR score was recorded at one hour, 12 hours, and 24 hours following the application of CPAP or HVNI. An elevated HACOR score, measured one hour after the NIV initiation, is accompanied by increased probability of intubation and mortality and \u0026nbsp;may be an indicator of switching to IMV after non-invasive mechanical ventilation (NIV) failure(12). \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOutcome Measures\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePrimary outcome: Requirement for to invasive mechanical ventilation (IMV) within 28 days of initiating CPAP or HVNI, secondary outcome: Mortality within 28 days of initiating CPAP or HVNI.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical methods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStatistical analysis was conducted using SPSS v26 (IBM Inc., Chicago, IL, USA). Quantitative variables were expressed as mean\u0026plusmn;SD and compared using the unpaired t-test, while qualitative variables were analyzed using the Chi-square or Fisher\u0026rsquo;s exact test. Multivariate regression was used to assess relationships between variables. Diagnostic performance was assessed through sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Sensitivity identified patients requiring to IMV and/or mortality within 28 days, while specificity determined those who did not. Receiver Operating Characteristic (ROC) curve was utilized to evaluate diagnostic accuracy, with area under the curve (AUC) values \u0026gt;0.5 indicating acceptable performance, \u0026gt;0.7 good, \u0026gt;0.8 strong, and 1.0 representing perfect prediction. AUC values below 0.5 indicated poor model performance, and p \u0026le; 0.05 was considered statistically significant.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eIn this study, 188 cases were evaluated for eligibility, of whom 70 didn\u0026rsquo;t meet the inclusion criteria and 10 declined participations. The remaining 108 cases were haphazardly assigned into two equal groups (54 patients each). Group 1 received HVNI, while Group 2 received CPAP (Fig 1).\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe basal characteristics of the studied groups showed non-significant differences in age (P = 0.783), sex distribution (P = 0.111) and smoking status (P = 0.909). Both groups were comparable to each other as regards hypertension, renal diseases, hepatic diseases ,cardiac diseases ,respiratory diseases, oncological diseases, and thyroid diseases frequencies. However, diabetes mellitus was significantly less frequent in the HVNI group (18.52%) compared to the CPAP group (40.74%) (P = 0.011). Regarding symptoms on presentation, dry cough was significantly more common in the HVNI group (48.15%) than in the CPAP group (22.22%) (P = 0.005), whereas expectoration was significantly decreased in the HVNI group (48.15%) than in the CPAP group (74.07%) (P = 0.006). Other symptoms, including shortness of breath , sore throat , smell and taste affection , fever, fatigue , bone ache and diarrhea were not significantly different between both groups (\u003cstrong\u003eTable 1).\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable 1: Baseline characteristics of the studied subjects\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristic\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHVNI Group\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n=54)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCPAP Group\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n=54)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge (years)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\u0026nbsp;\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\u0026nbsp;\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\u0026nbsp;\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003eMean\u0026plusmn;SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e57.63 \u0026plusmn; 15.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e58.41 \u0026plusmn; 13.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e0.783\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003eRange\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e21 \u0026ndash; 82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e24 \u0026ndash; 87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\u0026nbsp;\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\u0026nbsp;\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e24 (44.44%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e16 (29.63%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e30 (55.56%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e38 (70.37%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e0.111\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSmoking Status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\u0026nbsp;\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\u0026nbsp;\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\u0026nbsp;\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003eSmoker\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e16 (29.63%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e14 (25.93%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\u0026nbsp;\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003eEx-smoker\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e4 (7.41%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e4 (7.41%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e0.909\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003eNon-smoker\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e34 (62.96%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e36 (66.67%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\u0026nbsp;\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eComorbidities\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\u0026nbsp;\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\u0026nbsp;\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\u0026nbsp;\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e\u0026nbsp;Diabetes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e10 (18.52%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e22 (40.74%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e0.011*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e\u0026nbsp;HTN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e22 (40.74%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e26 (48.15%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e0.439\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003eRenal Comorbidity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e2 (3.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e0.153\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003eHepatic Comorbidity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e4 (7.41%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e2 (3.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e0.401\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003eCardiac Comorbidity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e4 (7.41%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e16 (29.63%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e0.133\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003eRespiratory Comorbidity\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e4 (7.41%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e4 (7.41%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003eOncological Comorbidity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e2 (3.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e2 (3.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003eThyroid Comorbidity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e4 (7.41%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e6 (11.11%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e0.507\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSymptoms on Presentation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\u0026nbsp;\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\u0026nbsp;\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\u0026nbsp;\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003eDry Cough\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e26 (48.15%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e12 (22.22%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e0.005*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003eExpectoration\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e26 (48.15%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e40 (74.07%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e0.006*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003eShortness of Breath\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e54 (100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e54 (100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003eSore Throat\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e18 (33.33%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e24 (44.44%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e0.236\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003eSmell and Taste Affection\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e14 (25.93%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e18 (33.33%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e0.296\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003eFever\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e54 (100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e54 (100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003eFatigue\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e44 (81.48%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e44 (81.48%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e0.808\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003eBone Ache\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e38 (70.37%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e42 (77.78%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e0.515\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003eDiarrhea\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e14 (25.93%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e14 (25.93%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e0.824\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eHVNI: High-Velocity Nasal Insufflation, CPAP: Continuous Positive Airway Pressure, SD: Standard Deviation, HTN: Hypertension, BA: Bronchial Asthma, n: Number, *: Statically significant as P \u0026le; 0.05.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSystolic blood pressure (SBP) was significantly diminished in the HVNI group compared with the CPAP group (P = 0.049). Additionally, platelet count (P = 0.014) was significantly decreased in the HVNI group compared to the CPAP group. Other parameters, including pulse rate, diastolic blood pressure, Glasgow Coma Scale (GCS), SpO₂/FiO₂ ratio, and respiratory rate (RR ), showed no significant differences between both groups. Similarly, hemoglobin , white blood cell count , lymphocyte count , C-Reactive Protein (CRP), pH , PaCO₂ , and bicarbonate, did not differ significantly between the HVNI and CPAP groups. \u003cstrong\u003eTable 2\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable 2: Clinical and laboratory parameters at baseline\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eParameter\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHVNI Group\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n=54)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCPAP Group\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n=54)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\u0026nbsp;\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\u0026nbsp;\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\u0026nbsp;\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\u0026nbsp;\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePulse Rate (beats/min)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e101.33 \u0026plusmn; 16.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e106.93 \u0026plusmn; 18.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e0.099\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRange\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e60 \u0026ndash; 128\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e75 \u0026ndash; 170\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\u0026nbsp;\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSBP (mmHg)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e120 \u0026plusmn; 14.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e125.93 \u0026plusmn; 16.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e0.049*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRange\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e100 \u0026ndash; 160\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e100 \u0026ndash; 160\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\u0026nbsp;\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDBP (mmHg)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e75.56 \u0026plusmn; 10.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e77.78 \u0026plusmn; 10.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e0.278\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRange\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e60 \u0026ndash; 90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e60 \u0026ndash; 100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\u0026nbsp;\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGCS\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003eFully Conscious\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003eFully Conscious\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSpO2/FiO2 Ratio\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e125.67 \u0026plusmn; 27.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e124.61 \u0026plusmn; 24.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e0.831\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRange\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e91 \u0026ndash; 194\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e93.68 \u0026ndash; 165\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\u0026nbsp;\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRespiratory Rate (RR) (breaths/min)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e34.11 \u0026plusmn; 4.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e33.33 \u0026plusmn; 4.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e0.371\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRange\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e28 \u0026ndash; 46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e26 \u0026ndash; 40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\u0026nbsp;\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\u0026nbsp;\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\u0026nbsp;\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\u0026nbsp;\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\u0026nbsp;\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHemoglobin (g/dL)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e12.15 \u0026plusmn; 2.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e12.53 \u0026plusmn; 1.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e0.299\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRange\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e8.1 \u0026ndash; 17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e8.8 - 15.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\u0026nbsp;\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;WBCs (k/uL)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e11.05 \u0026plusmn; 8.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e10.97 \u0026plusmn; 5.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e0.953\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRange\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e1.25 \u0026ndash; 50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e4.4 \u0026ndash; 27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\u0026nbsp;\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLymphocytes (k/uL)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e1.42 \u0026plusmn; 1.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e1.24 \u0026plusmn; 0.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e0.417\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRange\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e0.09 - 6.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e0.09 - 3.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\u0026nbsp;\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePlatelets (k/uL)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e183.56 \u0026plusmn; 84.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e233.27 \u0026plusmn; 117.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e0.014*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRange\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e35 \u0026ndash; 372\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e48 \u0026ndash; 523\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\u0026nbsp;\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;CRP (mg/L)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e98.44 \u0026plusmn; 82.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e119.35 \u0026plusmn; 88.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e0.212\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRange\u003c/strong\u003e\u003c/p\u003e\u0026nbsp;\u0026nbsp;\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e6 \u0026ndash; 322\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e3 \u0026ndash; 383\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\u0026nbsp;\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePH\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; 7.45 \u0026plusmn; 0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;7.44 \u0026plusmn; 0.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 0.302\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRange\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e7.35 - 7.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e7.35 - 7.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\u0026nbsp;\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePaCO2 (mmHg)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e34.01 \u0026plusmn; 5.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e34.69 \u0026plusmn; 4.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e0.480\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRange\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e22.5 \u0026ndash; 44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e25 - 43.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\u0026nbsp;\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHCO3 (mmol/L)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e23.87 \u0026plusmn; 3.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e23.72 \u0026plusmn; 3.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e0.795\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRange\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e18 \u0026ndash; 31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e17.3 \u0026ndash; 30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\u0026nbsp;\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eHVNI: High-Velocity Nasal Insufflation, CPAP: Continuous Positive Airway Pressure, SBP: Systolic Blood Pressure, DBP: Diastolic Blood Pressure, GCS: Glasgow Coma Scale, SpO₂/FiO₂ Ratio: Ratio of Peripheral Oxygen Saturation to Fraction of Inspired Oxygen, RR: Respiratory Rate, ROX Index: Respiratory Rate-Oxygenation Index, WBCs: White Blood Cells (k/uL), CRP: C-Reactive Protein (mg/L), PaCO₂: Partial Pressure of Carbon Dioxide (mmHg), HCO₃: Bicarbonate (mmol/L).\u003c/p\u003e\n\u003cp\u003eAll assessed respiratory parameters, including SpO₂/FiO₂ ratio, respiratory rate, ROX index, and HACOR score at baseline, 12 hours, and 24 hours, showed no significant differences between the HVNI and CPAP groups. Specifically, SpO₂/FiO₂ ratio (P = 0.831 at baseline, P = 0.783 at 12 hours, P = 0.642 at 24 hours), respiratory rate (P = 0.371 at baseline, P = 0.370 at 12 hours, P = 0.583 at 24 hours), ROX index (P = 0.724 at baseline, P = 0.561 at 12 hours, P = 0.670 at 24 hours), and HACOR score (P = 0.324 at 1 hour, P = 0.957 at 12 hours, P = 0.245 at 24 hours) did not differ significantly between both groups. \u003cstrong\u003eTable 3\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable 3: Respiratory parameters and HACOR score over time\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eParameter\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHVNI Group (n=54)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCPAP Group (n=54)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSpO2/FiO2 Ratio\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003eBaseline\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e125.67 \u0026plusmn; 27.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e124.61 \u0026plusmn; 24.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e0.831\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e12 h\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e131.97 \u0026plusmn; 44.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e129.9 \u0026plusmn; 30.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e0.783\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e24 h\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e131.18 \u0026plusmn; 46.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e135.03 \u0026plusmn; 36.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e0.642\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRespiratory Rate\u0026nbsp;\u003c/strong\u003e(breaths/min)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003eBaseline\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e34.11 \u0026plusmn; 4.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e33.33 \u0026plusmn; 4.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e0.371\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e12 h\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e28.26 \u0026plusmn; 4.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e29.08 \u0026plusmn; 4.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e0.370\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e24 h\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e27.92 \u0026plusmn; 4.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e28.46 \u0026plusmn; 5.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e0.583\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eROX Index\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003eBaseline\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e3.77 \u0026plusmn; 1.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e3.84 \u0026plusmn; 1.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e0.724\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e12 h\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e4.9 \u0026plusmn; 2.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e4.68 \u0026plusmn; 1.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e0.561\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e24 h\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e4.89 \u0026plusmn; 2.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e5.07 \u0026plusmn; 2.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e0.670\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHACOR Score\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e1 h\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e6.22 \u0026plusmn; 1.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e5.85 \u0026plusmn; 2.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e0.324\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e12 h\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e5.37 \u0026plusmn; 2.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e5.35 \u0026plusmn; 2.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e0.957\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e24 h\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e5.58 \u0026plusmn; 1.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e5.08 \u0026plusmn; 2.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e0.245\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eHVNI: High-Velocity Nasal Insufflation, CPAP: Continuous Positive Airway Pressure, SpO₂/FiO₂ Ratio: Ratio of Peripheral Oxygen Saturation to Fraction of Inspired Oxygen, ROX Index: Respiratory Rate-Oxygenation Index, HACOR Score: Heart Rate, Acidosis (pH), Consciousness (GCS), Oxygenation (PaO₂/FiO₂), and Respiratory Rate Score, n: Number.\u003c/p\u003e\n\u003cp\u003eThe need for IMV and mortality rates weren\u0026rsquo;t significantly different between the HVNI and CPAP groups (P = 0.700 for both). On the other hand, within subgroup analysis, all cases in the HVNI failure subgroup required IMV and experienced mortality, whereas none of the HVNI success subgroup required IMV or died (P = 0.001 for both). Similarly, all patients in the CPAP failure subgroup required IMV and experienced mortality, while none of the CPAP success subgroup required IMV or died (P = 0.001 for both). \u003cstrong\u003eTable 4\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 4: Study outcomes and comparison between groups and subgroups\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003eOutcome\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003eHVNI Group\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003e(n=54)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003eCPAP Group\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003e(n=54)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003eP-value\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003eNeed for IMV\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e28 (51.85%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e30 (55.56%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e0.700\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003eNo IMV\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e26 (48.15%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e24 (44.44%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003eMortality\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e28 (51.85%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e30 (55.56%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e0.700\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003eOutcome\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003eHVNI Success (n=26)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003eHVNI Failure (n=28)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003eP-value\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003eNeed for IMV\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e28 (100%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e0.001*\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003eMortality\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e28 (100%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e0.001*\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003eOutcome\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003eCPAP Success (n=24)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003eCPAP Failure\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003e(n=30)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003eP-value\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003eNeed for IMV\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e30 (100%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e0.001*\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003eMortality\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e30 (100%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e0.001*\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eHVNI: High-Velocity Nasal Insufflation, CPAP: Continuous Positive Airway Pressure, IMV: Invasive Mechanical Ventilation, n: Number, *: Statically significant as P \u0026le; 0.05.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe predictive power of the ROX index and HACOR score was assessed for both HVNI and CPAP failure. In the HVNI group, the ROX index at baseline (\u0026le;3.84) demonstrated a sensitivity of 71.43% and specificity of 69.23% (AUC = 0.714), while at 12 hours (\u0026le;4.2), the sensitivity increased to 92.86% with a specificity of 84.62% (AUC = 0.934). At 24 hours, the ROX index (\u0026le;4.2) retained high specificity (83.33%) and sensitivity (78.57%) (AUC = 0.875). The HACOR score in the HVNI group at 1 hour (\u0026gt;6) showed moderate sensitivity (57.14%) and high specificity (84.62%) (AUC = 0.706). At 12 hours (\u0026gt;5), it had 100% sensitivity and 69.23% specificity (AUC = 0.923), while at 24 hours (\u0026gt;5), it retained 100% sensitivity with 66.67% specificity (AUC = 0.905). \u003cstrong\u003eTable 5\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn the CPAP group, the ROX index at baseline (\u0026le;3.53) had a sensitivity of 73.33% and specificity of 83.33% (AUC = 0.833), while at 12 hours (\u0026le;4.11), the sensitivity was 85.71% and specificity was 91.67% (AUC = 0.952). At 24 hours (\u0026le;3.68), the ROX index showed 71.43% sensitivity and 100% specificity (AUC = 0.940). The HACOR score at 1 hour (\u0026gt;6) demonstrated 80% sensitivity and 100% specificity (AUC = 0.975). At 12 hours (\u0026gt;4), it reached 100% sensitivity and 66% specificity (AUC = 0.940), while at 24 hours (\u0026gt;5), it had a sensitivity of 92.86% and specificity of 75.0% (AUC = 0.926). \u003cstrong\u003eTable 5\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable 5: Predictive power of ROX Index and HACOR score for failure\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003eTime\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003eCut-off\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003eSensitivity\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003eSpecificity\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003ePPV\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003eNPV\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003eAUC\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003eROX Index (HVNI)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003eBaseline\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e\u0026le;3.84\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e71.43%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e69.23%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e71.4%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e69.2%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e0.714\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e12 h\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e\u0026le;4.2\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e92.86%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e84.62%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e86.7%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e91.7%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e0.934\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e24 h\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e\u0026le;4.2\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e78.57%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e83.33%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e84.6%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e76.9%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e0.875\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003eHACOR Score (HVNI)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e1 h\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e\u0026gt;6\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e57.14%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e84.62%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e80%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e64.7%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e0.706\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e12 h\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e\u0026gt;5\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e100%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e69.23%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e77.8%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e100%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e0.923\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e24 h\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e\u0026gt;5\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e100%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e66.67%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e77.8%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e100%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e0.905\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003eROX Index (CPAP)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003eBaseline\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e\u0026le;3.53\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e73.33%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e83.33%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e84.6%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e71.4%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e0.833\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e12 h\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e\u0026le;4.11\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e85.71%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e91.67%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e92.3%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e84.6%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e0.952\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e24 h\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e\u0026le;3.68\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e71.43%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e100%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e100%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e75.0%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e0.940\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003eHACOR Score (CPAP)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e1 h\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e\u0026gt;6\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e80.0%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e100%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e100%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e80.0%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e0.975\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e12 h\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e\u0026gt;4\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e100%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e66%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e77.8%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e100%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e0.940\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e24 h\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e\u0026gt;5\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e92.86%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e75.0%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e81.2%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e90.0%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e0.926\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eHVNI: High-Velocity Nasal Insufflation, CPAP: Continuous Positive Airway Pressure, ROX Index: Respiratory Rate-Oxygenation Index, HACOR Score: Heart Rate, Acidosis (pH), Consciousness (Glasgow Coma Scale), Oxygenation (PaO₂/FiO₂), and Respiratory Rate Score, PPV: Positive Predictive Value, NPV: Negative Predictive Value, AUC: Area Under the Curve.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study included 108 patients with COVID 19 pneumonia with AHRF. The participants were divided into two equal groups: the HVNI group and the CPAP group. Each group was further stratified into success and failure subgroups: HVNI success (n=26), HVNI failure (n=28), CPAP success (n=24), and CPAP failure (n=30).\u003c/p\u003e\n\u003cp\u003eIn our study, age and sex distribution weren\u0026rsquo;t significantly different between the HVNI and CPAP groups. Our findings align with Mirunalini et al. (13), who conducted a RCT on 100 cases with COVID-19 pneumonia and acute respiratory distress syndrome (ARDS), randomly allocating them to HFNC or CPAP groups. They found no significant differences in age and sex between the two groups.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Similarly, Nair et al. (14) conducted a randomised, controlled prospective trial comprising 109 cases with severe COVID-19 pneumonia, with 55 participants in the HFNC group and 54 in the NIV group. They also reported non-significant differences in age and sex distribution between both groups. Conversely, Duan et al. (15) found that age was significantly lower in the NIV group compared to the HFNC group, and the percentage of male patients was significantly diminished in the HFNC group compared to the NIV group.\u003c/p\u003e\n\u003cp\u003eIn our study, comorbidities, including HTN, renal, hepatic, cardiac, respiratory, oncological, and thyroid diseases, as well as presenting symptoms which include shortness of breath, sore throat, anosmia, fever, fatigue, bone pain, and diarrhea, weren\u0026rsquo;t significantly different between the HVNI and CPAP groups. However, DM and expectoration were significantly decreased in the HVNI group, while dry cough was significantly increased in the HVNI group compared to the CPAP group. Abd El Aziz et al. (16) recorded similar findings in a prospective RCT on 60 ARF cases receiving either NIV or HVNI. They found no significant differences in comorbidities which include HTN, cardiac diseases, chronic kidney failure, and chronic hepatic failure between the two groups.\u003c/p\u003e\n\u003cp\u003eIn our study, SBP was significantly decreased in the HVNI group compared with the CPAP group at baseline. However, baseline SpO₂/FiO₂ ratio, RR, pulse rate, DBP, and GCS revealed non-significant differences between both groups. Similarly, RR and SpO₂/FiO₂ ratio at 12 and 24 hours weren\u0026rsquo;t significantly different between the groups. Similarly, Nair et al. (14) recorded no significant differences in SBP, RR, and HR at baseline between the HFNC and NIV groups.\u003c/p\u003e\n\u003cp\u003eRegarding laboratory parameters, hemoglobin (HGB), WBC count, lymphocytes, CRP, pH, PaCO₂, and HCO₃ weren\u0026rsquo;t significantly different between both groups. However, platelet count \u0026nbsp;level were significantly lower in the HVNI group than in the CPAP group. These findings align with those of Abd El Aziz et al. (16), who also reported non-significant differences in pH, PaCO₂, and HCO₃ between the HVNI and NIV groups.\u003c/p\u003e\n\u003cp\u003eThe ROX index at baseline, 12 hours, and 24 hours and the HACOR score at one hour, 12 hours, and 24 hours weren\u0026rsquo;t significantly different between both groups. Furthermore, the need for IMV and 28-day mortality rates was comparable between the HVNI and CPAP groups. Another study conducted by Buend\u0026iacute;a et al. (17) assessed the efficacy and safety of CPAP versus HFNC in acute bronchiolitis and displayed non-significant differences in the risk of IMV or mortality between the two interventions. Similarly, da Silva Costa et al. (18) reported that IMV and mortality rates weren\u0026rsquo;t significantly different between NIV and HFNC groups.\u003c/p\u003e\n\u003cp\u003eThe ROX index demonstrated strong predictive value for HVNI failure, with an AUC of 0.714 at baseline (cut-off \u0026le;3.84), 0.934 at 12 hours (cut-off \u0026le;4.2), and 0.875 at 24 hours (cut-off \u0026le;4.2). The HACOR score at 1 hour (cut-off \u0026gt;6, AUC = 0.706), 12 hours (cut-off \u0026gt;5, AUC = 0.923), and 24 hours (cut-off \u0026gt;5, AUC = 0.905) also significantly predicted HVNI failure. Likewise, Ferrer et al. (19) demonstrated that the ROX index at 12 and 24 hours could reliably predict HFNC failure.\u003c/p\u003e\n\u003cp\u003eSimilarly, the ROX index and HACOR score significantly predicted CPAP failure, with an AUC of 0.833 at baseline (cut-off \u0026le;3.53), 0.952 at 12 hours (cut-off \u0026le;4.11), and 0.940 at 24 hours (cut-off \u0026le;3.68). The HACOR score at 1 hour (cut-off \u0026gt;6, AUC = 0.975), 12 hours (cut-off \u0026gt;4, AUC = 0.940), and 24 hours (cut-off \u0026gt;5, AUC = 0.926) also showed strong predictive performance.\u003c/p\u003e\n\u003cp\u003eOur study\u0026apos;s limitations comprise a small sample size and being conducted in a single center, which limits the generalizability of our findings. Additionally, the majority of patients were COVID-19 positive due to the study\u0026rsquo;s location in an Isolation ICU, despite our aim to include all pneumonic cases and AHRF. Firm infection control measures and the utilization of personal protective equipment posed operational challenges. The high admission rate in the ER and ICU, along with patient agitation or weak peripheral pulses, sometimes made ABG sampling difficult. Consequently, venous blood gas samples were utilized, preventing reliance on the PaO2/FiO2 (P/F) ratio at presentation. However, we mitigated this by using the SpO2/FiO2 (S/F) ratio as an alternative for oxygenation assessment.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eHVNI was as effective as CPAP in managing COVID 19 pneumonic cases with acute type 1 respiratory failure. The ROX index and HACOR score provided strong predictive value for treatment failure, enabling early intervention to prevent IMV\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eEthical Approval\u003c/h2\u003e\n\u003cp\u003eWritten informed consents were obtained from all subjects. Data confidentialities were warranted. The study was approved by Institutional Research Board (IRB) at faculty of medicine Mansoura University, code number: MS.21.08.1614\u003c/p\u003e\n\u003ch2\u003eConflict of interest:\u003c/h2\u003e\n\u003cp\u003eNone.\u003c/p\u003e\n\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\n\u003cp\u003eMohamed M El gamel , Asem Hewidy , Magda A Ahmed and Eman AA Ali wrote the main manuscript. Khalid M ELsherbiny collecting Data,data analysis. All authors reviewed the manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eDoshi P, Whittle JS, Bublewicz M, Kearney J, Ashe T, Graham R, et al. High-Velocity Nasal Insufflation in the Treatment of Respiratory Failure: A Randomized Clinical Trial. Ann Emerg Med. 2018;72(1):73-83.e5.\u003c/li\u003e\n\u003cli\u003eAliberti S, Radovanovic D, Billi F, et al. Helmet CPAP treatment in patients with COVID-19 pneumonia: a multicentre cohort study. Eur Respir J 2020;56:2001935. \u003c/li\u003e\n\u003cli\u003eColaianni-Alfonso N, Montiel GC, Castro-Sayat M, Roca O, Grieco DL. ROX index to predict CPAP outcome in hypoxemic respiratory failure due to COVID-19. Intensive Care Med. 2022;48(12):1818-9.\u003c/li\u003e\n\u003cli\u003eEsmond G, Mikelsons C. Non-invasive Respiratory Support Techniques: Oxygen Therapy, Non-invasive Ventilation and CPAP: John Wiley \u0026amp; Sons; 2009. \u003c/li\u003e\n\u003cli\u003eDysart K, Miller TL, Wolfson MR, Shaffer TH. Research in high flow therapy: mechanisms of action. Respir Med. 2009;103(10):1400-5.\u003c/li\u003e\n\u003cli\u003eDoshi PB, Whittle JS, Dungan G, 2nd, Volakis LI, Bublewicz M, Kearney J, et al. The ventilatory effect of high velocity nasal insufflation compared to non-invasive positive-pressure ventilation in the treatment of hypercapneic respiratory failure: A subgroup analysis. Heart Lung. 2020;49(5):610-5. \u003c/li\u003e\n\u003cli\u003eParke RL, McGuinness SP. Pressures delivered by nasal high flow oxygen during all phases of the respiratory cycle. Respir Care. 2013;58(10):1621-4. \u003c/li\u003e\n\u003cli\u003eRoca O, Messika J, Caralt B, Garc\u0026iacute;a-de-Acilu M, Sztrymf B, Ricard JD, et al. Predicting success of high-flow nasal cannula in pneumonia patients with hypoxemic respiratory failure: The utility of the ROX index. J Crit Care. 2016;35:200-5. \u003c/li\u003e\n\u003cli\u003eValencia, C. F., Lucero, O. D., Castro, O. C., Sanko, A. A., \u0026amp; Olejua, P. A. Comparison of ROX and HACOR scales to predict high-flow nasal cannula failure in patients with SARS-CoV-2 pneumonia. Scientific Reports.2021; 11(1), 22559.\u003c/li\u003e\n\u003cli\u003eColaianni-Alfonso, N., Montiel, G. C., Castro-Sayat, M., Roca, O., \u0026amp; Grieco, D. L.ROX index to predict CPAP outcome in hypoxemic respiratory failure due to COVID-19. Intensive Care Medicine. 2022; 48(12),1818-1819.\u003c/li\u003e\n\u003cli\u003eGrassi A, Foti G, Laffey JG, Bellani G. Noninvasive mechanical ventilation in early acute respiratory distress syndrome. Pol Arch Intern Med. 2017;127(9):614-20. \u003c/li\u003e\n\u003cli\u003eMannarino, M. R., Bianconi, V., Cosentini, E., Figorilli, F., Natali, C, et al. The HACOR score predicts worse in-hospital prognosis inpatients hospitalized with COVID-19. Journal of Clinical Medicine 2022; 11(12), 3509.\u003c/li\u003e\n\u003cli\u003eMirunalini G, Anand K, Pushparani A, Kadirvelu G. Comparison of High Flow Nasal Cannula and Continuous Positive Airway Pressure in COVID-19 Patients With Acute Respiratory Distress Syndrome in Critical Care Unit: A Randomized Control Study. Cureus. 2023;15(9):e45798. \u003c/li\u003e\n\u003cli\u003eNair PR, Haritha D, Behera S, Kayina CA, Maitra S, Anand RK, et al. Comparison of High-Flow Nasal Cannula and Noninvasive Ventilation in Acute Hypoxemic Respiratory Failure Due to Severe COVID-19 Pneumonia. Respir Care. 2021;66(12):1824-30. \u003c/li\u003e\n\u003cli\u003eDuan J, Chen B, Liu X, Shu W, Zhao W, Li J, et al. Use of high-flow nasal cannula and noninvasive ventilation in patients with COVID-19: A multicenter observational study. Am J Emerg Med. 2021;46:276-81. \u003c/li\u003e\n\u003cli\u003eAbd El Aziz AA, Abdelaal GA, Gasad HR, Tawadros BB. High velocity nasal insufflation versus non-invasive ventilation in acute respiratory failure: a comparative study. The Egyptian Journal of Chest Diseases and Tuberculosis. 2024;73(2):161-8.\u003c/li\u003e\n\u003cli\u003eBuend\u0026iacute;a JA, Feliciano-Alfonso JE, Laverde MF. Systematic review and meta-analysis of efficacy and safety of continuous positive airways pressure versus high flow oxygen cannula in acute bronchiolitis. BMC Pediatr. 2022;22(1):696.\u003c/li\u003e\n\u003cli\u003eda Silva Costa WN, Miguel JP, dos Santos Prado F, de Mello Lula LHS, Amarante GAJ, Righetti RF, et al. Noninvasive ventilation and high-flow nasal cannula in patients with acute hypoxemic respiratory failure by covid-19: A retrospective study of the feasibility, safety and outcomes. Respiratory Physiology \u0026amp; Neurobiology. 2022;298:103842.\u003c/li\u003e\n\u003cli\u003eFerrer S, Sancho J, Bocigas I, Bures E, Mora H, Monclou E, et al. ROX index as predictor of high flow nasal cannula therapy success in acute respiratory failure due to SARS-CoV-2. Respir Med. 2021;189:106638. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"the-egyptian-journal-of-bronchology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [The Egyptian Journal of Bronchology](https://ejb.springeropen.com/)","snPcode":"43168","submissionUrl":"https://submission.nature.com/new-submission/43168/3","title":"The Egyptian Journal of Bronchology","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Open","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"High-Velocity Nasal Insufflation, CPAP, Acute Respiratory Failure, ROX Index, HACOR Score","lastPublishedDoi":"10.21203/rs.3.rs-8041794/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8041794/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eTo compare the efficacy of High-Velocity Nasal Insufflation (HVNI) versus Continuous Positive Airway Pressure (CPAP) in managing COVID 19 pneumonic cases with acute type 1 respiratory failure, focusing on the need for invasive mechanical ventilation (IMV) and 28-day mortality.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA prospective randomised controlled trial (RCT) was conducted on 108 cases with COVID 19 pneumonia with acute hypoxemic respiratory failure (AHRF) at Mansoura University Hospitals. Cases were randomised into two equal groups: HVNI group and CPAP group. Baseline characteristics, respiratory parameters, and clinical outcomes were documented.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eBasal characteristics were comparable between groups with the exception of a higher prevalence of diabetes mellitus in the CPAP group (40.74% vs. 18.52%, P\u0026thinsp;=\u0026thinsp;0.011). The need for IMV (51.85% vs. 55.56%, P\u0026thinsp;=\u0026thinsp;0.700) and 28-day mortality (51.85% vs. 55.56%, P\u0026thinsp;=\u0026thinsp;0.700) didn't significantly vary between groups. The ROX index at 12 hours (cut-off \u0026le;\u0026thinsp;4.2, AUC\u0026thinsp;=\u0026thinsp;0.934, sensitivity 92.86%, specificity 84.62%) and HACOR score at 1 hour (cut-off \u0026gt;\u0026thinsp;6, AUC\u0026thinsp;=\u0026thinsp;0.975, sensitivity 80%, specificity 100%) were strong predictors of treatment failure.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eHVNI was as effective as CPAP in managing pneumonic cases with acute type 1 respiratory failure. The ROX index and HACOR score provided strong predictive value for treatment failure, enabling early intervention to prevent IMV.\u003c/p\u003e","manuscriptTitle":"High Velocity Nasal Insufflation versus Continuous Positive Airway Pressure in COVID 19 Pneumonic Patients with Acute Type 1 Respiratory Failure","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-12 13:20:42","doi":"10.21203/rs.3.rs-8041794/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-01-28T07:57:26+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-11T07:27:44+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-04T19:55:07+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"256857519934585833035827953198449651925","date":"2026-01-02T18:34:08+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"4118164979605868565275195438371228156","date":"2026-01-02T15:38:29+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-17T09:39:04+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"207340779536838200272835228410399604626","date":"2025-12-08T09:27:40+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-12-06T20:47:19+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-11-10T04:02:58+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-11-10T01:58:17+00:00","index":"","fulltext":""},{"type":"submitted","content":"The Egyptian Journal of Bronchology","date":"2025-11-05T21:01:17+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"the-egyptian-journal-of-bronchology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [The Egyptian Journal of Bronchology](https://ejb.springeropen.com/)","snPcode":"43168","submissionUrl":"https://submission.nature.com/new-submission/43168/3","title":"The Egyptian Journal of Bronchology","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Open","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"22b9d79d-6ff7-4df2-971a-a4d7bad18f47","owner":[],"postedDate":"December 12th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-03-23T22:38:10+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-12 13:20:42","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8041794","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8041794","identity":"rs-8041794","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}