Efficacy of non-invasive respiratory therapies in the clinical management of COVID-19

Abstract

Introduction: The COVID-19 pandemic highlighted the need for effective strategies to manage acute respiratory failure. Non-invasive respiratory therapies, such as non-invasive ventilation (CPAP, BiPAP) and high-flow oxygen therapy, emerged as relevant alternatives to invasive mechanical ventilation.

Objective: To analyze the clinical efficacy of non-invasive respiratory therapies in patients with acute respiratory failure secondary to COVID-19, with emphasis on their impact on intubation prevention and clinical outcomes.

Material and Methods: A narrative review of scientific literature published between January 2020 and May 2025 was conducted. Databases including PubMed, Scopus, SciELO, ScienceDirect, as well as institutional repositories specialized in respiratory care and intensive medicine (SCCM, ESICM, ATS, SEMICYUC, ALAT, PAHO), were consulted. DeCS/MeSH descriptors in Spanish and English were used, including “COVID-19,” “respiratory insufficiency,” “non-invasive ventilation,” “high-flow oxygen therapy,” “CPAP,” “BiPAP,” and “ROX index.” From 43 identified studies, 27 articles were selected based on methodological rigor and clinical relevance.

Development: High-flow oxygen therapy and non-invasive respiratory therapies showed benefits in reducing the need for intubation, improving oxygenation, and enhancing patient comfort. Although no conclusive reduction in mortality was demonstrated, early and well-monitored application increased clinical effectiveness. Predictive tools such as the ROX index and respiratory rate proved useful for identifying therapeutic failure.

Conclusions: Non-invasive respiratory therapies are safe and effective strategies for managing COVID-19-related acute respiratory failure, provided they are applied early, within structured protocols, and under strict clinical monitoring.