WORLD JOURNAL OF ADVANCE
HEALTHCARE RESEARCH

Hussein Mohammedali Hussein*, Wasnan M. Saed Mohsin, Ghazwan Abdulraheem A. Abdulkareem and Esam Shiaa Khudhair

ABSTRACT

Background: Severe COVID-19 pneumonia often results in hypoxemic respiratory failure, particularly in patientswith over 60% lung involvement. While non-invasive ventilation (NIV) offers supportive care without intubation,some patients fail to respond, and either they or their surrogates decline endotracheal intubation. This presents aclinical challenge, as escalating pressure in NIV may risk barotrauma. In response, a novel strategy combiningmandatory ventilator-generated breaths with spontaneous respiratory efforts—termed hybrid ventilation—wasproposed. Aim: To evaluate the efficacy of mandatory-spontaneous hybrid ventilation in improving oxygenationand clinical outcomes in NIV-failure COVID-19 patients who decline intubation. Methods: A prospective,randomized controlled trial was conducted on 100 COVID-19 patients with failed NIV and refusal of intubation.Patients were randomized into two groups: a control group receiving standard NIV and a study group receivinghybrid ventilation (NIV plus 8–10 machine-generated breathing cycles per minute). The primary outcome was theSpO?/FiO? (S/F) ratio measured at baseline, 12 hours, and 24 hours. Secondary outcomes included hemodynamicstability and adverse effects. Results: Both groups had similar baseline characteristics. The study group showedsignificant improvement in the S/F ratio at 12 hours (0.91±0.01 vs. 0.87±0.01, p<0.0001) and 24 hours (0.92±0.05vs. 0.88±0.04, p<0.0001) compared to controls. No adverse hemodynamic effects or complications were observed.Conclusion: Hybrid ventilation significantly improves oxygenation in COVID-19 ICU patients experiencing NIVfailure and declining intubation, offering a safe and effective alternative to invasive ventilation in this criticalsubset of patients.