As respiratory conditions deteriorate with COVID-19, high flow nasal cannula (HFNC) therapy is often first used as nonintubated ventilation. However, if the respiratory condition continues to deteriorate, it remains unclear whether treatment should be changed to noninvasive ventilation (NIV) or intubation. A 47-year-old man was hospitalized for pneumonia due to COVID-19. After hospitalization, we started HFNC therapy. His respiratory condition worsened, so we changed treatment from HFNC to NIV with dexmedetomidine. Afterwards, his dyspnea, respiratory rate, and oxygenation gradually improved and he could change pronation position himself. On day 14, he transferred from the ICU to the general ward and was discharged on day 21. We found that treatment of exacerbated respiratory failure with COVID-19, even after HFNC treatment, may be able to avoid intubation by using NIV with dexmedetomidine. Moreover, this treatment could reduce the burden on hospital staff as it allowed the patient to change prone position himself.
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