Since the first wave of COVID-19, different methods for management of COVID-19 ARDS were proposed. Early intubation and mechanical ventilation was performing more than other methods. after several mounths, limitation of equipment in hospitals, made the specialists think of less aggresive methods. NIV was one of suggestion performed before intubation which improve oxygenation of patients. They don't get any sedation and have regular diet. As a result, the need for ICU and ventilator for respiratory support decreases. In this case study, we report a patient that had permanent tracheostomy and hospitalised for COVID-19 ARDS. At first we connected the tracheostomy to a CPAP devise.

Purpose. The COVID-19 pandemic has overwhelmed many healthcare systems. Seasonality is a feature of several infectious diseases. Studies regarding the association of seasonal variations and COVID-19 have shown controversial results. Therefore, we aimed to compare COVID-19 characteristics and survival outcomes between the fourth and fifth waves in Iran, which corresponded to spring and summer, respectively. Methods. This is a retrospective study on the fourth and fifth COVID-19 waves in Iran. One hundred patients from the fourth and 90 patients from the fifth wave were included. Data from the baseline and demographic characteristics, clinical, radiological, and laboratory findings, and hospital outcomes were compared between the fourth and fifth COVID-19 waves in hospitalized patients in Imam Khomeini Hospital Complex, Tehran, Iran. Results. The fifth wave patients were more likely to present with gastrointestinal symptoms than the patients from the fourth wave. Moreover, patients in the fifth wave had lower arterial oxygen saturation on admission (88% vs. 90%; P = 0.026 ), lower levels of WBCs (neutrophils and lymphocytes) (6300.00 vs. 8000.00; P = 0.004 ), and higher percentages of pulmonary involvement in the chest CT scans (50% vs. 40%; P < 0.001 ). Furthermore, these patients had longer hospital stays than their fourth-wave counterparts (7.00 vs. 5.00; P < 0.001 ). Conclusions. Our study indicated that patients in the summer COVID-19 wave were more likely to present with gastrointestinal symptoms. They also experienced a more severe disease in terms of peripheral capillary oxygen saturation, percentages of pulmonary involvement in CT scans, and length of hospital stay.