High-flow nasal cannula versus noninvasive ventilation in the prevention of escalation to invasive mechanical ventilation in patients with acute hypoxemic respiratory failure

Background
High-flow nasal cannula (HFNC) is a device for conveying oxygen therapy. Emerging clinical evidence supports that it may be a compatible alternative for noninvasive ventilation (NIV) in patients with acute hypoxemic respiratory failure (ARF).


Objective
To compare the outcome of NIV versus HFNC oxygen therapy in preventing escalation to invasive mechanical ventilation in patients with ARF.


Patients and methods
A randomized controlled trial was conducted. One hundred consecutive patients who had ARF were allocated randomly to HFNC and NIV groups. The patients’ need for endotracheal intubation, dyspnea score, comfort scores, gasometric, in-hospital mortality, and vital sign parameters were the outcome measures. Patients’ baseline characteristics and the serial changes after HFNC or NIV therapy were measured.


Results
The HFNC group had 18% endotracheal intubation rate and 18% in-hospital mortality versus 50% and 48% for the NIV group (P=0.001). The median values of visual analog scale at 24, 48, 72, and 96 h were lower in the NIV group (P=0.000 for all). The median modified Borg scale at 24, 48, 72, and 96 h was lower in the HFNC group (P=0.00, 0.024, 0.040, and 0.001, respectively). The HFNC group had a significantly lower respiratory rate. Significant differences in baseline vital sign parameters between the NIV and HFNC groups were noticed after 1, 6, 24, and 48 h follow-up.


Conclusion
Delivering oxygen by HFNC is a new and efficient option for treating adults with ARF. HFNC showed a reduced rate of escalation to invasive mechanical ventilation and in-hospital mortality in comparison to NIV.