Excellent results for high-flow nasal cannula oxygen therapy in acute respiratory failure

In patients with acute hypoxemic respiratory failure, high-flow nasal cannula (HFNC) oxygen therapy was superior to non-invasive ventilation (NIV) in preventing progression to invasive mechanical ventilation. Furthermore, the HFNC technique was very well tolerated by most patients, supporting its use in this population.

Prof. Gamal Agmy (Assiut University, Egypt) and colleagues conducted a randomised clinical trial (NCT03788304) to compare HFNC (n=50) with standard NIV (n=50) in patients who were admitted to the intensive care unit (ICU) with type 1 respiratory failure [1,2]. The primary endpoint was the rate of endotracheal intubation.

Progression to this invasive mechanical ventilation was 50.0% in the NIV arm versus 18.0% in the HFNC arm (P<0.001). The most distinctive causes of progression to mechanical ventilation were retained secretions (48.0% vs 0.0%; P=0.010) and worsening conscious level (12.0% vs 0.0%; P=0.042); both results that favoured the HFNC arm. Importantly, duration of ICU stay (6.0 vs 4.0 days; P=0.001), duration of hospital stay (9.5 vs 7.0 days; P=0.002), and duration of device usage (3.0 vs 2.0 days; P=0.057) were all shorter in the HFNC arm compared with the NIV arm. Prof. Agmy pointed out that HFNC was extremely well tolerated by most patients and that complications such as nasal bridge ulceration (48.0% vs 0%), leak (84.0% vs 0%), asynchrony (74.0% vs 0%), claustrophobia (40.0% vs 0%), retained secretions (32.0% vs 0%), and facial laceration (32.0% vs 0%) were only observed in the NIV arm. Finally, survival rates (52.0% vs 82.0%) displayed a substantial advantage for patients in the HFNC arm over patients in the NIV arm.

Prof. Agmy concluded that these results add to the growing body of evidence that HFNC oxygen therapy is better tolerated than NIV and is associated with lower mortality rates and lower rates of treatment failure. “HFNC is a more physiological technique. The delivery of heated, humidified oxygen at high-flow rates leads to a number of positive effects on the airways and respiratory function, potentially changing the management for patients with acute and chronic respiratory failure.”

1. Agmy G, et al. High-flow nasal cannula versus noninvasive ventilation in the prevention of escalation to invasive mechanical ventilation in patients with acute hypoxemic respiratory failure. ALERT 1, RCT715, ERS International Congress 2022, Barcelona, Spain, 4‒6 September.
2. Agmy G, et al. Egypt J Chest Dis Tuberc. 2022;71(1);81.

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Posted on 30 October, 2022