A Randomised Comparative Study of High-Flow Oxygen Through Nasal Cannula and Non-invasive Ventilation in Patients with Acute Hypoxemic Respiratory Failure

Abstract

Introduction: Type 1 or acute hypoxemic respiratory failure(AHRF) is a condition of hypoxemia (PaO2<60 mm of Hg)– insufficient enough to meet the metabolism of the body– thereby requiring ICU admission and use of adequateventilatory support. Studies have not yet been able to confirmwhich out of the high-flow oxygen through nasal cannula(HFNC) and non-invasive ventilation (NIV) is better in managingsuch patients. To compare efficacy and outcome of HFNC andNIV in acute hypoxemic respiratory failure.Materials and Methods: This randomized comparative studyconducted at Critical Care Unit, SRMSIMS, Bareilly fromFebruary 2021 to August 2022, included 99 patients with AHRF(≥ 18 years) randomized to either those who received HFNC(n = 41) or those who received NIV (n = 58). The demographiccharacteristics were noted. The hemodynamic parameters werenoted at baseline, 1 to 2, 12 and 24 hours. The outcomes wereduration of treatment and mortality rate.Results: Compared to NIV group, Mean ± SD of FiO2 (%) atbaseline, 1 to 2, at 6, at 12, and 24 hours in HFNC was 97.46± 0.5, 93.05 ± 3.01, 82.49 ± 3.25, 74.78 ± 3.32, 58.83 ± 5.62respectively, which was significantly lower as compared toNIV (100 ± 0, 94.4 ± 2.11, 83.78 ± 2.88, 76.28 ± 2.93, 60.43 ±3.95, p<0.05). Median (25th–75th percentile) of PaO2/FiO2 atbaseline, at 1 to 2 hours, at 12 hours, at 24 hours in HFNC was156 (153–165), 195 (190–202), 237 (233–242), 266 (260–277)respectively which was significantly lower as compared toNIV 164.5 (157–174), 201.5 (191.25–215), 241 (235.25–245),277.5(262.25–288), respectively (p<0.05). HFNC group had asignificantly lower mean duration of respiratory support (2.37± 1.09 vs. 3.9 ± 2.03 days, P = 0.0002). Total 9 (21.95%) casesexpired in HFNC group as compared to 17 (29.31%) cases inNIV group (p = 0.412).Conclusion: To conclude, the treatment with non-invasiveventilation was better than high-flow nasal oxygen in patients ofAHRF and led to better maintenance of respiratory parameters.Overall, in terms of outcome, both interventions had similarmortality rates. Future studies should be conducted on largerset of the population for verifying the data for providing betteroutcomes to the patients.