High Flow nasal cannula for prevention of intubation in acute non-hypercapnic hypoxemic respiratory failure in immunocompromised patients, a randomized controlled trial

Abstract

Objectives To compare the outcomes of high flow nasal cannula (HFNC) with non-invasive ventila-tion (NIV) for treatment of acute non-hypercapnic hypoxemic respiratory failure in immunocompro-mised patients. Methods Immunocompromised patients with acute hypoxemic respiratory failure (AHRF) admitted to our university hospital were randomized 1:1 to receive either HFNC or NIV treatment in medical ICU. The primary outcome was the need for intubation and IMV within 48 hours after randomization. Secondary outcomes included ICU, 30-day and hospital mortality. Results During the study period, 19 patients were randomized. Baseline mean respiratory rate was 28.1±4.4/min vs 27.2±5.9 /min and mean P/F ratio was 197.8±66.1 vs 204.5±44.5 in the HFNC and NIV groups, respectively. Median SOFA score was 5 (IQR,3-7) vs 3.5 (IQR,2.75-5.75) and median SAPS II score was 26 in both groups. Causes of AHRF were 61.5% infection and 38.5% non-infection. The need for intubation and IMV within 48 hours after randomization was not significantly different between groups (33.3% vs 20.0%, p = 0.51). Mortality on day 30 was 55.6% vs 40%, p = 0.64). No significant difference was observed in ICU length of stay (2 vs 5.5 days; p = 0.168) or hospital length of stay (18 vs 21 days; p = 0.836). Conclusion Among immunocompromised patients with acute hypoxemic respiratory failure, HFNC did not significantly decrease intubation rate at 48 hour compared with NIV.