Table 4 Clinical studies on high-flow nasal oxygen (HFNO) therapy in adults with hypoxemic acute respiratory failure (ARF) [44–46]
Reference | Study design | Population | N patients | Results |
|---|---|---|---|---|
Hypoxemic acute respiratory failure in the ICU | ||||
[22] | Cohort, unselected patients. HFNO 50 L/min vs. face-mask oxygen | Hypoxemic ARF | 38 | Improved oxygenation Decreased respiratory rate |
[23] | Cohort, unselected patients. HFNO 20–30 L/min vs. face-mask oxygen | Hypoxemic ARF | 20 | Improved oxygenation Decreases in respiratory/heart rates, dyspnea, respiratory distress, and thoraco-abdominal asynchrony |
[47] | HFNO compared to face-mask oxygen | Hypoxemic ARF | 60 | Decreased treatment failure (defined as need for NIV) from 30% to 10%. Fewer desaturation episodes |
[48] | Cohort study. HFNO 20–30 L/min vs. face-mask oxygen | Hypoxemic ARF | 20 | Improved comfort; improved oxygenation |
[49] | Cohort study (post hoc) | Hypoxemic ARF (2009 A/H1N1v outbreak) | 20 | 9/20 (45%) success (no intubation). All 8 patients on vasopressors required intubation within 24 h. After 6 h of HFNO, non-responders had lower PaO2/FiO2 values and needed higher oxygen flow rates. |
[43] | Observational, single-centre study | ARDS | 45 | 40% intubation rate. HFNO failure associated with higher SAPSII, development of additional organ failure, and trends toward lower PaO2/FiO2 values and higher respiratory rates |
[13] | Multicentre, open-label RCT with 3 groups. HFNO, usual oxygen therapy (face mask), or non-invasive positive-pressure ventilation | Hypoxemic ARF, PaO2/FiO2 ≤ 300 | 310 | Intubation rate was 38% with HFNO, 47% with standard oxygen, and 50% with NIV. The number of ventilator-free days by day 28 was significantly higher with HFNO. Decreased day-90 mortality with HFNO |
[50] | Retrospective before/after study of HFNO | Hypoxemic ARF | 172 | Reduced need for ventilation (100% vs 63%, p < 0.01) and decreased ventilator-free days |
[42] | Patients intubated after HFNO | Hypoxemic ARF | 175 | In patients intubated early, lower mortality (39.2 vs. 66.7%), higher extubation success (37.7% vs. 15.6%) and more ventilator-free days. Early intubation was associated with decreased ICU mortality |
Hypoxemic acute respiratory failure in the ED | ||||
[51] | Patients with ARF (> 9 L/min oxygen or clinical signs of respiratory distress) | Hypoxemic ARF | 17 | Decreased dyspnea and respiratory rate and improved oxygenation |
[52] | RCT of HFNO vs. standard oxygen for 1 h | Hypoxemic ARF | 40 | Decreased dyspnea and improved comfort |