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 adequate
ventilatory support. Studies have not yet been able to confirm
which out of the high-flow oxygen through nasal cannula
(HFNC) and non-invasive ventilation (NIV) is better in managing
such patients. To compare efficacy and outcome of HFNC and
NIV in acute hypoxemic respiratory failure.
Materials and Methods: This randomized comparative study
conducted at Critical Care Unit, SRMSIMS, Bareilly from
February 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 demographic
characteristics were noted. The hemodynamic parameters were
noted at baseline, 1 to 2, 12 and 24 hours. The outcomes were
duration of treatment and mortality rate.
Results: Compared to NIV group, Mean ± SD of FiO2 (%) at
baseline, 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 ± 5.62
respectively, which was significantly lower as compared to
NIV (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 at
baseline, at 1 to 2 hours, at 12 hours, at 24 hours in HFNC was
156 (153–165), 195 (190–202), 237 (233–242), 266 (260–277)
respectively which was significantly lower as compared to
NIV 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 a
significantly lower mean duration of respiratory support (2.37
± 1.09 vs. 3.9 ± 2.03 days, P = 0.0002). Total 9 (21.95%) cases
expired in HFNC group as compared to 17 (29.31%) cases in
NIV group (p = 0.412).
Conclusion: To conclude, the treatment with non-invasive
ventilation was better than high-flow nasal oxygen in patients of
AHRF and led to better maintenance of respiratory parameters.
Overall, in terms of outcome, both interventions had similar
mortality rates. Future studies should be conducted on larger
set of the population for verifying the data for providing better
outcomes to the patients.