Findings seen for four of five causes of acute respiratory failure
By Lori Solomon HealthDay Reporter
MONDAY, Dec. 16, 2024 (HealthDay News) — High-flow nasal oxygen (HFNO) is noninferior to noninvasive ventilation (NIV) for endotracheal intubation or death within seven days for most patients with acute respiratory failure, according to a study published online Dec. 10 in the Journal of the American Medical Association to coincide with the Critical Care Reviews Down Under meeting, held from Dec. 10 to 11 in Melbourne, Australia.
Israel S. Maia, M.D., Ph.D., from the HCor Research Institute in São Paulo, Brazil, and colleagues assessed whether HFNO is noninferior to NIV on the rates of endotracheal intubation or death at seven days. The researchers randomly assigned 1,766 hospitalized patients with acute respiratory failure (classified into five groups) to HFNO (883 patients) or NIV (883 patients).
The researchers found that the primary outcome of endotracheal intubation or death within seven days occurred in 39 percent in the HFNO group versus 38 percent in the NIV group overall. The primary outcome occurred at the following rates in the immunocompromised patient group with hypoxemia: 57.1 percent in the HFNO group versus 36.4 percent in the NIV group, with enrollment stopped for futility. The corresponding rates were 32.5 versus 33.1 percent in the nonimmunocompromised group with hypoxemia; 10.3 versus 21.3 percent in the acute cardiogenic pulmonary edema group; 51.3 versus 47.0 percent in the hypoxemic COVID-19 group; and 28.6 versus 26.2 percent in the group with chronic obstructive pulmonary disease exacerbation with respiratory acidosis. The incidence of serious adverse events was similar between the groups (HFNO: 9.4 percent; NIV: 9.9 percent).
“The small sample sizes in some patient groups and the sensitivity of the findings to the choice of analysis model suggests the need for further study in patients with chronic obstructive pulmonary disease, immunocompromised patients, and patients with acute cardiogenic pulmonary edema,” the authors write.
One author disclosed ties to Roche Diagnostics, Novartis, and Bayer.
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