Outcome of Early Initiation of High-flow Nasal Oxygen Therapy among Pneumonia Patients Presenting with Acute Hypoxemic Respiratory Failure.

Background: High-flow nasal oxygen (HFNO) therapy is an upcoming and beneficial modality for patients with acute hypoxemic respiratory failure (AHRF).

Objectives: To evaluate whether early use of HFNO in pneumonia patients with AHRF can reduce the need for invasive ventilation.

Patients and methods: In this prospective, randomized controlled trial, 160 patients who fulfilled the criteria were included. The patient's characteristics, sequential organ failure assessment score, and simplified acute physiology score were recorded. Respiratory rate (RR), and oxygenation parameters (PaO₂/FiO₂), and RR-oxygenation index at selected time intervals were collected and analyzed. The primary outcome was the number of patients who needed intubation. Secondary outcomes included length of intensive care unit (ICU) and hospital stay and mortality at day 28.

Results: The rate of intubation was not statistically significant between the two groups 15 vs 18.7%; difference 3.7% [(95% confidence interval (CI): 2.5-5.7%]. In 48-hour time periods, the mean PaO₂/FiO₂ ratio was significantly increased in the HFNO group compared with the non-invasive ventilation (NIV) group. The RRs and heart rate (HR) showed a significant decrease in the HFNO group.The length of ICU and hospital stays was not different between both groups. No significant differences were found in mortality rates between the HFNO and NIV groups 9 (11.2%) and 10 (12.5%), with 1.3% (95% CI: 0.7-3.8%) (p = 0.21). Multivariate analysis demonstrated that low baseline PaO₂/FiO₂, Respiratory rate-oxygenation index (ROX index) ≤ 5.4 measured at 12 hour and high severity scores were independent risk factors for intubation.

Conclusion: Treatment with HFNO did not reduce the need for intubation among patients with pneumonia-induced AHRF, despite the improved PaO₂/FiO₂ observed with HFNO compared with NIV.

Clinical trial no: NCT05809089.

How to cite this article: Magdy DM. Outcome of Early Initiation of High-flow Nasal Oxygen Therapy among Pneumonia Patients Presenting with Acute Hypoxemic Respiratory Failure. Indian J Crit Care Med 2024;28(8):753-759.