Comparison Between High-Flow Nasal Cannula and Noninvasive Ventilation for Acute Hypoxemic Respiratory Failure: A Retrospective Study

Abstract

PURPOSE: To evaluate the impact of high-flow nasal cannula (HFNC) on patients with acute hypoxemic respiratory failure (AHRF) when compared to noninvasive mechanical ventilation (NIV). METHODS: We conducted a retrospective single-center study of patients with AHRF admitted in the Intensive Care Unit (ICU) who performed HFNC or NIV. The primary outcomes included mortality during ICU stay and 90-day mortality. The need for invasive mechanical ventilation (IMV) and ICU length of stay were defined as secondary outcomes. RESULTS: A total of 101 patients were included in the study (NIV 82; HFNC 19). Mortality during ICU stay (NIV 19.5% versus HFNC 0%; p=0.037) and need for IMV (NIV 45.1% versus HFNC 15.8%; p=0.018) were significantly lower in the HFNC group. No differences were observed in 90-day mortality or ICU length of stay. In the subgroup analysis, HFNC was associated with a decreased risk of longer ICU stay in the following subgroups: 100<PaO2/FiO2 ratio≤200; 200<PaO2/FiO2 ratio≤300; Pneumonia, Acute respiratory distress syndrome or Other as cause of AHRF. However, in patients with Decompensated heart failure, HFNC was associated with an increased risk of longer ICU stay. CONCLUSION: Among AHRF patients, HFNC was associated with significantly lower mortality during ICU stay and need for IMV.