High-flow oxygen therapy provides no survival advantage in hypoxemic respiratory failure

Oxygen therapy delivered through a high-flow nasal cannula does not appear to significantly lower mortality compared with standard oxygen therapy in patients with hypoxemic respiratory failure, according to an open-label trial.

Researchers enrolled patients with a ratio of the partial pressure of arterial oxygen to the fraction of inspired oxygen of ≤200, a respiratory rate of >25 breaths per min, and pulmonary infiltrate on chest imaging.

A total of 1,110 patients were randomly allocated to the high-flow-oxygen group (n=556) or the standard-oxygen group (n=554).

The primary outcome of mortality at day 28 did not significantly differ between the high-flow-oxygen and standard-oxygen groups, both at 14.6 percent (difference, −0.05 percentage points, 95 percent confidence interval [CI], −4.21 to 4.10; p=0.98).

At day 28, 42.4 percent of patients in the high-flow-oxygen group and 48.4 percent in the standard-oxygen group required intubation (difference, −5.93 percentage points, 95 percent CI, −11.78 to −0.08).

In terms of safety, serious adverse events such as cardiac arrest or pneumothorax occurred during spontaneous breathing in 2.3 percent of patients in the high-flow-oxygen group and in 1.1 percent of those in the standard-oxygen group.