No mortality benefit with high-flow nasal oxygen in immunocompromised patients with acute hypoxemic respiratory failure

Reference

Azoulay E, Lemiale V, Mokart D, et al. Effect of high-flow nasal oxygen vs. standard oxygen on 28-day mortality in immunocompromised patients with acute respiratory failure: The HIGH randomized clinical trial. JAMA 2018;320(20):2099-2107.

Synopsis

In this multicenter French trial, investigators recruited immunocompromised adult patients in the intensive care unit (ICU) with acute hypoxemic respiratory failure who were requiring 6 liters per minute or greater oxygen flow. Using concealed allocation, patients were randomized to receive either high-flow oxygen therapy (n = 389) or standard oxygen therapy (n = 389) during the ICU stay. In the high-flow group, oxygen was initiated via nasal cannula at 50 liters per minute with the flow rate and fraction of inspired oxygen titrated to achieve pulse oximetry of 95% or greater. In the standard group, oxygen was delivered via nasal cannula or mask with the same goal. Patients in the 2 groups had similar baseline characteristics. Cancer was the most common cause of immunosuppression and pneumonia was the most common cause of respiratory failure. In the intention-to-treat analysis, no significant difference was detected in 28-day mortality (35.6% in high-flow group vs 36.1% in standard group; P = .94). The need for mechanical ventilation, comfort and dyspnea scores, number of ICU-acquired infections, and ICU or hospital lengths of stay also did not differ.