High-Flow Nasal Cannula Versus Noninvasive Ventilation as Initial Treatment in Acute Hypoxia: A Propensity Score-Matched Study-Reference-Cited by-同舟云学术

High-Flow Nasal Cannula Versus Noninvasive Ventilation as Initial Treatment in Acute Hypoxia: A Propensity Score-Matched Study

Published:2024-05 Issue:5 Volume:6 Page:e1092
ISSN:2639-8028
Container-title:Critical Care Explorations
language:en
Short-container-title:

Author:

Munroe Elizabeth S.¹,Prevalska Ina²,Hyer Madison³,Meurer William J.²,Mosier Jarrod M.⁴⁵,Tidswell Mark A.⁶,Prescott Hallie C.¹⁷,Wei Lai³,Wang Henry⁸,Fung Christopher M.²

Affiliation:

1. Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Michigan, Ann Arbor, MI.

2. Department of Emergency Medicine, University of Michigan, Ann Arbor, MI.

3. Center for Biostatistics, Ohio State University, Columbus, OH.

4. Department of Emergency Medicine, University of Arizona College of Medicine, Tucson, AZ.

5. Division of Pulmonary, Allergy, Critical Care and Sleep, Department of Medicine, University of Arizona College of Medicine, Tucson, AZ.

6. Division of Pulmonary and Critical Care, Department of Medicine, University of Massachusetts Chan Medical School—Baystate Medical Center, Springfield, MA.

7. VA Center for Clinical Management Research, Ann Arbor, MI.

8. Department of Emergency Medicine, Ohio State University, Columbus, OH.

Abstract

IMPORTANCE: Patients presenting to the emergency department (ED) with hypoxemia often have mixed or uncertain causes of respiratory failure. The optimal treatment for such patients is unclear. Both high-flow nasal cannula (HFNC) and noninvasive ventilation (NIV) are used. OBJECTIVES: We sought to compare the effectiveness of initial treatment with HFNC versus NIV for acute hypoxemic respiratory failure. DESIGN, SETTING, AND PARTICIPANTS: We conducted a retrospective cohort study of patients with acute hypoxemic respiratory failure treated with HFNC or NIV within 24 hours of arrival to the University of Michigan adult ED from January 2018 to December 2022. We matched patients 1:1 using a propensity score for odds of receiving NIV. MAIN OUTCOMES AND MEASURES: The primary outcome was major adverse pulmonary events (28-d mortality, ventilator-free days, noninvasive respiratory support hours) calculated using a win ratio. RESULTS: A total of 1154 patients were included. Seven hundred twenty-six (62.9%) received HFNC and 428 (37.1%) received NIV. We propensity score matched 668 of 1154 (57.9%) patients. Patients on NIV versus HFNC had lower 28-day mortality (16.5% vs. 23.4%, p = 0.033) and required noninvasive treatment for fewer hours (median 7.5 vs. 13.5, p < 0.001), but had no difference in ventilator-free days (median [interquartile range]: 28 [26, 28] vs. 28 [10.5, 28], p = 0.199). Win ratio for composite major adverse pulmonary events favored NIV (1.38; 95% CI, 1.15–1.65; p < 0.001). CONCLUSIONS AND RELEVANCE: In this observational study of patients with acute hypoxemic respiratory failure, initial treatment with NIV compared with HFNC was associated with lower mortality and fewer composite major pulmonary adverse events calculated using a win ratio. These findings underscore the need for randomized controlled trials to further understand the impact of noninvasive respiratory support strategies.

Publisher

Ovid Technologies (Wolters Kluwer Health)

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