Oxygenation Strategies May Not Be Most Effective for Treating Acute Hypoxemic Respiratory Failure, Study Finds

High-flow nasal oxygen therapy is often used for treating acute hypoxemic respiratory failure (AHRF). A study that examined mortality among immunocompromised patients with AHRF found that high-flow oxygen therapy did not significantly decrease 28-day mortality compared with standard oxygen therapy.

The study enrolled 776 adult immunocompromised patients with AHRF at 32 intensive care units (ICUs) in France between May 19, 2016, and December 31, 2017. All of the patients were randomized, with 388 patients receiving continuous high-flow oxygen therapy and the other 388 receiving standard oxygen therapy. The researchers’ primary outcome was 28-day mortality, according to the study.

“Survival with immune deficiencies is increasingly common, owing to the increasing life expectancy after cancer and expanding use of transplantation and immunosuppressant drugs. In immunocompromised patients, intensive treatments improve survival but only at the cost of life-threatening events, chiefly affecting the lungs,” the authors explained. “[AHRF] in immunocompromised patients, the first reason for [ICU] admission, is still associated with high mortality rates.”

In total, 776 patients completed the trial of the 778 randomized patients who were enrolled. According to the results, the median respiratory rates were 25 and 26 per minute and ratios of Pao₂:Fio₂ were 150 and 119 in the intervention and control groups, respectively. Furthermore, mortality on day 28 was not significantly different between the 2 groups, and the intubation rate was also not significantly different. As for ICU length of stay, hospital length of stay, and patient comfort and dyspnea scores, there was not a significant difference between the 2 groups observed.

“These results agree with those of 2 post hoc analyses showing no significant clinical benefits from high-flow oxygen therapy compared with standard oxygen therapy in immunocompromised patients with AHRF. Noninvasive ventilation was either neutral or harmful in that population,” noted the authors. “Also, both standard oxygen therapy and high-flow oxygen therapy are valid options in immunocompromised patients with AHRF.”

The authors concluded by suggesting that these results demonstrate that attention to oxygenation strategies may not be the best means of improving survival among immunocompromised patients with AHRF.

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 [published online October 24, 2018]. JAMA. doi: 10.1001/jama.2018.14282.