High flow nasal cannula versus non- invasive ventilation in prevention of intubation in immunocompromised patient with acute hypoxemic respiratory failure

Background
Acute respiratory failure (ARF) in immunocompromised patients is associated with increased incidence of mortality when endotracheal intubation is used. Early use of high flow nasal cannula (HFNC) or non-invasive ventilation (NIV) may prevent intubation. This prospective randomized controlled study was designed to evaluate the use of HFNC versus NIV in prevention of intubation in immunocompromised patients suffering from ARF.
Methods
After ethical committee’s approval and written informed consent, 76 patients were enrolled in the study, 38 in each group. Patients were randomized into High Flow Nasal Cannula (HFNC) group as they connected to HFNC to keep SpO 92% or more alternating with simple face mask 10–15 L/min, or non-invasive ventilation (NIV) group as they connected to ICU ventilator pressure support 8 cmHO and PEEP 5 cmHO or more to keep SpO 92% or more alternating with simple face mask 10–15 L/min. Tolerance to HFNC or NIV, need for intubation, ICU stay, hospital stay and 28-day mortality rate were documented and compared between the two groups.
Results
Seventy six patients were enrolled, 38 in each group, VAS tolerance was statistically significant higher in HFNC than NIV group 7(6–7) vs 6(5–7), respectively, p value < 0.001. Incidence of intubation was statistically significant lower in HFNC than NIV (31.6% vs 55.3%), respectively, (p value 0.037), however both groups had similar 28-day mortality rate, (p value 0.195).
Conclusion
Use of high flow nasal cannula in immunocompromised patients suffering from ARF has less incidence of endotracheal intubation but same 28-day mortality rate when compared to non-invasive ventilation.