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The following is a summary of “High-flow nasal cannula oxygen versus noninvasive ventilation for the management of acute cardiogenic pulmonary edema: a randomized controlled pilot study,” published in the August 2024 issue of Emergency Medicine by Marjanovic et al.
Acute heart failure (AHF) leads to acute respiratory failure. High-flow nasal oxygen and noninvasive ventilation (NIV) are the standard treatment options for AHF. High-flow nasal oxygen has particular effectiveness in improving clinical signs of AHF.
Researchers conducted a retrospective study to compare high-flow oxygen with noninvasive ventilation (NIV) in patients admitted to an ED for AHF-related acute respiratory failure.
They designed the study in 3 French EDs; patients with suspected AHF were included. Critical exclusion criteria for intubation are Glasgow Coma Scale <13 points or hemodynamic instability. Patients were grouped to receive high-flow oxygen (minimum 50 l/min). A linear mixed model was used to analyze the treatment.
The results showed that 145 patients and 60 were analyzed [median age 86 (IQR, 90; 92) years]. The median respiratory rate of 30.5 (IQR, 28; 33) and 29.5 (IQR, 27; 35) breaths/min in the high-flow oxygen and NIV groups respectively, with a median change of −10 (IQR, −12; −8) with high-flow nasal oxygen and −7 (IQR, −11; −5) breaths/min with NIV [estimated difference −2.6 breaths/min (95% CI, −0.5–5.7), P=0.052] at 60 min. A median SpO2of 95 (IQR, 92; 97) and 96 (IQR, 93; 97) in the high-flow oxygen and NIV groups respectively, with a median change at 60 min of 2 (IQR, 0; 5) with high-flow nasal oxygen and 2 (IQR, −1; 5) % with NIV [estimated difference 0.8% (95% CI, −1.1–2.8), P=0.60]. PaO2, PaCO2 and pH, treatment failure, intubation, and mortality rates remain the same within the groups.
They concluded no significant changes in the respiratory rate in patients with acute respiratory failure due to AHF and managed with high-flow oxygen or NIV.
