High-Flow Nasal Oxygen versus Continuous Positive Airway Pressure in patients with hypoxemic acute respiratory failure due to pneumonia

Purpose: No study has ever compared Continuous Positive Airway Pressure (CPAP) and High Flow Nasal Oxygen (HFNO) in adult patients with hypoxemic acute respiratory failure (h-ARF) due to pneumonia. For this reason, our study used a retrospective analysis to assess patients admitted to an IMCU with a diagnosis of hypoxemic acute respiratory failure secondary to pneumonia. The aim was to determine whether CPAP, as compared with HFNO, could reduce the rate of intubation and improve some outcomes.Materials and methods: A retrospective analysis reviewing all patients admitted in our IMCU with a diagnosis of h-ARF and oxygenated by CPAP or HFNO was carried out. The inclusion criteria were: a PaO2/ FiO2 ratio of 300 mmHg or less; a PaCO2 not higher than 45 mmHg; and a diagnosis of pneumonia as the only cause of h-ARF. The study analyzed two groups of patients (CPAP and HFNO), matched for age, SAPS II score, SOFA score, and PaO2/FiO2 ratio before the start of oxygenation by CPAP or HFNO.Main outcomes: The primary outcome was the proportion of patients who required intubation secondary to a failure of treatment by CPAP or HFNO at 28 days. Secondary outcomes were mortality in the IMCU, mortality at 90 days, the length of IMCU and hospital stay, and the duration of HFNO/CPAP treatment. Results: In total, 45 patients were eligible for inclusion in the study, and all were included in the analysis d 18 patients in the CPAP group and 27 in the HFNO group. There was no significant difference in intubation rates between the two groups (OR 0.57, 0.13e2.58, p = 0.47). The rate of IMCU mortality was 17% in the CPAP group and 7% in the HFNO group (OR 2.5, 0.37e16.72, p = 0.34), and the rate of mortality at 90 days was 28% in the CPAP group and 22% in the HFNO group (OR 1.34, 0.34e5.32, p = 0.67). Conclusions: Our analysis showed that CPAP, when compared with HFNO, did not reduce intubation and mortality rates in patients affected by hypoxemic acute respiratory failure due to pneumonia.(c) 2023 Elsevier Ltd. All rights reserved.