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

ABSTRACT

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 SpO₂ 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 cmH₂O and PEEP 5 cmH₂O or more to keep SpO₂ 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.

KEYWORDS:

• High flow nasal cannula
• non-invasive ventilation
• immunocompromised
• acute hypoxemic respiratory failure

Acknowledgments

We wish to thank Prof Dr Rafaat Abd El Azim Hammad. Professor of anesthesia and intensive care Ain Shams University for his continuous encouragement and revision of manuscript of this work, ICU staff for their assistance and data collection of this study.

Ethical committee approval number is: (FMASU R 9/2020).

Clinical trial .gov number is: (NCT04293991).

Disclosure statement

No potential conflict of interest was reported by the author(s).