The following is the summary of “High-Flow Nasal Cannula and Standard Oxygen in Acute Hypoxemic Respiratory Failure Due to COVID-19” published in December 2022 issue of Respiratory Care by Gallardo, et al.

The benefits of high-flow nasal cannula (HFNC) use for patients with COVID-19 are debated. The purpose of this study was to compare the frequency of endotracheal intubation at 28 days between participants with acute hypoxemic respiratory failure (AHRF) due to SARS-CoV-2 infection who were treated with HFNC and those who were treated with normal oxygen therapy. Participants with moderate-to-severe AHRF were included in a retrospective, age- and sex-matched paired cohort study. Standard oxygen therapy was used on the control group, while HFNC was used in the intervention group. Results from the analysis of baseline data and clinical development are presented. For categorical variables, researchers utilized the Mantel-Haenszel test. For numerical variables, a Wilcoxon signed-rank test was performed on pairs of data. Conditional multiple logistic regression was used for the multivariate analysis.

The final tally of participants was 84. Between admission and beginning oxygen therapy at FIO2 ≥0.5 or HFNC, the median period was 1 (IQR 0-3) days. Median PaO2/FIO2 was 150.5 (IQR 100.0-170.0) at the time of oxygen therapy progression for the overall sample, and it was lower in the HFNC group compared to the control group (median 135 [IQR 96-162] vs. median 158 [IQR 132-174]; P=.02). At 28 days, 74.2% of those receiving conventional oxygen and 54.8% of those receiving HFNC required endotracheal intubation (unadjusted hazard ratio 0.38 [95% CI 0.13-1.07], P=.069). 

Confounding factors for the association between the intervention group and the outcome were identified in a multivariate analysis, including the presence of dyspnea at hospital admission, the Sequential Organ Failure Assessment score, and the PaO2 /FIO2 at the time of progression of oxygen therapy to FIO2  ≥0.5. After accounting for covariates, the risks of needing endotracheal intubation decreased to (odds ratio 0.26 (95% CI: 0.04-0.51)P=.13) when HFNC was used. After controlling for potential confounding factors, the authors concluded that HFNC therapy for patients with AHRF due to COVID-19 did not independently predict endotracheal intubation when compared with normal oxygen therapy.