In immunocompromised patients with acute respiratory failure, does the use of high-flow oxygen therapy decrease mortality?

High-flow oxygen therapy in immunocompromised patients with acute hypoxemic respiratory failure does not reduce deaths nor improve other patient-centered outcomes. (LOE = 1b-)

Azoulay E, Lemiale V, Mokart D, et al. Effect of high-flow nasal oxygen vs. standard oxygen on 28-day mortality in immunocompromised patients with acute respiratory failure: The HIGH randomized clinical trial. JAMA 2018;320(20):2099-2107.  [PMID:30357270]

Randomized controlled trial (nonblinded)

Government

Concealed

Inpatient (ICU only)

In this multicenter French trial, investigators recruited immunocompromised adult patients in the intensive care unit (ICU) with acute hypoxemic respiratory failure who were requiring 6 liters per minute or greater oxygen flow. Using concealed allocation, patients were randomized to receive either high-flow oxygen therapy (n = 389) or standard oxygen therapy (n = 389) during the ICU stay. In the high-flow group, oxygen was initiated via nasal cannula at 50 liters per minute with the flow rate and fraction of inspired oxygen titrated to achieve pulse oximetry of 95% or greater. In the standard group, oxygen was delivered via nasal cannula or mask with the same goal. Patients in the 2 groups had similar baseline characteristics. Cancer was the most common cause of immunosuppression and pneumonia was the most common cause of respiratory failure. In the intention-to-treat analysis, no significant difference was detected in 28-day mortality (35.6% in high-flow group vs 36.1% in standard group; P = .94). The need for mechanical ventilation, comfort and dyspnea scores, number of ICU-acquired infections, and ICU or hospital lengths of stay also did not differ.