Azoulay E, et al. - In this randomized clinical trial, researchers determined if high-flow oxygen therapy reduces mortality among immunocompromised patients with acute hypoxemic respiratory failure (AHRF) vs standard oxygen therapy. They found that high-flow oxygen therapy did not significantly lower day-28 mortality vs standard oxygen therapy among critically ill immunocompromised patients with acute respiratory failure. In addition, they did not find a significant difference in intensive care unit (ICU) length of stay, ICU-acquired infections, hospital length of stay, or patient comfort and dyspnea scores.

Methods

• Study participants included 776 adult immunocompromised patients with AHRF (Pao₂ < 60 mmHg or Spo₂ < 90% on room air, or tachypnea > 30 per minute or labored breathing or respiratory distress, and need for oxygen ≥ 6 L per minute) at 32 ICUs in France between May 19, 2016, and December 31, 2017.
• Patients were randomized 1:1 to continuous high-flow oxygen therapy (n=388) or to standard oxygen therapy (n=388).
• Day 28 mortality was the primary outcome.
• Intubation and mechanical ventilation by day 28, Pao₂:Fio₂ ratio over the 3 days after intubation, respiratory rate, ICU and hospital lengths of stay, ICU-acquired infections, and patient comfort and dyspnea were included secondary outcomes.

Results

• Of 778 randomized patients (median age, 64 [IQR, 54-71] years; 259 [33.3%] women), 776 (99.7%) completed the trial.
• Median respiratory rate was 33 per minute (IQR, 28-39) vs 32 (IQR, 27-38) and Pao₂:Fio₂ was 136 (IQR, 96-187) vs 128 (IQR, 92-164) in the intervention and control groups, respectively, at randomization.
• It was noted that median SOFA score was 6 (IQR, 4-8) in both groups.
• Mortality on day 28 was not significantly different between groups (35.6% vs 36.1%; difference, -0.5% [95% CI, -7.3% to +6.3%]; hazard ratio, 0.98 [95% CI, 0.77 to 1.24]; P=0.94).
• Researchers found that intubation rate was not significantly different between groups (38.7% vs 43.8%; difference, −5.1% [95% CI, −12.3% to +2.0%]).
• Patients randomized to high-flow oxygen therapy had a higher Pao₂:Fio₂ (150 vs 119; difference, 19.5 [95% CI, 4.4 to 34.6]) and lower respiratory rate after 6 hours (25 per minute vs 26 per minute; difference, −1.8 per minute [95% CI, −3.2 to −0.2]) compared with controls.
• They did not find significant difference in ICU length of stay (8 vs 6 days; difference, 0.6 [95% CI, −1.0 to +2.2]), ICU-acquired infections (10.0% vs 10.6%; difference, −0.6% [95% CI, −4.6 to +4.1]), hospital length of stay (24 vs 27 days; difference, −2 days [95% CI, −7.3 to +3.3]), or patient comfort and dyspnea scores.