Continuous positive airway pressure versus high-flow nasal cannula oxygen therapy for acute hypoxemic respiratory failure: A randomized controlled trial

Respirology. 2024 Jan;29(1):36-45. doi: 10.1111/resp.14588. Epub 2023 Aug 30.


Background and objective: The relative effectiveness of initial non-invasive respiratory strategies for acute respiratory failure using continuous positive airway pressure (CPAP) or high-flow nasal cannula (HFNC) is unclear.

Methods: We conducted a multicenter, open-label, parallel-group randomized controlled trial to compare the efficacy of CPAP and HFNC on reducing the risk of meeting the prespecified criteria for intubation and improving clinical outcomes of acute hypoxemic respiratory failure. The primary endpoint was the time taken to meet the prespecified criteria for intubation within 28 days.

Results: Eighty-five patients were randomly assigned to the CPAP or HFNC group. Eleven (28.9%) in the CPAP group and twenty (42.6%) in the HFNC group met the criteria for intubation within 28 days. Compared with HFNC, CPAP reduced the risk of meeting the intubation criteria (hazard ratio [HR], 0.327; 95% CI, 0.148-0.724; p = 0.006). There were no significant between-group differences in the intubation rates, in-hospital and 28-day mortality rates, ventilator-free days, duration of the need for respiratory support, or duration of hospitalization for respiratory illness. Pulmonary oxygenation was significantly better in the CPAP group, with significantly lower pH and higher partial pressure of carbon dioxide, but there were no differences in the respiratory rate between groups. CPAP and HFNC were associated with few possibly causal adverse events.

Conclusion: CPAP is more effective than HFNC at reducing the risk of meeting the intubation criteria in patients with acute hypoxemic respiratory failure.

Keywords: acute hypoxemic respiratory failure; continuous positive airway pressure; high-flow nasal cannula oxygen therapy.

Publication types

  • Randomized Controlled Trial
  • Multicenter Study

MeSH terms

  • Cannula
  • Continuous Positive Airway Pressure* / adverse effects
  • Humans
  • Oxygen
  • Oxygen Inhalation Therapy
  • Respiratory Insufficiency* / etiology
  • Respiratory Insufficiency* / therapy


  • Oxygen

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