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High flow nasal cannula combined with non-invasive ventilation versus high flow nasal cannula alone in patients with acute hypoxemic respiratory failure due to pneumonia: a randomized controlled trial

Authors

Leonardo Ghezzi
leonardo.ghezzi88@gmail.com
https://orcid.org/0000-0002-4913-358X
Department of Emergency Medicine, Ospedale Niguarda, Milan, Italy.
Francesca Graziano
Bicocca Bioinformatics, Biostatistics and Bioimaging Centre (B4), School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.
Giulia Bottani
Department of Emergency Medicine, Ospedale Maggiore, Lodi, Italy.
Giulia Marullo
Department of Emergency Medicine, Ospedale San Raffaele, Milan, Italy.
Nicolò Capsoni
Department of Emergency Medicine, Ospedale Niguarda, Milan, Italy.
Elisa Forni
Department of Emergency Medicine, Ospedale Niguarda, Milan, Italy.
Fabrizio Vincenti
Department of Emergency Medicine, Ospedale Niguarda, Milan, Italy.
Paola Rebora
Bicocca Bioinformatics, Biostatistics and Bioimaging Centre (B4), School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.
Andrea Bellone
Department of Emergency Medicine, Ospedale Niguarda, Milan, Italy.

In this monocentric, open label, randomized controlled trial we aimed to compare the efficacy of combined High Flow Nasal Cannula (HFNC) and Non invasive Ventilation (NIV) versus HFNC alone in acute hypoxemic respiratory failure (hARF) in patients affected by Community Acquired Pneumonia (CAP). We enrolled 49 patients affected by CAP with moderate to severe hypoxemic respiratory failure (P/F < 300). The patients were randomized into two groups: one has been treated with HFNC alone (group A) while the other received NIV alternated to HFNC every 3 hours (group B). The primary outcome was P/F change from baseline to 21 hours. Secondary outcomes included variation of pH and pCO2, need to continue HFNC or NIV/HFNC after 45 hours, orotracheal intubation, mortality rate, and the devices comfort. Not statistical significant differences between the two arms were shown in the P/F change at 21 hours since baseline, in pCO2 and pH variation, mortality at hospital and at follow-up. We emphasize the importance of combined HFNC with NIV as a first step for severe pneumonia treatment whereas HFNC might represent as the first step treatment in less severe patients and during the NIV intervals.

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How to Cite

Ghezzi, L., Graziano, F., Bottani, G., Marullo, G., Capsoni, N., Forni, E., Vincenti, F., Rebora, P., & Bellone, A. (2023). High flow nasal cannula combined with non-invasive ventilation versus high flow nasal cannula alone in patients with acute hypoxemic respiratory failure due to pneumonia: a randomized controlled trial. Emergency Care Journal, 19(1). https://doi.org/10.4081/ecj.2023.11088
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