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High-Flow or Standard Oxygen in Acute Hypoxemic Respiratory Failure
Jean-Pierre Frat1,2, Jean-Pierre Quenot3, Christophe Guitton4
1Médecine Intensive Réanimation, Centre Hospitalier Universitare (CHU) de Poitiers, Poitiers, France.
The New England Journal of Medicine
|March 17, 2026
Summary
High-flow nasal cannula oxygen therapy did not reduce mortality in acute hypoxemic respiratory failure patients. However, it did show a trend toward reducing intubation rates compared to standard oxygen therapy.
Area of Science:
- Critical Care Medicine
- Respiratory Medicine
- Clinical Trials
Background:
- Acute hypoxemic respiratory failure (AHRF) necessitates effective oxygenation strategies.
- The comparative efficacy of high-flow nasal cannula (HFNC) oxygen therapy versus standard oxygen therapy (SOT) in AHRF requires further investigation.
Purpose of the Study:
- To evaluate the impact of HFNC compared to SOT on mortality and intubation rates in patients with AHRF.
Main Methods:
- A multicenter, open-label trial randomized 1116 patients with AHRF (PaO2/FiO2 ≤ 200, RR > 25, pulmonary infiltrate) to HFNC or SOT.
- The primary outcome was all-cause mortality by day 28.
Main Results:
- Day 28 mortality was 14.6% in both the HFNC and SOT groups (P=0.98).
- Intubation by day 28 occurred in 42.4% of the HFNC group versus 48.4% in the SOT group (difference -5.93 percentage points).
- Serious adverse events were slightly higher in the HFNC group (2.3% vs 1.1%).
Conclusions:
- HFNC oxygen therapy did not significantly reduce 28-day mortality in patients with AHRF.
- A trend towards reduced intubation was observed with HFNC, warranting further research.
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