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Preoxygenation Techniques for Tracheal Intubation in Critically Ill Adults Utilizing Oxygen Mask and Noninvasive Ventilation

Preoxygenation Techniques for Tracheal Intubation in Critically Ill Adults Utilizing Oxygen Mask and Noninvasive Ventilation

Published on: December 5, 2025

Comparison of Efficacy Between Non-Invasive Ventilation and High-Flow Nasal Cannula Oxygen Therapy in Treating Acute

Qiaoyun Huang^1,2, Jianyi Niu^1,2, Shanshan Zha^1,2

¹Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.

Respirology (Carlton, Vic.)

|August 26, 2026

Abstract

Background And Objective:

Non-invasive ventilation (NIV) is the first-line treatment for acute pulmonary edema (APE). However, with the development of high-flow nasal cannula oxygen therapy (HFNC), recent small-sample prospective studies have suggested comparable efficacy between HFNC and NIV in treating acute cardiogenic pulmonary edema. To further evaluate the efficacy of these two respiratory support modalities, we directly compared their outcomes using data from two public databases, aiming to provide higher-quality evidence on the differences in benefit between the treatments.

Methods:

Patients diagnosed with APE and treated with NIV or HFNC were identified from the MIMIC-IV and eICU databases. Relevant demographics, vital signs, clinical outcomes, and other metrics were extracted. The primary outcome was the respiratory rate (RR) at 1 h post-treatment. The secondary outcomes were the 7-day intubation rate, 28-day mortality, and intensive care unit length of stay.

Results:

In total, 1180 patients were included in the study (161 in the HFNC group and 1019 in the NIV group). After propensity score matching, 158 patients were included in each group for analysis. There was no statistically significant difference in the RR at 1 h post-treatment between the NIV and HFNC groups (21 vs. 22 beats/min, p > 0.05). The 7-day intubation rate was significantly lower in the NIV group (8.23%; 13/158) than in the HFNC group (28.48%; 45/158) (p < 0.001).

Conclusions:

In this retrospective cohort study using propensity score matching, there was no statistically significant difference in RR at 1 h post-treatment between patients treated with HFNC or NIV for APE.

Keywords:

acute pulmonary edema conventional oxygen therapy high‐flow nasal oxygen therapy non‐invasive ventilation

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