Efficacy and safety of high-flow nasal cannula versus noninvasive ventilation for pulmonary arterial hypertension-associated acute respiratory failure: A retrospective cohort study stratified by the severity of right ventricular dysfunction

Pulmonary hypertension (PH) patients with acute respiratory failure (ARF) face high morbidity and mortality rates. This study aimed to determine the optimal respiratory support strategy (high-flow nasal cannula [HFNC] vs noninvasive ventilation) across different grades of RV dysfunction severity in these patients. In this retrospective cohort study, we stratified 90 PH patients with ARF into mild, moderate or severe right ventricular (RV) dysfunction subgroups via propensity score matching. We compared 28-day mortality rates and intubation rates as primary outcomes between the HFNC and noninvasive ventilation (NIV) groups. There were no differences in 28-day mortality between HFNC therapy and NIV among the RV dysfunction subgroups. In patients with severe RV dysfunction, however, HFNC therapy was associated with significantly greater intubation rates. Both therapies improved right heart function, but NIV yielded better oxygenation. HFNC therapy is as effective as NIV in mild to moderate RV dysfunction; nevertheless, NIV might be more advantageous for severe cases. These findings can help in choosing between HFNC therapy and NIV for PH patients who present with ARF. Nonetheless, larger prospective trials are needed to validate these findings.