The Comparative Effectiveness of High-Flow Nasal Cannula Therapy Versus Noninvasive Positive Pressure Ventilation in Patients With Acute Hypoxemic Respiratory Failure

This retrospective observational study assessed the comparative effectiveness of high-flow nasal cannula (HFNC) therapy versus noninvasive positive pressure ventilation (NIPPV) in a cohort of 300 patients diagnosed with acute hypoxemic respiratory failure (AHRF). The mean age of the participants was 53.92 years (SD = 22.08), with 55.3% males (n = 166) and a mean BMI of 27.07 kg/m² (SD = 4.85). Patients were nearly evenly distributed between the HFNC (n = 152) and NIPPV (n = 148) groups. Survival was observed in 51.7% (n = 155), with no statistically significant difference between groups. Oxygen saturation improvement was significantly greater in the HFNC group [median SpO₂ = 94%, interquartile range (IQR): 92-96] compared to the NIPPV group (median SpO₂ = 93%, IQR: 91-95; U = 9543.0, p = 0.018). Other metrics, including respiratory rate (HFNC median = 28, NIPPV median = 29; p = 0.207), ICU stay >7 days (28.7%, n = 86), and need for intubation (35.7%, n = 107), did not differ significantly. Multivariate regression showed poor model fit (adjusted R² = -0.017), and logistic regression failed to identify significant survival predictors (χ² = 15.425, df = 17, p = 0.565). These results support HFNC as a viable, potentially superior noninvasive option, particularly for enhancing oxygenation.