High-Flow Nasal Cannula Oxygen Therapy Versus Mechanical Ventilation for Burn Patients with Acute Respiratory Distress Syndrome

Acute respiratory distress syndrome (ARDS) is a major cause of mortality in patients with severe burns. High-flow nasal cannula (HFNC) and mechanical ventilation (MV) are the primary respiratory support modalities used in these cases. Nevertheless, comparative evidence on their effectiveness in adults with burn-related ARDS remains scarce. This retrospective cohort study included 124 burn patients diagnosed with ARDS between January 2016 and December 2023. Participants were classified into either an MV (n = 81) or an HFNC (n = 43) group according to the initial respiratory support they received. We analyzed demographic information, burn characteristics, physiological parameters, and clinical outcomes. The MV group exhibited significantly more severe burns, as indicated by a larger total burn surface area (69% vs. 45%, P = .043), a greater full-thickness burn area (33.5% vs. 25%, P = .012), and higher Abbreviated Burn Severity Index and Prognostic Burn Index scores (all P < .001). However, the worst pre-treatment P/F ratio did not differ significantly between groups (MV 170.00 vs. HFNC 183, P = .235). A numerical difference in mortality was observed, with higher rates in the MV group (13.58%) than in the HFNC group (6.98%), though this difference was not statistically significant (P = .269). No significant differences were found in length of hospital stay or total medical costs. These results indicate that HFNC may represent a feasible alternative to MV for providing initial respiratory support in burn patients with ARDS.