High flow nasal cannula combined with non-invasive ventilation versus high flow nasal cannula alone in patients with acute hypoxemic respiratory failure due to pneumonia: a randomized controlled trial

Patients with hypoxemic respiratory failure due to community acquired pneumonia are actually treated with a wide range of oxy-gen devices from nasal cannula to mechanical ventilation. In this monocentric, open label, randomized controlled trial we aimed to compare the efficacy of combined High Flow Nasal Cannula (HFNC) and Non-Invasive Ventilation (NIV) versus HFNC alone in acute Hypoxemic Respiratory Failure (hARF) in patients affect-ed by Community Acquired Pneumonia (CAP). We enrolled 49 patients affected by CAP with hypoxemic respiratory failure (PO2/FiO2 < 300). The patients were randomized into two groups: one has been treated with HFNC alone (group A) while the other received NIV alternated to HFNC every 3 hours (group B). The primary outcome was PO2/FiO2 change from baseline to 21 hours. Secondary outcomes included variation of pH and pCO2, need to continue HFNC or NIV/HFNC after 45 hours, orotracheal intuba-tion, mortality rate, and device comfort. No statistically significant differences between the two arms were shown in PO2/FiO2 change at 21 hours since baseline, in pCO2 and pH variation, mortality at hospital and at follow-up. Further research is needed to better understand the role of combined HFNC and NIV in hypoxemic respiratory failure in patients with CAP.