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ACP Issues Guideline on High-Flow Nasal Oxygen for Respiratory Failure

TUESDAY, May 4, 2021 -- For hospitalized patients, high-flow nasal oxygen (HFNO) should be used instead of noninvasive ventilation (NIV) for acute hypoxemic respiratory failure and instead of conventional oxygen therapy (COT) for management of postextubation acute hypoxemic respiratory failure, according to a new clinical guideline issued by the American College of Physicians and published online April 27 in the Annals of Internal Medicine.

Arianne K. Baldomero, M.D., from the Minneapolis Veterans Affairs Health Care System, and colleagues conducted a systematic review to examine HFNO versus NIV or COT for acute respiratory failure (ARF) in hospitalized adults. Data were included from 29 randomized controlled trials. The researchers found that HFNO may reduce all-cause mortality, intubation, and hospital-acquired pneumonia and improve patient comfort in initial ARF management compared with NIV, but not in postextubation management. HFNO may reduce reintubation and improve patient comfort compared with COT in postextubation ARF management.

Based on these findings, Amir Qaseem, M.D., Ph.D., from the American College of Physicians in Philadelphia, and colleagues suggest use of HFNO instead of NIV for management of acute hypoxemic respiratory failure in hospitalized adults (conditional recommendation; low-certainty evidence). In addition, for hospitalized adults with postextubation acute hypoxemic respiratory failure, HFNO is suggested rather than COT (conditional recommendation; low-certainty evidence).

"More research is needed to identify which patients (for example, high-risk patients) are most likely to benefit from HFNO, particularly by type of acute respiratory failure," Qaseem and colleagues write.

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