Noninvasive Technique and High Flow Nasal Oxygen in Respiratory Failure
Different Modalities of Combined Noninvasive Ventilation With High Flow Nasal Oxygen Versus Noninvasive Ventilation Alone in Acute Respiratory Failure
Minia University
75 participants
Jun 1, 2025
INTERVENTIONAL
Conditions
Summary
After obtaining Institutional Ethical Committee approval of Faculty of Medicine, Minia University and written informed consent from patients or first- degree relatives, this prospective randomized non-blind comparative study will be conducted in adult intensive care unit (ICU) of Anesthesia, Intensive Care and Pain management department Minia university hospital over a period from September 2025 to April 2026. This study is designed to compare the effectiveness of two protocols of sequential use of High Flow Nasal Cannula (HFNC) and noninvasive ventilation (NIV) versus NIV alone in patients with Acute Respiratory failure (ARF) admitted to the intensive care unit (ICU). The study will include 75 patients of both sexes, classified as ASA class Ⅰ-ⅠⅠⅠ, divided into three groups with 25 patients in each group.
Eligibility
Inclusion Criteria1
- Age ≥18 year of both sexes. • Diagnosed with Acute Respiratory Failure (ARF) defined as the combination of a PaO2/FiO2 ratio < 300 after 15 minutes of conventional oxygen delivered through a face mask, with a FiO2 at least of 50% and respiratory rate > 30 breaths/min.
Exclusion Criteria9
- Chronic respiratory disease
- Cardiogenic pulmonary edema
- Life-threatening arrythmias
- Hemodynamic instability requiring vasopressors
- Facial abnormalities preventing NIV or HFNC application
- Glasgow coma score of ≤ 12 points (Teasdale et al. 1974)
- Agitated patients characterized by RASS score (Richmond Agitation Sedation Scale) ≥ +2
- Patients who needed immediate endotracheal intubation
- Pregnant patients
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Interventions
High-flow nasal cannula (HFNC) is a valuable alternative for delivering oxygen therapy in patients with acute respiratory failure. It delivers heated and humidified oxygen at high flow rates-up to 60 L/min-through nasal prongs, allowing for better matching of inspiratory flow, a degree of positive airway pressure, and washout of nasopharyngeal dead space. These features contribute to improved oxygenation and reduced respiratory rate. Additionally, HFNC offers superior comfort and ease of communication compared to traditional masks, which may enhance patient compliance. Importantly, recent evidence suggests that HFNC can also assist in mild hypercapnic conditions by reducing the work of breathing and improving CO₂ clearance in selected patients
Noninvasive ventilation (NIV) delivers positive airway pressure either continuously or in a bilevel mode to support ventilation and oxygenation. It has been widely used in managing conditions such as COPD exacerbations, cardiogenic pulmonary edema, and moderate forms of ARDS. NIV enhances alveolar ventilation, unloads respiratory muscles, and improves gas exchange while reducing the need for intubation in many cases. However, its effectiveness depends on proper patient selection and interface tolerance, and it may be less beneficial in patients with excessive secretions, altered mental status, or hemodynamic instability
Locations(1)
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NCT07521254