Comparison of high-flow nasal oxygen therapy and noninvasive ventilation in suspected sepsis patients with acute respiratory distress in the emergency department: a retrospective cohort study

Abstract

Introduction: High-flow nasal cannula (HFNC) and non-invasive ventilation (NIV) are widely utilized respiratory support modalities for patients presenting with suspected sepsis and respiratory distress.This study aims to compare the 48-hour intubation rates between HFNC and NIV therapies in patients with suspected sepsis and respiratory distress. Methods: This retrospective cohort study collected data over a 2-year period (January 2022 to December 2023) from patients presenting to the ED of Ramathibodi Hospital with suspected sepsis who received respiratory support with either HFNC or NIV. To analyze the incidence of intubation and 28-day mortality, we employed multivariable Cox regression to estimate hazard ratios (HRs). The hospital length of stay and ventilator-free days at 28 days were compared using Gaussian regression analysis. Results: A total of 546 patients met the inclusion criteria. The intubation at 48 h was 17.39% in the HFNC group and 19.47% in the NIV group (adjusted HR 0.74; 95% CI, 0.48 to 1.15; p = 0.18). The HFNC group demonstrated a trend toward lower 28-day mortality than the NIV group (adjusted HR 0.34; 95% CI, 0.12 to 1.02; p = 0.053). Additionally, the HFNC group had significantly more ventilator-free days (adjusted mean difference 1.46 days; 95% CI, 0.11 to 2.80; p = 0.034). Conclusions: In patients with suspected sepsis and acute respiratory distress, HFNC therapy did not significantly reduce the 48-hour intubation compared to NIV. However, HFNC was associated with a trend toward lower 28-day mortality and a significantly greater number of ventilator-free days on day 28. Trial registration: This trial was retrospectively registered in the Thai Clinical Trial Registry on 09 November 2023. The TCTR identification number is TCTR20231109004.