HIGH
Trial question
Is high-flow nasal oxygen superior to standard oxygen in immunocompromised patients with acute respiratory failure?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
33.0% female
67.0% male
N = 776
776 patients (259 female, 517 male).
Inclusion criteria: adult immunocompromised patients with acute hypoxemic respiratory failure.
Key exclusion criteria: imminent death; anatomical factors precluding the use of a nasal cannula; hypercapnia and isolated cardiogenic pulmonary edema indicating noninvasive ventilation; and surgery within the last 6 days.
Interventions
N=388 high-flow oxygen therapy (initiated at 50 L/min and 100% FiO2, with a subsequent flow rate increase up to 60 L/min as needed to achieve SpO2 ≥ 95%).
N=388 standard oxygen therapy (oxygen delivered via nasal prongs or mask with or without a reservoir bag and with or without a Venturi system to achieve SpO2 ≥ 95%).
Primary outcome
Rate of death by day 28
35.6%
36.1%
36.1 %
27.1 %
18.1 %
9.0 %
0.0 %
High-flow oxygen
therapy
Standard oxygen
therapy
No significant
difference ↔
No significant difference in the rate of death by day 28 (35.6% vs. 36.1%; HR 0.98, 95% CI 0.77 to 1.24).
Secondary outcomes
No significant difference in invasive mechanical ventilation (38.7% vs. 43.8%; HR 0.85, 95% CI 0.68 to 1.06).
No significant difference in ICU acquired infection (10% vs. 10.6%; HR 1.01, 95% CI 0.96 to 1.06).
No significant difference in death in the hospital (41.2% vs. 41.7%; RR 0.99, 99% CI 0.84 to 1.17).
Safety outcomes
No significant difference in patient comfort and dyspnea scores.
Significant differences in respiratory rate after 6 hours (25/min vs. 26/min), the ratio of the partial pressure of oxygen and FiO2 until day 4 (150 vs. 119).
Conclusion
In adult immunocompromised patients with acute hypoxemic respiratory failure, high-flow oxygen therapy was not superior to standard oxygen therapy with respect to the rate of death by day 28.
Reference
Elie Azoulay, Virginie Lemiale, Djamel Mokart et al. Effect of High-Flow Nasal Oxygen vs Standard Oxygen on 28-Day Mortality in Immunocompromised Patients With Acute Respiratory Failure: The HIGH Randomized Clinical Trial. JAMA. 2018 Nov 27;320(20):2099-2107.
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