Continuous positive airway pressure versus high-flow nasal cannula oxygen therapy for acute hypoxemic respiratory failure: A randomized controlled trial
Corresponding Author
Kazuma Nagata
Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
Correspondence
Kazuma Nagata
Email: [email protected]
Contribution: Conceptualization (lead), Funding acquisition (lead), Investigation (lead), Writing - original draft (lead)
Search for more papers by this authorToshiki Yokoyama
Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto, Aichi, Japan
Contribution: Conceptualization (equal), Investigation (equal), Writing - review & editing (lead)
Search for more papers by this authorRyosuke Tsugitomi
Department of Pulmonary Medicine, Thoracic Center, St. Luke's International Hospital, Chuo City, Tokyo, Japan
Contribution: Conceptualization (supporting), Investigation (equal), Writing - review & editing (equal)
Search for more papers by this authorHarunori Nakashima
Department of Respiratory Medicine, Ogaki Municipal Hospital, Ogaki, Gifu, Japan
Contribution: Conceptualization (supporting), Investigation (equal), Writing - review & editing (equal)
Search for more papers by this authorHiroshi Kuraishi
Department of Pulmonary Medicine, Nagano Red Cross Hospital, Nagano, Nagano, Japan
Contribution: Conceptualization (supporting), Investigation (equal), Writing - review & editing (equal)
Search for more papers by this authorShinichiro Ohshimo
Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Hiroshima, Japan
Contribution: Conceptualization (supporting), Investigation (equal), Writing - review & editing (equal)
Search for more papers by this authorYoshihiro Mori
Department of Respiratory Medicine, KKR Takamatsu Hospital, Takamatsu, Kagawa, Japan
Contribution: Conceptualization (supporting), Investigation (equal), Writing - review & editing (equal)
Search for more papers by this authorMasaaki Sakuraya
Department of Emergency and Intensive Care Medicine, JA Hiroshima General Hospital, Hiroshima, Hiroshima, Japan
Contribution: Conceptualization (supporting), Investigation (equal), Writing - review & editing (equal)
Search for more papers by this authorRyogo Kagami
Department of Pulmonary Medicine, National Hospital Organization Himeji Medical Center, Himeji, Hyogo, Japan
Contribution: Conceptualization (supporting), Investigation (equal), Writing - review & editing (equal)
Search for more papers by this authorMotoaki Tanigawa
Department of Respiratory Medicine, Japanese Red Cross Ise Hospital, Ise, Mie, Japan
Contribution: Conceptualization (supporting), Investigation (equal), Writing - review & editing (equal)
Search for more papers by this authorKazunori Tobino
Department of Respiratory Medicine, Iizuka Hospital, Iizuka, Fukuoka, Japan
Contribution: Conceptualization (supporting), Investigation (equal), Writing - review & editing (equal)
Search for more papers by this authorTetsuro Kamo
Department of Respiratory Medicine, Saiseikai Utsunomiya Hospital, Utsunomiya, Tochigi, Japan
Contribution: Conceptualization (supporting), Investigation (equal), Writing - review & editing (equal)
Search for more papers by this authorToru Kadowaki
Department of Pulmonary Medicine, National Hospital Organization Matsue Medical Center, Matsue, Shimane, Japan
Contribution: Conceptualization (supporting), Investigation (equal), Writing - review & editing (equal)
Search for more papers by this authorYasutaka Koga
Advanced Medical Emergency and Critical Care Center, Yamaguchi University Hospital, Ube, Yamaguchi, Japan
Contribution: Conceptualization (supporting), Investigation (equal), Writing - review & editing (equal)
Search for more papers by this authorYoshitaka Ogata
Department of Critical Care Medicine, Yao Tokushukai General Hospital, Yao, Osaka, Japan
Contribution: Conceptualization (supporting), Investigation (equal), Writing - review & editing (equal)
Search for more papers by this authorNaoki Nishimura
Department of Pulmonary Medicine, Thoracic Center, St. Luke's International Hospital, Chuo City, Tokyo, Japan
Contribution: Conceptualization (supporting), Investigation (equal), Writing - review & editing (equal)
Search for more papers by this authorYasuhiro Kondoh
Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto, Aichi, Japan
Contribution: Conceptualization (equal), Investigation (equal), Writing - review & editing (equal)
Search for more papers by this authorSatsuki Taniuchi
Department of Medical Statistics, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Osaka, Japan
Contribution: Formal analysis (lead), Writing - review & editing (equal)
Search for more papers by this authorAyumi Shintani
Department of Medical Statistics, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Osaka, Japan
Contribution: Formal analysis (equal), Writing - review & editing (equal)
Search for more papers by this authorKeisuke Tomii
Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
Contribution: Conceptualization (equal), Formal analysis (equal), Funding acquisition (equal), Investigation (equal), Writing - original draft (supporting)
Search for more papers by this authorthe JaNP-Hi Study Investigators
Search for more papers by this authorCorresponding Author
Kazuma Nagata
Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
Correspondence
Kazuma Nagata
Email: [email protected]
Contribution: Conceptualization (lead), Funding acquisition (lead), Investigation (lead), Writing - original draft (lead)
Search for more papers by this authorToshiki Yokoyama
Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto, Aichi, Japan
Contribution: Conceptualization (equal), Investigation (equal), Writing - review & editing (lead)
Search for more papers by this authorRyosuke Tsugitomi
Department of Pulmonary Medicine, Thoracic Center, St. Luke's International Hospital, Chuo City, Tokyo, Japan
Contribution: Conceptualization (supporting), Investigation (equal), Writing - review & editing (equal)
Search for more papers by this authorHarunori Nakashima
Department of Respiratory Medicine, Ogaki Municipal Hospital, Ogaki, Gifu, Japan
Contribution: Conceptualization (supporting), Investigation (equal), Writing - review & editing (equal)
Search for more papers by this authorHiroshi Kuraishi
Department of Pulmonary Medicine, Nagano Red Cross Hospital, Nagano, Nagano, Japan
Contribution: Conceptualization (supporting), Investigation (equal), Writing - review & editing (equal)
Search for more papers by this authorShinichiro Ohshimo
Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Hiroshima, Japan
Contribution: Conceptualization (supporting), Investigation (equal), Writing - review & editing (equal)
Search for more papers by this authorYoshihiro Mori
Department of Respiratory Medicine, KKR Takamatsu Hospital, Takamatsu, Kagawa, Japan
Contribution: Conceptualization (supporting), Investigation (equal), Writing - review & editing (equal)
Search for more papers by this authorMasaaki Sakuraya
Department of Emergency and Intensive Care Medicine, JA Hiroshima General Hospital, Hiroshima, Hiroshima, Japan
Contribution: Conceptualization (supporting), Investigation (equal), Writing - review & editing (equal)
Search for more papers by this authorRyogo Kagami
Department of Pulmonary Medicine, National Hospital Organization Himeji Medical Center, Himeji, Hyogo, Japan
Contribution: Conceptualization (supporting), Investigation (equal), Writing - review & editing (equal)
Search for more papers by this authorMotoaki Tanigawa
Department of Respiratory Medicine, Japanese Red Cross Ise Hospital, Ise, Mie, Japan
Contribution: Conceptualization (supporting), Investigation (equal), Writing - review & editing (equal)
Search for more papers by this authorKazunori Tobino
Department of Respiratory Medicine, Iizuka Hospital, Iizuka, Fukuoka, Japan
Contribution: Conceptualization (supporting), Investigation (equal), Writing - review & editing (equal)
Search for more papers by this authorTetsuro Kamo
Department of Respiratory Medicine, Saiseikai Utsunomiya Hospital, Utsunomiya, Tochigi, Japan
Contribution: Conceptualization (supporting), Investigation (equal), Writing - review & editing (equal)
Search for more papers by this authorToru Kadowaki
Department of Pulmonary Medicine, National Hospital Organization Matsue Medical Center, Matsue, Shimane, Japan
Contribution: Conceptualization (supporting), Investigation (equal), Writing - review & editing (equal)
Search for more papers by this authorYasutaka Koga
Advanced Medical Emergency and Critical Care Center, Yamaguchi University Hospital, Ube, Yamaguchi, Japan
Contribution: Conceptualization (supporting), Investigation (equal), Writing - review & editing (equal)
Search for more papers by this authorYoshitaka Ogata
Department of Critical Care Medicine, Yao Tokushukai General Hospital, Yao, Osaka, Japan
Contribution: Conceptualization (supporting), Investigation (equal), Writing - review & editing (equal)
Search for more papers by this authorNaoki Nishimura
Department of Pulmonary Medicine, Thoracic Center, St. Luke's International Hospital, Chuo City, Tokyo, Japan
Contribution: Conceptualization (supporting), Investigation (equal), Writing - review & editing (equal)
Search for more papers by this authorYasuhiro Kondoh
Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto, Aichi, Japan
Contribution: Conceptualization (equal), Investigation (equal), Writing - review & editing (equal)
Search for more papers by this authorSatsuki Taniuchi
Department of Medical Statistics, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Osaka, Japan
Contribution: Formal analysis (lead), Writing - review & editing (equal)
Search for more papers by this authorAyumi Shintani
Department of Medical Statistics, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Osaka, Japan
Contribution: Formal analysis (equal), Writing - review & editing (equal)
Search for more papers by this authorKeisuke Tomii
Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
Contribution: Conceptualization (equal), Formal analysis (equal), Funding acquisition (equal), Investigation (equal), Writing - original draft (supporting)
Search for more papers by this authorthe JaNP-Hi Study Investigators
Search for more papers by this authorAbstract
Background and Objective
The relative effectiveness of initial non-invasive respiratory strategies for acute respiratory failure using continuous positive airway pressure (CPAP) or high-flow nasal cannula (HFNC) is unclear.
Methods
We conducted a multicenter, open-label, parallel-group randomized controlled trial to compare the efficacy of CPAP and HFNC on reducing the risk of meeting the prespecified criteria for intubation and improving clinical outcomes of acute hypoxemic respiratory failure. The primary endpoint was the time taken to meet the prespecified criteria for intubation within 28 days.
Results
Eighty-five patients were randomly assigned to the CPAP or HFNC group. Eleven (28.9%) in the CPAP group and twenty (42.6%) in the HFNC group met the criteria for intubation within 28 days. Compared with HFNC, CPAP reduced the risk of meeting the intubation criteria (hazard ratio [HR], 0.327; 95% CI, 0.148–0.724; p = 0.006). There were no significant between-group differences in the intubation rates, in-hospital and 28-day mortality rates, ventilator-free days, duration of the need for respiratory support, or duration of hospitalization for respiratory illness. Pulmonary oxygenation was significantly better in the CPAP group, with significantly lower pH and higher partial pressure of carbon dioxide, but there were no differences in the respiratory rate between groups. CPAP and HFNC were associated with few possibly causal adverse events.
Conclusion
CPAP is more effective than HFNC at reducing the risk of meeting the intubation criteria in patients with acute hypoxemic respiratory failure.
CONFLICT OF INTEREST STATEMENT
Keisuke Tomii received speaker's honoraria from Phillips, Fisher & Paykel, Teijin Healthcare, and Fukuda. The other authors have nothing to disclose.
Open Research
DATA AVAILABILITY STATEMENT
All requests for raw and analyzed data and materials will be reviewed by the corresponding author to verifyif the request is subject to confidentiality obligations.
Supporting Information
| Filename | Description |
|---|---|
| resp14588-sup-0001-Supinfo.docxWord 2007 document , 296.3 KB | Appendix S1. The exclusion criterion of COVID-19. Table S1. Inclusion and exclusion criteria. Appendix S2. Predefined intubation criteria. Table S2. Causes of meeting the intubation criteria. Figure S1. Kaplan–Meier plots of the primary and secondary outcomes in the ‘per-protocol’ analysis. (a) Time to meet the intubation criteria within 28 days. (b) Time to intubation within 28 days. (c) Time to death within 28 days. (d) Time to death in hospital. Appendix S3. Statistical differences in vital signs between both groups. Table S3. Continuous sedative drugs administered to each group. Table S4. Adverse events that may have been caused by the assigned treatment. |
| resp14588-sup-0002-Visual Abstract.pdfPDF document, 184.3 KB | Visual Abstract Continuous positive airway pressure versus high-flow nasal cannula oxygen therapy for acute hypoxemic respiratory failure: a randomized controlled trial (JaNP-Hi trial) |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
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