RCT

FLORALI

High-flow oxygen through nasal cannula in acute hypoxemic respiratory failure

NEJM, 2015 · Multicenter randomized controlled trial (n=310)

Clinical question

Does high-flow nasal cannula (HFNC) reduce intubation or mortality compared with standard oxygen or noninvasive ventilation in acute hypoxemic failure?

Population: ICU patients with non-hypercapnic acute hypoxemic respiratory failure (PaO2/FiO2 <= 300)
Intervention: High-Flow Nasal Cannula (HFNC) at 50 L/min titrated to SpO2 >= 92%
Comparator: Standard oxygen mask or Noninvasive Ventilation (BiPAP)
Primary outcome: Rate of endotracheal intubation at 28 days
Result: In patients with PaO2/FiO2 <= 200, intubation rate was significantly lower with HFNC (35%) vs standard oxygen (53%) and NIV (58%, P=0.009). 90-day mortality was significantly reduced with HFNC (HR 0.42, P=0.02).

What the trial found

HFNC reduced 90-day mortality and intubation rates in severe hypoxemic respiratory failure without increasing complications.

Current guideline position

Recommended by ESICM and ATS guidelines over standard O2 and NIV.

Clinical interpretation

Established HFNC as preferred first-line noninvasive support for de-novo hypoxemic respiratory failure.

Clinical Context & Relevant Topics (1)

Disease Reference

Hypoxemic Respiratory Failure

Pathophysiologic mechanisms (shunt vs V/Q mismatch), dynamic ROX index trajectories, P-SILI prevention, and evidence-based oxygen escalation ladders.

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