RCT

SOHO

High-Flow or Standard Oxygen in Acute Hypoxemic Respiratory Failure

NEJM, 2026 · Multicenter randomized open-label trial (n=1110 in analysis)

Clinical question

Does high-flow nasal oxygen reduce 28-day mortality compared with standard oxygen in acute hypoxemic respiratory failure?

Population: Adults with acute hypoxemic respiratory failure, P/F <=200, RR >25/min, and pulmonary infiltrates
Intervention: High-flow nasal oxygen
Comparator: Standard oxygen therapy
Primary outcome: Death by day 28
Result: 28-day mortality was 14.6% with HFNO and 14.6% with standard oxygen; intubation by day 28 was 42.4% vs 48.4%.

What the trial found

HFNO did not reduce 28-day mortality, although intubation occurred modestly less often than with standard oxygen.

Current guideline position

Major 2026 trial refining the evidence for HFNO in de novo acute hypoxemic respiratory failure.

Clinical interpretation

Use HFNO for its physiologic and comfort advantages and possible reduction in intubation, but do not teach a proven mortality benefit; reassess frequently for 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.

View Topic Context →