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
Dublin Core
Title
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
Subject
Sepsis, Respiratory distress, High-flow nasal cannula, Noninvasive ventilation, Intubation
Description
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.
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.
Creator
Chuenruthai Angkoontassaneeyarat1 , Prapimporn Charoenphon1 , Pitsucha Sanguanwit1* ,
Chaiyaporn Yuksen1 and Suteenun Seesuklom1
Chaiyaporn Yuksen1 and Suteenun Seesuklom1
Source
https://doi.org/10.1186/s12245-025-00842-2
Date
2025
Contributor
Peri Irawan
Format
pdf
Language
english
Type
text
Files
Collection
Citation
Chuenruthai Angkoontassaneeyarat1 , Prapimporn Charoenphon1 , Pitsucha Sanguanwit1* ,
Chaiyaporn Yuksen1 and Suteenun Seesuklom1, “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,” Repository Horizon University Indonesia, accessed April 25, 2026, https://repository.horizon.ac.id/items/show/12689.