Abstract
High-flow nasal cannula (HFNC) and non-invasive ventilation(NIV) are commonly used for hypoxemic respiratory failure, but their comparative efficacy remains unclear. This prospective cohort study enrolled 259 non-hypercapnic hypoxemic respiratory failure patients (PaO₂ <60 mmHg, PaCO₂ <50 mmHg, pH ≥ 7.30) in a Chinese ICU. Patients were allocated to HFNC (n = 128) or NIV (n = 131) based on physician judgment. Primary outcome was 28-day intubation rate; secondary outcomes included 28-day mortality, treatment withdrawal, and ICU/hospital stay duration. Baseline characteristics were similar except for higher respiratory/heart rates and disease severity in the NIV group. Before adjustment, the HFNC group had a lower intubation rate (P < 0.05) and fewer events of death or treatment withdrawal(P<0.01). After propensity score matching, all group differences became non-significant: intubation(aOR 2.61,95%CI 0.58–11.68,P = 0.21), hospital mortality (aOR 0.91,95%CI 0.31–2.62,P = 0.86),death or withdrawing treatment༈aOR 0.54,95%CI 0.26–1.13,P = 0.10),and the composite endpoint (aOR = 1.14,95%CI 0.42–3.08, P = 0.80).The durations of ICU stay (8 vs. 8 days, P = 0.87) and hospital stay (13 vs. 12 days, P = 0.10) showed no significant differences both before and after matching.Patients transitioning from HFNC to NIV had longer ICU stays than NIV-only patients (12 vs. 8 days, P < 0.05). Outcomes did not differ between HFNC-failure patients transitioning to NIV or intubation (P > 0.05). HFNC and NIV show similar efficacy in preventing intubation and reducing mortality. NIV may shorten ICU stay in severe cases, but escalation to NIV or intubation after HFNC failure does not improve outcomes. Treatment should be individualized based on disease severity and patient response. However, given the non-randomized design and potential for residual confounding despite multivariate adjustment, these findings should be interpreted with caution and require validation in randomized controlled trials.
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Acknowledgements
The authors would like to thank all the staffs in RICU to participate in data collection.
Funding
This study was supported by the Chongqing Joint Medical Research Program of Science & Health(Project No. 2020FYYX138). The funder had no role in the study design, data collection, statistical analysis, or manuscript writing.
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All the authors participated in the article preparation. The authors read and approved the final manuscript.1.Literature search: Zhao Qianru, Jiang Heyue.2.Data collection: Zhao Qianru, Liu Qiao.3.Study design: Hong Yueling，PanLongfan.4.Data analysis: Duan Jun.5.Manuscript preparation: Hong Yueling, Zhao Qianru, Jiang Heyue.6.Manuscript review: Hong Yueling, Pan Longfang.
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The study was approved by the Ethics Committee of the First Affiliated Hospital of Chongqing Medical University. Written informed consent was obtained from all participants prior to their inclusion in the study.Ethics Number:2020-1.
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Qianru, Z., Heyue, J., Longfang, P. et al. High-flow nasal cannula versus noninvasive ventilation in patients with hypoxemic respiratory failure: a prospective cohort study. Sci Rep (2026). https://doi.org/10.1038/s41598-026-38516-5
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DOI: https://doi.org/10.1038/s41598-026-38516-5
