{"doi":"10.1101/2023.09.26.23296167","title":"High-flow nasal cannula vs non-invasive ventilation in acute hypoxia: Propensity score matched study","abstract":"RATIONALE: The optimal treatment for early hypoxemic respiratory failure is unclear, and both high-flow nasal cannula and non-invasive ventilation are used. Determining clinically relevant outcomes for evaluating non-invasive respiratory support modalities remains a challenge. OBJECTIVES: To compare the effectiveness of initial treatment with high-flow nasal cannula versus non-invasive ventilation for acute hypoxemic respiratory failure. METHODS: We conducted a retrospective cohort study of patients with acute hypoxemic respiratory failure treated with high-flow nasal cannula or non-invasive ventilation within 24 hours of Emergency Department arrival (1/2018-12/2022). We matched patients 1:1 using a propensity score for odds of receiving non-invasive ventilation. The primary outcome was major adverse pulmonary events (28-day mortality, ventilator-free days, non-invasive respiratory support hours) calculated using a Win Ratio. MEASUREMENTS AND MAIN RESULTS: 1,265 patients met inclusion criteria. 795 (62.8%) received high-flow oxygen and 470 (37.2%) received non-invasive ventilation. We propensity score matched 736/1,265 (58.2%) patients. There was no difference between non-invasive ventilation vs high-flow nasal cannula in 28-day mortality (17.7% vs 23.1%, p=0.08) or ventilator-free days (median [Interquartile Range]: 28 [25, 28] vs 28 [13, 28], p=0.50), but patients on non-invasive ventilation required treatment for fewer hours (median 7 vs 13, p< 0.001). Win Ratio for composite major adverse pulmonary events favored non-invasive ventilation (1.26, 95%CI 1.06-1.49, p< 0.001). CONCLUSIONS: In this observational study of patients with acute hypoxemic respiratory failure, initial treatment with non-invasive ventilation was superior to high-flow nasal cannula for major pulmonary adverse events. Evaluation of composite outcomes is important in the assessment of respiratory support modalities.","journal":"medRxiv","year":2023,"id":411914,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":0,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.955,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2023-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1192484,"name":"Ina Prevalska","orcid":"0000-0003-3151-3960","position":1,"is_corresponding":false},{"id":1114897,"name":"Madison Hyer","orcid":null,"position":2,"is_corresponding":false},{"id":426431,"name":"William J. Meurer","orcid":"0000-0002-1158-5302","position":3,"is_corresponding":false},{"id":231643,"name":"Jarrod Mosier","orcid":"0000-0002-5371-0845","position":4,"is_corresponding":false},{"id":870190,"name":"Mark Tidswell","orcid":"0000-0001-6333-6810","position":5,"is_corresponding":false},{"id":266626,"name":"Hallie C. Prescott","orcid":"0000-0002-8442-6724","position":6,"is_corresponding":false},{"id":336036,"name":"Lai Wei","orcid":"0000-0002-7248-3828","position":7,"is_corresponding":false},{"id":295517,"name":"Henry E. Wang","orcid":"0000-0002-4738-0093","position":8,"is_corresponding":false},{"id":226890,"name":"Christopher Fung","orcid":"0000-0003-3585-1385","position":9,"is_corresponding":false},{"id":1043277,"name":"Elizabeth Munroe","orcid":"0000-0003-3353-612X","position":0,"is_corresponding":true}],"reference_count":21,"raw_metadata":{"citation_network_status":"fetched"},"created_at":"2026-07-19T01:21:46.548301Z","pmid":"37808723","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}