Impact of high-flow oxygen therapy and non-invasive ventilation on respiratory rate and clinical status in patients with cardiogenic pulmonary edema and acute respiratory failure
Z Sharipov, N Fayziyeva, I Meray, E Kazahmedov, J Matola, A S Pisaryuk, Z H D KobalavaAbstract
Background
Acute respiratory failure (ARF) is a common complication of cardiogenic pulmonary edema and worsens prognosis in acute heart failure (AHF) patients. High-flow oxygen therapy (HFOT) and non-invasive ventilation (NIV) are commonly used to correct hypoxemia, but comparative data on their effects on respiratory function and patient comfort are limited.
Aim
To compare the effects of HFOT and NIV on respiratory rate, blood gas parameters, patient comfort, and clinical outcomes in patients with cardiogenic pulmonary edema and acute respiratory failure.
Methods
This single-centre randomized study was conducted in the cardiac intensive care unit of our University Clinical Hospital from September 2022 to September 2024. A total of 120 patients with ARF were randomized to receive HFOT (n=60) or NIV (n=60). Randomization was computer-generated. The primary endpoint was the change in respiratory rate (RR) over 60 minutes. Secondary endpoints included PaO₂, PaCO₂, SpO₂, hemodynamic parameters, patient discomfort (10-point visual analog scale), and safety outcomes (premature discontinuation and clinical deterioration). Statistical analysis included t-test or Mann–Whitney U test for independent samples; significance was set at p0.05 for all). SpO₂ increased by 11.2%, 10.8%, and 10.5% in HFOT, and 10.5%, 10.9%, and 10.7% in NIV (p>0.05). Patient discomfort after 60 minutes was lower in HFOT (median 3, IQR 2–4) than in NIV (median 5, IQR 3–7; p=0.038). Moderate-to-severe discomfort (EVA>3) was reported in 36.7% (22/60) in HFOT and 63.3% (38/60) in NIV. PaO₂ and PaCO₂ changes at 60 minutes were not significantly different between groups (PaO₂ +63.5% HFOT vs +62.8% NIV, p=0.274; PaCO₂ −13.6% HFOT vs −15.2% NIV, p=0.312). Premature discontinuation due to discomfort occurred in 3.3% (2/60) in HFOT vs 8.3% (5/60) in NIV; clinical deterioration requiring conversion to invasive ventilation occurred in 6.7% (4/60) and 3.3% (2/60), respectively.
Conclusions
HFOT and NIV effectively reduce RR and improve oxygenation in patients with cardiogenic pulmonary edema. HFOT provides better patient comfort and fewer therapy interruptions. Blood gas improvements are similar between methods. Early initiation and optimal selection of respiratory support are critical to enhance tolerance and clinical outcomes in acute heart failure patients.