High-Flow Oxygen for Cardiogenic Pulmonary Edema? Don’t Bother

Daniel J. Pallin, MD, MPH


A decrease in respiratory rate was not accompanied by more-meaningful improvements in outcomes.


High-flow nasal cannula oxygen (HFO) therapy is an evidence-based modality for treatment of hypoxemic respiratory failure (a href=”http://dx.doi.org/10.1056/NEJMoa1503326″ target=_blank”>N Engl J Med 2015 Jun 4; 372:2185). Now, investigators in a Thai emergency department (ED) have compared the effectiveness of HFO versus conventional oxygen therapy in 128 patients with cardiogenic pulmonary edema.


The respiratory rate at 60 minutes (the primary outcome) was reduced with HFO (21.8 vs. 25.1 breaths per minute; difference, 3.3; 95% confidence interval, 1.9–4.6). However, HFO provided no benefit in use of noninvasive ventilation or intubation; and mortality, admission rate, and lengths of ED and hospital stay were unchanged.


This study serves as a reminder that a statistically significant outcome is not necessarily a clinically significant outcome. There was a small decrease in the respiratory rate with HFO, but no benefit in hard outcomes, such as decreased use of noninvasive ventilation or intubation rates. Unless stronger supportive evidence emerges, HFO is not indicated for treatment of cardiogenic pulmonary edema.


Makdee O et al. High-flow nasal cannula versus conventional oxygen therapy in emergency department patients with cardiogenic pulmonary edema: A randomized controlled trial. Ann Emerg Med 2017 Jun 8; [e-pub]. (http://dx.doi.org/10.1016/j.annemergmed.2017.03.028)
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