Is High-Flow Nasal Oxygen as Effective as Non-Invasive Ventilation in Acute Cardiogenic Pulmonary Edema?

Is High-Flow Nasal Oxygen as Effective as Non-Invasive Ventilation in Acute Cardiogenic Pulmonary Edema?

Erhan Altunbas, Nurseli Bayram, Emir Unal, Cigdem Ozpolat, Sinan Karacabey, Haldun Akoglu, Arzu Denizbasi
 American Journal of Emergency Medicine, August 15, 2025

šŸ©ŗ Clinical Implications

  • Efficacy: HFNC appears to be non-inferior to NIV in improving respiratory rate and other clinical parameters in ACPE.

  • Tolerability: HFNC is often better tolerated, more comfortable, and easier to administer than NIV.

  • Clinical takeaway: HFNC can be a viable first-line alternative to NIV for patients with ACPE, especially when NIV is poorly tolerated or contraindicated.

šŸ” Study Design

  • Design: Prospective, randomized, single-center, superiority trial

  • Population: Adult ED patients (ā‰„18 years) with acute cardiogenic pulmonary edema (ACPE)

  • Intervention: High-flow nasal cannula (HFNC) vs. Non-invasive ventilation (NIV)

  • Primary outcome: Change in respiratory rate (RR) over time

  • Sample size: 178 patients randomized from 1376 screened

šŸ“Š Key Results

  • Baseline RR: Comparable in both groups (~34 breaths/min)

  • Respiratory rate reduction: No significant difference between HFNC and NIV at 30, 60, or 120 minutes

  • Secondary measures: No significant differences in:

    • Vital signs

    • Arterial blood gas parameters

    • Dyspnea scores

Altunbas, E., Bayram, N., Unal, E., Ozpolat, C., Karacabey, S., Akoglu, H. and Denizbasi, A., 2025. Is high-flow nasal oxygen as effective as non-invasive ventilation in acute cardiogenic pulmonary Edema?. The American Journal of Emergency Medicine.

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