High-flow nasal cannula therapy versus standard pressure support non-invasive ventilation in treating adult patients with severe asthma exacerbation complicated with respiratory failure

Evidence to support the use of high-flow nasal cannula HFNC in patients with severe asthma exacerbation complicated with respiratory failure is limited. This study was conducted to compare the effectiveness of HFNC versus non-invasive ventilation (NIV) in adults with severe asthma exacerbation complicated with respiratory failure. Patients & Methods:  62 patients with asthma exacerbation were randomized to receive either HFNC or NIV. Clinical parameters (heart rate (HR), respiratory rate (RR), blood pressure and arterial blood gas parameters at selected time intervals were collected and analyzed. Results: There was no difference in HR, MAP, and pCO2 between the two groups. The HFNC group had significantly lower RR at 48 h [20 (16.3–23.8) vs. 23.5 (18.6–25) /min, p < 0.05] as compared with NIV. It was observed that HFNC was more efficient than NIV in elevating  PaO2/FiO2 after treatment. There were no treatment failures in the HFNC group. However, 3 patients (10%) in the NIV group required escalation to invasive ventilation. The comfort score in patients treated with HFNC was significantly higher as compared with NIV [7 (6–8) vs. 5 (4–7), p=0.000*]. The NIV group had a longer mean ICU, or hospital total lengths of stay compared to HFNC group. Conclusion: HFNC would be a preferred option in treating adults patients with asthma exacerbation.