Methodology: 3.5/5
Usefulness: 3/5
Question and methods: This multicentre, adaptive, RCT aimed to demonstrate noninferiority of HFNO vs NIV in preventing intubation or death within 7 days across five respiratory failure groups.
Findings: 1800 patients were enrolled. Compared to NIV, HFNO met the prespecified criteria for non-inferiority for the primary outcome in 4/5 patient groups with respiratory failure.
Limitations: Small sample size in some groups, complex analysis with contradicting post-hoc results, and exclusion of more unstable patients. May not reflect the ED population.
Interpretation: HFNO is non-inferior to NIV in some patient groups with acute respiratory failure, but more evidence is needed in patients with immunocompromise, COPD, or ACPE.
