PulmCrit - November 1, 2018 - By Josh Farkas
"Summary The Bullet:
- Conventional wisdom is that FLORALI is a positive trial, whereas HIGH is a negative trial. As such, these trials are portrayed as contradicting each other.
- The actual data from FLORALI and HIGH are consistent. FLORALI isn’t quite as optimistic as it is commonly perceived, whereas HIGH isn’t quite as dreary as it has been described. The truth probably lies in between.
- Evidence doesn’t show a mortality benefit from HFNC. However, combining data from HIGH and FLORALI does suggest a non-significant reduction in intubation rates. Such a reduction has been shown in two RCTs following extubation.4 5
- HFNC is remarkably safe. None of these trials report any worrisome complications from HFNC.
- Currently, benefit/risk analysis continues to favor the use of HFNC for hypoxemic respiratory failure. HFNC isn’t a magic bullet for hypoxemic respiratory failure, but it may help some patients and it is extremely safe."