Observational studyIntensive care medicine2015
Failure of high-flow nasal cannula therapy may delay intubation and increase mortality.
Observational study in Intensive care medicine, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04632043 (Effect of Early versUs Delayed intubatiOn on Clinical Outcomes of Patients With COVID-19), which is not on this map. Cited by 282 papers, 8 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Effect of Early versUs Delayed intubatiOn on Clinical Outcomes of Patients With COVID-19 (EUDOCO): a Feasibility Randomized Controlled Trial
Who cites it
282 citing papers in PubMed, 8 syntheses or guidelines pooled it.
- Performance of the ROX index in predicting high flow nasal cannula failure in COVID-19 patients: a systematic review and meta-analysis.Critical care (London, England) · 2023Pooled it
- Prophylactic noninvasive respiratory support in the immediate postoperative period after cardiac surgery - a systematic review and network meta-analysis.BMC pulmonary medicine · 2023Pooled it
- Effect of noninvasive respiratory support on interstitial lung disease with acute respiratory failure: A systematic review and meta-analysis.Canadian journal of respiratory therapy : CJRT = Revue canadienne de la therapie respiratoire : RCTR · 2023Pooled it
- The ROX index as a predictor of high-flow nasal cannula outcome in pneumonia patients with acute hypoxemic respiratory failure: a systematic review and meta-analysis.BMC pulmonary medicine · 2022Pooled it
- Non-invasive oxygenation strategies for respiratory failure with COVID-19: A concise narrative review of literature in pre and mid-COVID-19 era.Anaesthesia, critical care & pain medicine · 2021Pooled it
- Effect of timing of intubation on clinical outcomes of critically ill patients with COVID-19: a systematic review and meta-analysis of non-randomized cohort studies.Critical care (London, England) · 2021Pooled it
- Longer Prehospitalization and Preintubation Periods in Intubated Non-survivors and ECMO Patients With COVID-19: A Systematic Review and Meta-Analysis.Frontiers in medicine · 2021Pooled it
- The role for high flow nasal cannula as a respiratory support strategy in adults: a clinical practice guideline.Intensive care medicine · 2020Guideline
- Use of rescue noninvasive ventilation for post-extubation respiratory failure.Critical care (London, England) · 2025Trial
- A comparison of conventional high-flow nasal cannula vs the duet high-flow nasal cannula in extubated patients: a randomized crossover trial.European journal of medical research · 2025Trial
- Physiological effects of awake prone position in acute hypoxemic respiratory failure.Critical care (London, England) · 2023Trial
- High-Dose Dexamethasone and Oxygen Support Strategies in Intensive Care Unit Patients With Severe COVID-19 Acute Hypoxemic Respiratory Failure: The COVIDICUS Randomized Clinical Trial.JAMA internal medicine · 2022Trial
- Predictors of Respiratory Support Use in Emergency Department Patients With COVID-19-Related Respiratory Failure.Respiratory care · 2022Trial
- Trial
- Non-invasive respiratory supports in ARDS: Physiology-guided use, pitfalls, and pathways to success.Intensive care medicine · 2026Article
- Article
- Impact of an ROX index-guided intubation strategy on mortality in patients receiving high-flow nasal cannula: a target trial emulation.Journal of intensive care · 2026Article
- Prediction of high-flow nasal cannula failure in patients with sepsis by a preliminary risk stratification model based on the ROX index.BMC infectious diseases · 2026Article
- Development of a predictive model for high-flow nasal cannula treatment failure in emergency department patients with acute heart failure: a retrospective secondary data analysis.Journal of Korean biological nursing science · 2026Article
- Article
222 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
11 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeIntubation in patients with respiratory failure can be avoided by high-flow nasal cannula (HFNC) use. However, it is unclear whether waiting until HFNC fails, which would delay intubation, has adverse effects. The present retrospective observational study assessed overall ICU mortality and other hospital outcomes of patients who received HFNC therapy that failed.
methodsAll consecutive patients in one tertiary hospital who received HFNC therapy that failed and who then required intubation between January 2013 and March 2014 were enrolled and classified according to whether intubation started early (within 48 h) or late (at least 48 h) after commencing HFNC.
resultsOf the 175 enrolled patients, 130 (74.3 %) and 45 (25.7 %) were intubated before and after 48 h of HFNC, respectively. The groups were similar in terms of most baseline characteristics. The early intubated patients had better overall ICU mortality (39.2 vs. 66.7 %; P = 0.001) than late intubated patients. A similar pattern was seen with extubation success (37.7 vs. 15.6 %; P = 0.006), ventilator weaning (55.4 vs. 28.9 %; P = 0.002), and ventilator-free days (8.6 ± 10.1 vs. 3.6 ± 7.5; P = 0.011). In propensity-adjusted and -matched analysis, early intubation was also associated with better overall ICU mortality [adjusted odds ratio (OR) = 0.317, P = 0.005; matched OR = 0.369, P = 0.046].
conclusionsFailure of HFNC might cause delayed intubation and worse clinical outcomes in patients with respiratory failure. Large prospective and randomized controlled studies on HFNC failure are needed to draw a definitive conclusion.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.