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Over the last decade, clinicians have increasingly used high-flow oxygen to support patients with hypoxemic respiratory failure. Adoption was initially driven by physiologic principles (dead-space washout and low levels of positive end-expiratory pressure), and use increased with a study that demonstrated decreased mortality with high-flow compared with standard oxygen or noninvasive ventilation. Subsequent studies, mostly during the Covid-19 pandemic, had more mixed results.
To better understand the potential benefits of high-flow oxygen, industry-supported investigators randomized over 1100 adults (from ≈40 French ICUs) with acute hypoxemic respiratory failure to high-flow oxygen delivered by nasal cannula (≥48 hours of high flow) o…