Noninvasive oxygenation strategies were associated with lower risk of death in patients with acute hypoxemic respiratory failure, according to the results of a recent study published in the JAMA.

Researchers conducted a systematic literature review using the MEDLINE, Embase, PubMed, Cochrane Central Register of Controlled Trials, CINAHL, Web of Science, and LILACS databases to find randomized clinical trials with adult participants with acute hypoxemic respiratory failure. Mortality and endotracheal intubation rates were compared between groups receiving noninvasive oxygenation strategies such as high-flow nasal oxygen, face mask noninvasive ventilation, helmet noninvasive ventilation, or standard oxygen therapy.

A total of 25 randomized clinical trials were included in the analysis, representing a total of 3804 participants. In the primary study outcome, treatment with helmet noninvasive ventilation or face mask noninvasive ventilation were associated with a lower risk of mortality up to 90 days (risk ratio, 0.40 and 0.83, respectively) compared to standard oxygen therapy. Furthermore, helmet noninvasive ventilation, face mask noninvasive ventilation, and high-flow nasal oxygen were associated with lower risk of endotracheal intubation up to 30 days (risk ratio, 0.26, 0.76, and 0.76, respectively). However, according to the researchers, the risk of bias because of a lack of blinding for intubation was considered high.

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“In this network meta-analysis of trials of adults with acute hypoxemic respiratory failure, treatment with noninvasive oxygenation strategies compared with standard oxygen therapy was associated with lower risk of death,” the study authors wrote. The results also “raise the question of whether helmet noninvasive ventilation and face mask noninvasive ventilation should be considered distinct therapeutic interventions with potentially different physiological and clinical effects.”

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


Ferreyro BL, Angriman F, Munshi L, et al. Association of noninvasive oxygenation strategies with all-cause mortality in adults with acute hypoxemic respiratory failure: a systematic review and meta-analysis [published online June 4, 2020]. JAMA. doi:10.1001/jama.2020.9524