RENOVATE Trial: High-Flow Nasal Oxygen vs. Noninvasive Ventilation in Acute Respiratory Failure
RENOVATE Investigators and the BRICNet Authors. JAMA. Published online December 10, 2024. doi:10.1001/jama.2024.26244
Objective:
- To compare the effectiveness of high-flow nasal oxygen (HFNO) versus noninvasive ventilation (NIV) in reducing endotracheal intubation or death within 7 days among patients with acute respiratory failure (ARF).
Design:
- Prospective, multicenter, randomized controlled trial.
- Utilized a Bayesian adaptive trial design with predefined patient subgroups:
- Non-immunocompromised.
- Immunocompromised.
- Chronic obstructive pulmonary disease (COPD) with respiratory acidosis.
- Acute cardiogenic pulmonary edema (ACPO).
- Hypoxemic COVID-19 (added later).
Participants:
- Adults with ARF from various etiologies, including COPD exacerbations, ACPO, and hypoxemic respiratory failure due to COVID-19.
Interventions:
- Randomized 1:1 to receive either HFNO or NIV as the initial respiratory support strategy.
Primary Outcome:
- Composite of endotracheal intubation or death within 7 days.
Key Findings:
- HFNO was found to be noninferior to NIV regarding the primary outcome across the diverse ARF etiologies.
- The trial’s pragmatic design and inclusion of various ARF causes enhance its generalizability.
- Detailed protocols for intervention settings, titration, weaning, and clear intubation criteria were established.
- Low crossover rates between treatment groups were observed, indicating protocol adherence.
Conclusion:
- HFNO is a viable alternative to NIV for initial respiratory support in patients with acute respiratory failure, offering similar effectiveness in preventing intubation or death within 7 days
- Further research is warranted to specifically compare between these therapies in patients with COPD, cariogenic pulmonary oedema and immunocompromised states
Article: https://jamanetwork.com/journals/jama/article-abstract/2828065
