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High-flow oxygen through nasal cannula in acute hypoxemic respiratory failure

Journal Club Summary:

Methodology Score: 4/5                 
Usefulness Score: 4/5

Frat JP, et al.
N Engl J Med. 2015 Jun 4;372(23):2185-96.

Editorial:
Saving lives with high-flow nasal oxygen
Matthay MA
N Engl J Med. 2015 Jun 4;372(23):2225-6.

This ICU RCT compared high flow nasal cannula vs NIPPV vs non rebreather facemask in acute hypoxemic respiratory failure without hypercapnia (primarily patients with pneumonia and excluding COPD or pulmonary edema). This is the first RCT directly comparing NIPPV to high flow oxygen therapy and found that ICU mortality outcomes were significantly worse in the NIPPV group and improved in the high flow nasal cannula group in this patient population.
By: Dr. Rory Connolly

Epi lesson:


The sample size of a clinical trial must be adequately powered to show a minimal clinically important difference (MCID) between the intervention and control arms. MCID is the absolute difference in outcome proportions that would have to be shown By: the study intervention for clinicians to accept the new treatment as better. In an effort to keep sample size low, investigators sometimes estimate an MCID much larger than is reasonable or use an outcome that is not the most important, e.g. 4-hour survival rather than survival to discharge. 

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