Longonot

Acute hypoxemia is a serious condition that commonly occurs in adults in resource-limited settings and can be deadly. This trial investigates whether high flow oxygen therapy leads to better survival outcomes compared to standard flow oxygen in adults with low blood oxygen levels treated in five hospitals in low or lower middle income countries. The study also aims to understand what helps or hinders the use of high flow oxygen in these settings and to measure how much oxygen each method uses. Participants will be randomly assigned to receive either high flow oxygen delivered through a large nasal cannula at up to 60 liters per minute, or standard flow oxygen delivered by nasal cannula, face mask, or non-rebreather mask at flows up to 15 liters per minute. Both treatment groups aim to maintain blood oxygen saturation between 90% and 94%. The study will compare outcomes between these two oxygen delivery methods throughout the hospital stay. During the study, participants will be monitored for survival in the hospital up to day 90, as well as functional status, need for mechanical ventilation, days requiring oxygen, and length of hospital and ICU stay. Researchers will also track the time until escalation to more intensive respiratory support if needed. The study will examine oxygen use and barriers to implementing high flow oxygen therapy. Participants involvement will include regular assessments and follow-up during hospitalization and up to 90 days after admission.