Effects of Continuous Positive Airway Pressure Versus High Flow Nasal Oxygenation for Acute Respiratory Distress Syndrome A Randomized Clinical Trial Comparing Two Non-invasive Respiratory Support Methods

What this Trial Is About

Acute Respiratory Distress Syndrome (ARDS) causes breathing difficulties due to fluid buildup in the lungs not related to heart disease. Some affected patients may require invasive mechanical ventilation, but milder cases can receive extra oxygen through non-invasive devices like CPAP (continuous positive airway pressure) or HFNO (high flow nasal oxygenation). This trial examines whether CPAP, which may reduce lung injury caused by patients' own breathing efforts (P-SILI), actually leads to less lung damage compared to HFNO in real patients with ARDS. In this multicenter, randomized trial, 120 non-intubated ARDS patients will be assigned to receive either CPAP at 12 cmH2O or HFNO at 50 L/min for 48 hours along with standard intensive care. CPAP uses a nasal or facial mask to deliver oxygen at high pressure, while HFNO provides oxygen through nasal cannulas at high flow. Therapy breaks and adjustments after 48 hours are allowed based on clinical judgment, but non-invasive ventilation is not permitted during the study period. Participants will be monitored through blood tests measuring lung injury biomarkers such as sRAGE, angiotensin-II, interleukin-6, and interleukin-10, along with respiratory mechanics related to P-SILI. Researchers will also track rates of tracheal intubation at 48 hours and 90 days, as well as 90-day mortality. The study aims to improve understanding and treatment of ARDS in patients breathing spontaneously, potentially reducing the need for invasive ventilation and improving outcomes.

Physiologic Effects of Continuous Positive Airway Pressure and High Flow Nasal Oxygenation in Patients with Acute Respiratory Distress Syndrome.