IJMABHR International Journal of Medical and All Body Health ResearchIJMABHR 2582-8940 Anfo Publication House 419 10.54660/IJMBHR.2026.7.1.13-23 Comparative Evaluation of High-Flow Nasal Cannula and Non-Invasive Ventilation in Patients with Type II Respiratory Failure: A Randomized Controlled Study SolankiSagar RedhuSumit Anashmohd SahaySanjay SainiRajinder Rama Medical College Hospital, Hapur, Uttar Pradesh, India 2026 7 1 13 23 26102025 27112025 CC BY-NC-SA 4.0

Background: Type II respiratory failure remains a significant cause of morbidity and mortality in critically ill patients. While non-invasive ventilation (NIV) is the established standard of care, high-flow nasal cannula (HFNC) has emerged as a promising alternative respiratory support modality. Objective: To compare the clinical efficacy, safety, and patient tolerance of HFNC versus NIV in patients with acute type II respiratory failure. Methods: This prospective randomized controlled trial was conducted over 18 months in a tertiary care respiratory intensive care unit. Eighty patients with acute type II respiratory failure were randomly allocated to receive either HFNC (n=40) or NIV (n=40). Primary outcome measures included improvement in arterial blood gas parameters (pH, PaCO₂, PaO₂), respiratory rate, heart rate, and treatment failure rates. Secondary outcomes included patient comfort scores, complications, duration of respiratory support, intensive care unit length of stay, and in-hospital mortality. Results: Both groups demonstrated significant improvement in arterial blood gas parameters at 1, 6, 12, and 24 hours. The NIV group showed faster correction of hypercapnia and respiratory acidosis at 1 hour (mean PaCO₂: 52.3±6.8 vs 58.7±7.2 mmHg, p

 High-flow nasal cannulaNon-invasive ventilationType II respiratory failureHypercapniaAcute respiratory failureRespiratory support References Roussos C, Koutsoukou A. Respiratory failure. Eur Respir J Suppl. 2003;47:3s-14s. Carlucci A, Richard JC, Wysocki M, Lepage E, Brochard L. Noninvasive versus conventional mechanical ventilation: an epidemiologic survey. Am J Respir Crit Care Med. 2001;163(4):874-880. Lightowler JV, Wedzicha JA, Elliott MW, Ram FS. Non-invasive positive pressure ventilation to treat respiratory failure resulting from exacerbations of chronic obstructive pulmonary disease: Cochrane systematic review and meta -analysis. BMJ. 2003;326(7382):185. Mehta S, Hill NS. Noninvasive ventilation. Am J Respir Crit Care Med. 2001;163(2):540-577. Scala R, Naldi M. Ventilators for noninvasive ventilation to treat acute respiratory failure. Respir Care. 2008;53(8):1054-1080. Brochard L, Mancebo J, Wysocki M, et al. Noninvasive ventilation for acute exacerbations of chronic obstructive pulmonary disease. N Engl J Med. 1995;333(13):817-822. Plant PK, Owen JL, Elliott MW. Early use of non-invasive ventilation for acute exacerbations of chronic obstructive pulmonary disease on general respiratory wards: a multicentre randomised controlled trial. Lancet. 2000;355(9219):1931-1935. Keenan SP, Sinuff T, Cook DJ, Hill NS. Does noninvasive positive pressure ventilation improve outcome in acute hypoxemic respiratory failure? A systematic review. Crit Care Med. 2004;32(12):2516-2523. Ram FS, Picot J, Lightowler J, Wedzicha JA. Non-invasive positive pressure ventilation for treatment of respiratory failure due to exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2004;(3):CD004104. Osadnik CR, Tee VS, Carson-Chahhoud KV, et al. Non-invasive ventilation for the management of acute hypercapnic respiratory failure due to exacerbation of chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2017;7(7):CD004104. Global Initiative for Chronic Obstructive Lung Disease. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease: 2023 Report. Available from: www.goldcopd.org. Rochwerg B, Brochard L, Elliott MW, et al. Official ERS/ATS clinical practice guidelines: noninvasive ventilation for acute respiratory failure. Eur Respir J. 2017;50(2):1602426. Carlucci A, Delmastro M, Rubini F, Fracchia C, Nava S. Changes in the practice of non-invasive ventilation in treating COPD patients over 8 years. Intensive Care Med. 2003;29(3):419-425. Nava S, Hill N. Non-invasive ventilation in acute respiratory failure. Lancet. 2009;374(9685):250-259. Dysart K, Miller TL, Wolfson MR, Shaffer TH. Research in high flow therapy: mechanisms of action. Respir Med. 2009;103(10):1400-1405. Möller W, Feng S, Domanski U, et al. Nasal high flow reduces dead space. J Appl Physiol. 2017;122(1):191-197. Parke RL, McGuinness SP. Pressures delivered by nasal high flow oxygen during all phases of the respiratory cycle. Respir Care. 2013;58(10):1621-1624. Mauri T, Turrini C, Eronia N, et al. Physiologic effects of high-flow nasal cannula in acute hypoxemic respiratory failure. Am J Respir Crit Care Med. 2017;195(9):1207-1215. International Journal of Medical and All Body Health Research www.allmedicaljournal.com Frat JP, Thille AW, Mercat A, et al. High-flow oxygen through nasal cannula in acute hypoxemic respiratory failure. N Engl J Med. 2015;372(23):2185-2196. Rochwerg B, Granton D, Wang DX, et al. High flow nasal cannula compared with conventional oxygen therapy for acute hypoxemic respiratory failure: a systematic review and meta-analysis. Intensive Care Med. 2019;45(5):563-572. Lee MK, Choi J, Park B, et al. High flow nasal cannulae oxygen therapy in acute-moderate hypercapnic respiratory failure. Clin Respir J. 2018;12(6):2046-2056. Pilcher J, Eastlake L, Richards M, et al. Physiological effects of titrated oxygen via nasal high-flow cannulae in COPD exacerbations: a randomized controlled cross-over trial. Respir Res. 2017;18(1):51. Bräunlich J, Köhler M, Wirtz H. Nasal highflow improves ventilation in patients with COPD. Int J Chron Obstruct Pulmon Dis. 2016;11:1077-1085. Hernández G, Vaquero C, González P, et al. Effect of postextubation high-flow nasal cannula vs conventional oxygen therapy on reintubation in low-risk patients: a randomized clinical trial. JAMA. 2016;315(13):1354-1361. Maggiore SM, Battilana M, Serano L, Petrini F. Ventilatory support after extubation in critically ill patients. Lancet Respir Med. 2018;6(12):948-962. Hess DR. Noninvasive ventilation for acute respiratory failure. Respir Care. 2013;58(6):950-972. Nishimura M. High-flow nasal cannula oxygen therapy in adults: physiological benefits, indication, clinical benefits, and adverse effects. Respir Care. 2016;61(4):529-541. Roca O, Riera J, Torres F, Masclans JR. High-flow oxygen therapy in acute respiratory failure. Respir Care. 2010;55(4):408-413. Demoule A, Girou E, Richard JC, Taille S, Brochard L. Benefits and risks of success or failure of noninvasive ventilation. Intensive Care Med. 2006;32(11):1756-1765. Mas A, Masip J. Noninvasive ventilation in acute respiratory failure. Int J Chron Obstruct Pulmon Dis. 2014;9:837-852. Parke R, McGuinness S, Eccleston M. Nasal high-flow therapy delivers low level positive airway pressure. Br J Anaesth. 2009;103(6):886-890. Möller W, Celik G, Feng S, et al. Nasal high flow clears anatomical dead space in upper airway models. J Appl Physiol. 2015;118(12):1525-1532. Hasani A, Chapman TH, McCool D, Smith RE, Dilworth JP, Agnew JE. Domiciliary humidification improves lung mucociliary clearance in patients with bronchiectasis. Chron Respir Dis. 2008;5(2):81-86. Appendini L, Patessio A, Zanaboni S, et al. Physiologic effects of positive end-expiratory pressure and mask pressure support during exacerbations of chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 1994;149(5):1069-1076. Girault C, Richard JC, Chevron V, et al. Comparative physiologic effects of noninvasive assist-control and pressure support ventilation in acute hypercapnic respiratory failure. Chest. 1997;111(6):1639-1648. Doshi P, Whittle JS, Bublewicz M, et al. High-velocity nasal insufflation in the treatment of respiratory failure: a randomized clinical trial. Ann Emerg Med. 2018;72(1):73-83. Cortegiani A, Crimi C, Sanfilippo F, et al. High flow nasal therapy in immunocompromised patients with acute respiratory failure: a systematic review and meta-analysis. J Crit Care. 2019;50:250-256. Gregoretti C, Confalonieri M, Navalesi P, et al. Evaluation of patient skin breakdown and comfort with a new face mask for non-invasive ventilation: a multi-center study. Intensive Care Med. 2002;28(3):278-284. Carlucci A, Richard JC, Wysocki M, Lepage E, Brochard L. Noninvasive versus conventional mechanical ventilation: an epidemiologic survey. Am J Respir Crit Care Med. 2001;163(4):874-880. Spoletini G, Alotaibi M, Blasi F, Hill NS. Heated humidified high-flow nasal oxygen in adults: mechanisms of action and clinical implications. Chest. 2015;148(1):253-261. Yamaguti WP, Moderno EV, Yamashita SY, et al. Treatment-related risk factors for development of skin breakdown in subjects with acute respiratory failure undergoing noninvasive ventilation or CPAP. Respir Care. 2014;59(10):1530-1536. Weng MH. The effect of protective treatment in reducing pressure ulcers for non-invasive ventilation patients. Intensive Crit Care Nurs. 2008;24(5):295-299. Roca O, Pérez-Terán P, Masclans JR, et al. Patients with New York Heart Association class III heart failure may benefit more from high flow nasal cannula than from non-invasive positive pressure ventilation. Crit Care. 2013;17(2):R46. Gregoretti C, Pelosi P, Gianni R, et al. Comparison between a new and conventional helmet for noninvasive ventilation: a physiological and comfort study. Intensive Care Med. 2003;29(10):1788-1794. Rittayamai N, Tscheikuna J, Rujiwit P. High-flow nasal cannula versus conventional oxygen therapy after endotracheal extubation: a randomized crossover physiologic study. Respir Care. 2014;59(4):485-490. Keenan SP, Sinuff T, Burns KE, et al. Clinical practice guidelines for the use of noninvasive positive-pressure ventilation and noninvasive continuous positive airway pressure in the acute care setting. CMAJ. 2011;183(3):E195-E214. Fernandez R, Subira C, Frutos-Vivar F, et al. High-flow nasal cannula to prevent postextubation respiratory failure in high-risk non-hypercapnic patients: a randomized multicenter trial. Ann Intensive Care. 2017;7(1):47. Esteban A, Anzueto A, Frutos F, et al. Characteristics and outcomes in adult patients receiving mechanical ventilation: a 28-day international study. JAMA. 2002;287(3):345-355. Stéphan F, Barrucand B, Petit P, et al. High-flow nasal oxygen vs noninvasive positive airway pressure in hypoxemic patients after cardiothoracic surgery: a randomized clinical trial. JAMA. 2015;313(23):2331-2339. Lemiale V, Mokart D, Mayaux J, et al. Effect of noninvasive ventilation vs oxygen therapy on mortality among immunocompromised patients with acute respiratory failure: a randomized clinical trial. JAMA. 2015;314(16):1711-1719. Köhnlein T, Windisch W, Köhler D, et al. Non-invasive positive pressure ventilation for the treatment of severe International Journal of Medical and All Body Health Research www.allmedicaljournal.com stable chronic obstructive pulmonary disease: a prospective, multicentre, randomised, controlled clinical trial. Lancet Respir Med. 2014;2(9):698-705. Carrillo A, Gonzalez-Diaz G, Ferrer M, et al. Non-invasive ventilation in community-acquired pneumonia and severe acute respiratory failure. Intensive Care Med. 2012;38(3):458-466. Thille AW, Contou D, Fragnoli C, Córdoba-Izquierdo A, Boissier F, Brun-Buisson C. Non-invasive ventilation for acute hypoxemic respiratory failure: intubation rate and risk factors. Crit Care. 2013;17(6):R269. Rello J, Pérez M, Roca O, et al. High-flow nasal therapy in adults with severe acute respiratory infection: a cohort study in patients with 2009 influenza A/H1N1v. J Crit Care. 2012;27(5):434-439. Mauri T, Alban L, Turrini C, et al. Optimum support by high-flow nasal cannula in acute hypoxemic respiratory failure: effects of increasing flow rates. Intensive Care Med. 2017;43(10):1453-1463.