This retrospective cohort study compared NIV vs. HFNC in 1,180 ICU patients with acute pulmonary edema (APE), using propensity score matching (158 per group) from the MIMIC-IV and eICU databases. The primary outcome was respiratory rate (RR) at 1 hour post-treatment; secondary outcomes included 7-day intubation rate, 28-day mortality, and ICU length of stay.
No significant difference in RR at 1 h post-treatment (NIV 21 vs. HFNC 22 breaths/min, p > 0.05). However, the 7-day intubation rate was markedly lower with NIV (8.23%; 13/158) than HFNC (28.48%; 45/158) (p < 0.001).
- Retrospective design with residual confounding despite propensity score matching. - The HFNC group was much smaller at baseline (161 vs. 1,019), limiting balance before matching. - 28-day mortality and ICU length of stay results are not reported in detail in the abstract or results.
Despite similar short-term respiratory rates, NIV was associated with a substantially lower 7-day intubation rate compared to HFNC in APE — clinicians should be cautious about substituting HFNC for NIV as first-line therapy until prospective RCT data confirm equivalence.
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