https://doi.org/10.4081/gc.2026.14472
High-flow nasal cannula oxygen therapy for refractory hypoxemia in hospitalized older patients with end-stage respiratory failure
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Published: 19 June 2026
Limited data exist regarding the effectiveness of high-flow nasal cannula (HFNC) oxygen therapy in older patients with terminal acute respiratory failure (ARF). We examined the impact of HFNC on arterial oxygenation after failure of conventional oxygen therapy (COT) and non-invasive ventilation (NIV) or continuous positive airway pressure (CPAP) in a retrospective physiologic study of 37 consecutive patients admitted to a geriatric ward with end-stage ARF who received HFNC for refractory hypoxemia after failure of NIV/CPAP (n=18) or COT (n=19). Oxygenation parameters obtained during initial respiratory support were compared with those measured after the transition to HFNC. We observed that 22 patients died, 2 were transferred to the intensive care unit, and 13 were discharged alive. A “do not intubate” status was identified in 17 of the 22 deceased patients. Following HFNC application, improvements were observed in partial pressure of oxygen (PaO2, p<0.0001), oxygen saturation (SO2, p<0.0001), PaO2/fraction of inspired oxygen (FiO2) ratio (p=0.004), and peripheral SO2 (p<0.0001). Oxygenation improvements were greater after transition from NIV/CPAP despite lower FiO2 set with HFNC and in patients discharged alive despite unchanged FiO2. HFNC successfully corrected refractory hypoxemia following NIV/CPAP or COT failure in patients with terminal ARF hospitalized in a geriatric acute-care ward.
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CRediT authorship contribution
Filippo Fimognari, Massimo Rizzo: conceptualization. Filippo Fimognari, Valentina Bambara, Paola Scarpino, Chiara Settino, Massimo Rizzo, Marco Filice: data curation. Giuseppe Armentaro, Virginia Boccardi: formal analysis. Valentina Bambara, Paola Scarpino, Virginia Boccardi: supervision. Virginia Boccardi: validation. Filippo Fimognari, Virginia Boccardi: writing of original draft.
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