Objective: To compare clinical and hemodynamic efficacy, safety, and short-term outcomes of high-flow oxygen therapy (HFOT) and non-invasive ventilation (NIV) in CPAP mode in patients with acute hypertensive pulmonary edema (AHPE), a subgroup with limited published data. Design and method: This prospective randomized study was conducted from December 2022 to March 2023. Among 120 screened patients with acute pulmonary edema, 50 met inclusion criteria and were randomized to HFOT (n=25) or NIV in CPAP mode (n=25). Baseline characteristics, including age, sex, blood pressure, respiratory rate, SpO2, and arterial blood gas values, were comparable between groups (p>0.05). All patients received respiratory support for at least six hours. Evaluations were performed at 1, 6, and 24 hours, including clinical parameters, gas exchange, and lung ultrasound B-lines to assess pulmonary congestion. Results: Mean respiratory support duration was 7.0 ± 0.5 h (HFOT) and 7.0 ± 0.6 h (NIV) (p=1.0). Systolic blood pressure decreased by 18%, 24%, and 45% (HFOT) and 23%, 24%, and 42% (NIV); diastolic pressure decreased by 10%, 11%, and 25% (HFOT) and 11%, 10%, and 23% (NIV). Respiratory rate decreased by 12–33% (HFOT) and 13–35% (NIV). SpO2 increased within 1 hour (+15% HFOT, +17% NIV) and remained stable. Pulmonary congestion (B-lines) decreased by 73% (HFOT) and 72% (NIV) at 6 hours. No significant intergroup differences were observed (p>0.05). ROX index (HFOT) and HACOR score (NIV) indicated low risk of progression to invasive ventilation. No serious adverse events or deaths occurred during the 28-day follow-up. Both therapies were safe, effective, and well-tolerated, with HFOT providing comparable outcomes to NIV and potential for greater patient comfort. Conclusions: HFOT and NIV in CPAP mode provide similar clinical and hemodynamic improvements in AHPE. This study adds new data for this underrepresented subgroup, showing rapid improvement in oxygenation, hemodynamic stabilization, reduction of pulmonary congestion, and excellent short-term safety.
Sharipov et al. (Fri,) studied this question.