In patients with resolving acute hypoxemic respiratory failure (ARF), early extubation with high flow nasal oxygen is feasible and provides a better alternative to conventional weaning from invasive mechanical ventilation, as it is associated with more invasive mechanical ventilation free days without adversely affecting other outcomes.

In this randomized controlled trial, 80 adults with acute hypoxemic respiratory failure requiring invasive mechanical ventilation for > 48 hours were enrolled and divided into two groups: conventional weaning and early weaning via high-flow nasal oxygen.

Extubation failure was not significantly different between the high-flow nasal oxygen group and the conventional weaning group [12.5% versus 25%, respectively; odds ratio (95%CI) 0.5 (0.19 – 1.33)] (p = 0.25).

Early weaning from invasive mechanical ventilation via high-flow nasal oxygen (HFNO) was associated with significantly increased invasive mechanical ventilation-free days and total oxygen requirement days (p = 0.02 and p = 0.01, respectively).

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