Patients with sepsis and septic shock of extrapulmonary origin present elevated respiratory drive and effort, which can be effectively reduced by high-flow nasal cannula.

25 nonintubated patients with extrapulmonary sepsis or septic shock were enrolled.

13 patients (52%) were in septic shock.

The Sequential Organ Failure Assessment score was 5 [4 to 9].

During low-flow oxygen at baseline, respiratory drive and effort were elevated and significantly correlated with arterial lactate and inversely with dynamic lung compliance.

Noninvasive support by high-flow nasal cannula induced a significant decrease of respiratory drive and effort.

Oxygenation and arterial carbon dioxide levels remained stable during all study phases.

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