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The FLORALI randomized trial compared high-flow nasal oxygen, standard oxygen and noninvasive positive-pressure ventilation as initial support for patients with acute hypoxemic respiratory failure. The primary composite endpoint did not significantly differ across groups, but high-flow oxygen was associated with lower 90-day mortality in the overall cohort and better ventilator-free days in some analyses. The study helped establish high-flow nasal cannula as an important noninvasive respiratory-support modality. For internists, patient selection and close monitoring are essential. High-flow oxygen can improve oxygen delivery and patient comfort, but failure should not be allowed to delay escalation to invasive ventilation in patients with worsening respiratory effort, hemodynamic instability or persistent hypoxemia. The therapy is best used within a structured reassessment pathway. In practice, the decision should combine oxygenation, work of breathing, mental status, hemodynamics and trajectory rather than relying on a single saturation value.
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The FLORALI randomized trial compared high-flow nasal oxygen, standard oxygen and noninvasive positive-pressure ventilation as initial support for patients with acute hypoxemic respiratory failure. The primary composite endpoint did not significantly differ across groups, but high-flow oxygen was associated with lower 90-day mortality in the overall cohort and better ventilator-free days in some analyses. The study helped establish high-flow nasal cannula as an important noninvasive respiratory-support modality. For internists, patient selection and close monitoring are essential. High-flow oxygen can improve oxygen delivery and patient comfort, but failure should not be allowed to delay escalation to invasive ventilation in patients with worsening respiratory effort, hemodynamic instability or persistent hypoxemia. The therapy is best used within a structured reassessment pathway. In practice, the decision should combine oxygenation, work of breathing, mental status, hemodynamics and trajectory rather than relying on a single saturation value.
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