The RENOVATE Clinical Trial | F&P Healthcare analysis

The RENOVATE Randomized Clinical Trial (JAMA, 2024)

High-flow Nasal Oxygen vs. Noninvasive Ventilation in Patients with Acute Respiratory Failure

Trial summary

The rate of endotracheal intubation or mortality within seven days of using high-flow nasal oxygen (HFNO) was non-inferior to noninvasive ventilation (NIV) in four of the five patient groups with acute respiratory failure (ARF).

Patient groups (n = 1766)

Non-immunocompromised with hypoxemia (non-inferior)
AECOPD with respiratory acidosis (non-inferior)
Acute cardiogenic pulmonary edema (non-inferior)
Hypoxemic COVID-19 (non-inferior)
Immunocompromised with hypoxemia (stopped due to futility)

HFNO was found to be significantly more comfortable than NIV across the entire study population.

Key takeaways

This research demonstrates that HFNO is non-inferior to NIV for most causes of ARF and is significantly more comfortable for patients.

Building on the existing body of literature and numerous clinical practice guidelines that recommend HFNO, these insights could significantly advance the management of patients with ARF.

These broad findings may be particularly useful in settings where patients initially present, such as the Emergency Department (ED).

Notably, 32% of HFNO initiation in the RENOVATE study took place in the ED.

HFNO may be considered a safe and effective first-line and/or bridge therapy, providing time to:

Establish the diagnosis and underlying cause of respiratory failure.

Select the most suitable form of treatment, which might include continuing with HFNO or transitioning to a different form of respiratory support.

Download research infographic

“These results suggest that high flow oxygen can serve as a safe-bridge therapy while the underlying cause of acute respiratory failure is determined, and the most appropriate respiratory support is ultimately implemented.”

Jean-Pierre Frat, MD, PhD; Sylvain Le Pape, MD, PhD & Arnaud W. Thille, MD, PhD (JAMA editorial, 2024)

RENOVATE study: High-Flow Nasal Oxygen vs. Noninvasive Ventilation in Patients with Acute Respiratory Failure. RENOVATE: The Randomized Clinical Trial. JAMA, December 2024 View abstract

Frat, Le Pape & Thille, JAMA editorial: Is high-flow nasal oxygen the standard for patients with acute respiratory conditions? JAMA, December 10, 2024 View editorial

Freund & Vromant, JAMA editorial: Re-evaluating Respiratory Support in Acute Respiratory Failure. Insights from the RENOVATE Trial and Implications for Practice. JAMA, December 10, 2024 View editorial

The dynamics of nasal high flow therapy

Enhance your knowledge of the therapy, its use and how it can be effectively used to support respiratory care patients in hospitals

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Optiflow

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F&P and Optiflow are trademarks of Fisher & Paykel Healthcare Limited. For patent information, see www.fphcare.com/ip

Fisher & Paykel Healthcare provided equipment for the RENOVATE Randomized Clinical Trial. Dr Frat has received grants from Fisher & Paykel Healthcare.